76例腹膜透析相关性腹膜炎患者腹膜透出液主要致病菌构成及药敏实验结果分析

Main pathogenic bacteria composition and drug sensitivity test of peritoneal effusion in 76 patients with peritoneal dialysis-associated peritonitis

目的分析腹膜透析相关性腹膜炎(PDAP)患者腹膜透出液主要致病菌构成及药敏实验结果。方法选取2019年4月至2021年4月洛阳市中心医院收治的76例PDAP患者,观察患者腹膜透出液主要致病菌构成情况,统计患者腹膜透出液细菌培养革兰阳性菌(G+菌)及革兰阴性菌(G-菌)药敏实验结果,分析患者转归情况。结果76例PDAP患者腹膜透出液培养中,共有51例(67.11%)培养阳性,其中G+菌29例(56.86%),G-菌21例(41.18%),肺炎克雷伯杆菌与大肠埃希菌混合感染1例(1.96%);G+菌中表皮葡萄球菌阳性率最高31.03%(9例),G-菌中大肠埃希菌阳性率最高28.57%(6例);G+菌对氯霉素、利奈唑胺、头孢噻肟敏感性较高,对复方新诺明(47.62%)、环丙沙星(40.00%)、苯唑西林(62.50%)、红霉素(68.89%)、氯洁霉素(60.98%)、青霉素G(61.90%)等药物耐药率较高;G-菌对妥布霉素、丁胺卡那、庆大霉素、哌拉西林/他唑巴坦、头孢吡肟较敏感,对呋喃妥因(60.00%)、头孢替坦(70.00%)、头孢唑林(66.67%)、氨苄西林(72.73%)、氨苄西林/舒巴坦(63.64%)等药物耐药率较高;76例PDAP患者治愈71例,病死3例,拔管转血液透析2例,培养阴性、G+菌感染、G-菌感染及混合感染PDAP患者退出率、病死率、治愈率对比,差异无统计学意义(P>0.05)。结论PDAP患者主要致病菌为G+菌,对氯霉素、利奈唑胺、头孢噻肟等药物较敏感,可用于PDAP经验性药物选择。

【Objective】To analyze the composition and drug sensitivity of main pathogenic bacteria in peritoneal effusion of76 patients with peritoneal dialysis-associated peritonitis(PDAP).【Methods】A total of 76 PDAP patients admitted to our hospital from April 2019 to April 2021 were selected to observe the composition of main pathogenic bacteria in peritoneal effusion of PDAP patients,and the drug sensitivity test results of G+bacteria(gram-positive bacteria)and G-bacteria(gram-negative bacteria)in peritoneal effusion of PDAP patients were counted,and the outcomes of PDAP patients were analyzed.【Results】In the peritoneal fluid culture of 76 PDAP patients,51 cases(67.11%)were positive,including 29 cases(56.86%)of G+bacteria,21 cases(41.18%)of G-bacteria,and 1 case(1.96%)of Klebsiella pneumoniae and Escherichia coli.The positive rate of Staphylococcus epidermidis in G+was 31.03%(9 cases),and that of Escherichia coli in G-was 28.57%(6 cases).G+had high sensitivity to chloramphenicol,linezolid and cefotaxime,and high resistance rate to cotrimoxazole(47.62%),ciprofloxacin(40.00%),benzacillin(62.50%),erythromycin(68.89%),chlorlincomycin(60.98%),penicillin G(61.90%)and other drugs.G-bacteria were sensitive to tobramycin,butamicana,gentamicin,piperacillin/tazobactam and cefepime,and had higher drug resistance rates to furantoin(60.00%),cefotetan(70.00%),cefazolin(66.67%),ampicillin(72.73%),ampicillin/sulbactam(63.64%).Among 76 PDAP patients,71 were cured,3died,and 2 were transferred to hemodialysis by extubation.There were no significant differences in the withdrawal rate,mortality rate and cure rate among patients with negative culture,G+infection,G-infection and mixed infection of PDAP(P>0.05).【Conclusion】The main pathogenic bacteria of PDAP patients are G+bacteria,which are sensitive to chloramphenicol,linezolid,cefotaxime and other drugs,and can be used for the empirical drug selection of PDAP.