腹膜透析相关性腹膜炎的致病菌及药敏试验分析

Analysis of pathogenic bacteria and drug sensitivity test in peritoneal dialysis-related peritonitis

目的回顾性分析该院腹膜透析相关性腹膜炎(PDAP)的病原菌谱特点及预后转归情况,为该院腹膜炎的防治提供科学依据。方法回顾性选取2017年1月至2023年2月该院收治的69例PDAP患者的临床资料,分析其发病原因、病原菌谱特点及预后转归情况。结果69例PDAP患者腹膜透析透出液共培养出病原菌43例,阳性率为62.32%,43例病原菌中革兰阳性菌23例(53.49%),革兰阴性菌17例(39.53%),真菌3例(6.98%)。43例病原菌感染原因包括肠道感染18例(41.86%),换液操作不规范11例(25.58%),呼吸道感染8例(18.60%),原因不明6例(13.95%)。革兰阳性菌以表皮葡萄球菌(10例)为主,革兰阴性菌以大肠埃希菌(7例)为主。革兰阳性菌对万古霉素、利奈唑胺、替加环素、替考拉宁、莫西沙星均敏感,对克林霉素(52.17%)、红霉素(56.52%)、阿莫西林/克拉维酸(60.87%)、青霉素G(78.26%)耐药;革兰阴性菌对美罗培南、亚胺培南、黏菌素均敏感,对阿莫西林/克拉维酸(47.06%)、头孢呋辛(47.06%)、头孢唑啉(52.94%)、氨苄西林(82.35%)耐药;真菌对氟康唑、伏立康唑、两性霉素B和卡泊芬净均敏感。69例PDAP患者共治愈53例,退出14例,死亡2例,治愈率为76.81%,真菌性PDAP患者退出率明显高于革兰阳性菌、革兰阴性菌及培养阴性的PDAP患者。结论该院腹膜透析患者发生PDAP的主要原因为换液操作不规范和肠道感染,PDAP相关致病菌以革兰阳性菌为主,真菌性PDAP患者退出率较高。

Objective To retrospectively analyze the characteristics of pathogenic bacteria spectrum and prognosis of peritoneal dialysis-associated peritonitis(PDAP)in the hospital,and to provide scientific basis for the prevention and treatment of peritonitis in the hospital.Methods The clinical data of 69 patients with PDAP admitted to the hospital from January 2017 to February 2023 were retrospectively selected,and the etiology,characteristics of pathogenic bacteria spectrum and prognosis were analyzed.Results A total of 43 pathogenic bacteria were cultured from 69 patients with PDAP,and the positive rate was 62.32%,including 23 cases of Gram-positive bacteria(53.49%),17 cases of Gram-negative bacteria(39.53%),and 3 cases of fungi(6.98%).The causes of 43 cases of pathogenic bacteria infection included:intestinal infection in 18 cases(41.86%),the operation of fluid exchange was not standard in 11 cases(25.58%),8 cases(18.60%)had respiratory tract infection,6 cases(13.95%)were unknown.Gram-positive bacteria were mainly Staphylococcus epidermidis(10 cases),and Gram-negative bacteria were mainly Escherichia coli(7 cases).Gram-positive bacteria were sensitive to vancomycin,linezolid,tigecycline,teicoplanin and Moxifloxacin,but resistant to clindamycin(52.17%),erythromycin(56.52%),amoxicillin/clavulanic acid(60.87%)and penicillin G(78.26%).Gram-negative bacteria were sensitive Medopenem,Imipenem and colistin,but resistant to amoxicillin/clavulanic acid(47.06%),cefuroxime(47.06%),cefazolin(52.94%)and ampicillin(82.35%).Fungi were sensitive to fluconazole,voriconazole,amphotericin B and caspofungin.Among 69 patients with PDAP,53 cases were cured,14 cases withdrew and 2 cases died,with a cure rate of 76.81%.The dropout rate of patients with fungal PDAP was significantly higher than that of Gram-positive bacteria,Gram-negative bacteria and culture negative bacteria peritonitis.Conclusion The main causes of PDAP in PD patients in the hospital are irregular fluid exchange and intestinal infection.The main pathogenic bacteria associated with PDAP are Gram-positive bacteria,and the dropout rate of patients with fungal PDAP is high.