中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (11): 590-593.doi: 10.3969/j.issn.1671-4091.2013.11.00

• 临床研究 • 上一篇    下一篇

91例次腹膜透析相关性腹膜炎的致病菌耐药性分析及其与预后的关系

杨杰1,张炜炜1,万成1,龚文江1,余燕1,何娅妮2   

  1. 1. 第三军医大学大坪医院野战外科研究所肾内科
    2. 重庆市第三军医大学大坪医院肾内科
  • 收稿日期:2013-05-14 修回日期:2013-08-13 出版日期:2013-11-12 发布日期:2013-11-12
  • 通讯作者: 何娅妮 heynmail@yahoo.com E-mail:heynmail@yahoo.com

Analysis of drug resistance of pathogenic bacteria and disease prognosis in Peritoneal Dialysis-Related Peritonitis: a study of 91cases

  • Received:2013-05-14 Revised:2013-08-13 Online:2013-11-12 Published:2013-11-12

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摘要： 【摘要】 目的　分析单中心腹膜透析相关性腹膜炎的致病菌的耐药情况及其与患者预后的关系。方法　回顾性分析单中心5年间91例次腹膜透析相关性腹膜炎病例资料，总结腹膜炎发生率、致病菌分布、耐药菌株分布情况，分析细菌耐药与预后关系。结果　66例患者共发生腹膜炎91例次,培养阳性71例次，阳性率为78.0%，培养阴性20例次。71例次致病菌中，革兰氏阳性菌占32例次，革兰氏阴性菌31例次，混合菌感染1例次，真菌感染7例次。革兰氏阳性菌中最多为表皮葡萄球菌，革兰氏阴性菌中最多者为大肠埃希菌。革兰氏阳性菌中对苯唑西林及头孢唑啉耐药高达80.8%，但均对万古霉素及替考拉宁敏感。革兰氏阴性菌中对头孢他啶及氨曲南耐药达23.1%-26.9%，对阿米卡星均敏感。退出组对头孢耐药率为66.7%（8/12），复发组耐药率为50.0（5/10），治愈组耐药率为58.1%（25/43），退出组与治愈组耐药率比较差异无统计学意义（p>0.05）, 复发组与治愈组比较差异也无统计学意义（p>0.05）。结论 不同致病原导致的腹膜透析相关腹膜炎在耐药性、抗生素选择、疗效及预后等方面具有各自的特点。治疗上应当结合病原学临床特点和药敏，初始治疗方案按照“中心个体化”的主张选择适当的抗生素。细菌对经验性使用的抗生素耐药并非患者反复发生腹膜炎及退出的主要原因。

关键词: 腹膜透析, 腹膜炎, 耐药性

Abstract: 【Abstract】 Objective To investigate the correlation between drug resistance of pathogenic bacteria and patient prognosis in peritoneal dialysis-related peritonitis in a single peritoneal dialysis center. Methods Ninety-one peritonitis episodes in 61 patients from January 2008 to January 2013 were analyzed. The incidence of peritonitis, pathogenic bacteria and drug-resistant strain distribution, and the relationship between drug-resistant bacteria and prognosis were retrospectively analyzed. Results There are 71 cases culture-positive and 20 cases culture-negative in bacterial culture. The culture positive rate and negative rate occupy 78.0% and 22.0% respectively. Among the culture positive peritonitis episodes, there are 32 cases with gram-positive bacteria infection, 31 cases with Gram-negative bacteria infection, 1 cases with mixed bacteria infection and 9 cases with fungal infection. Staphylococcus epidermidis and Escherichia coli are the most common pathogens in gram-positive bacteria and gram-negative bacteria separately. Gram-positive bacteria are resistance to Oxacillin and Cefazolin (80.8%) and susceptible to Vancomycin and Teicoplanin. Gram-negative bacteria are resistance to Ceftazidime and Aztreonam (23.1% to 26.9%) and susceptible to Amikacin. There is no statistically significant change in drug resistance rate among the dropout patients (66.7%（8/12）), relapsed patients (50.0（5/10）) and cured patients (58.1%（25/43）)（p>0.05）.Conclusion The characteristics of peritoneal dialysis related peritonitis caused by different pathogens are varied from drug resistance, antibiotic selection and curative efficacy and prognosis. The initial treatment of peritonitis should be based on the principles of “individualized treatment” to choose appropriate antibiotics, which is according to the analysis of etiology, clinical feature and drug susceptibility of patient. Bacterial resistance to empirical antibiotics is not the main reason contributes to the disease recurrence and exit.

Key words: peritoneal dialysis, peritonitis, drug resistance