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102例次腹膜透析相关性腹膜炎的致病菌谱和耐药性分析
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DOI:
作者:
陈越,侯伟伟,崔春黎,李江涛, 张昆, 余晨
CChen Yue, Hou Weiwei,,Cui Chunli, Li Jiangtao, Zhang Kun, Yu Chen
作者单位:
上海市同济医院
Tongji Hospital, Shanghai
关键词:
腹膜透析 腹膜炎 致病菌 耐药性
Peritoneal dialysis; Peritonitis; Causative pathogen; Drug resistance
摘要:
目的:探讨腹膜透析患者发生腹膜透析相关性腹膜炎的致病菌和耐药性,指导临床合理应用抗菌药物。方法:选取我院2012年01月~2015年06月腹膜透析相关性腹膜炎102例次(77例患者),回顾性分析其透析液致病菌培养结果、耐药情况、疗效和治疗转归。结果:(1)102例次腹膜炎中81例次透析流出液培养阳性,培养阳性率为79.4%,其中培养阳性的致病菌中革兰氏阳性菌56例次(69.1%),革兰氏阴性菌20例次(24.7%),真菌2例次(2.5%),2种以上致病菌有3例次(3.7%)。(2)革兰氏阳性菌对青霉素的耐药率最高(78.6%),对苯唑西林的耐药率为42.9%,对万古霉素均敏感;革兰氏阴性菌对头孢唑啉的耐药率最高(65.0%),对亚胺培南的耐药率最低(10.0%),而对头孢他啶和阿米卡星的耐药率分别为20%和25%;革兰氏阳性菌中以葡萄球菌属最多,而葡萄球菌属对苯唑西林的耐药率较高,达45%,对万古霉素均敏感。(3)腹膜透析相关性腹膜炎的总体治愈率为82.4%;真菌或合并真菌感染的腹膜炎的退出率显著高于革兰氏阳性菌、革兰氏阴性菌和培养阴性的腹膜炎。结论:腹膜透析相关性腹膜炎的致病菌仍以革兰氏阳性菌为主。膜透析相关性腹膜炎的经验治疗应以中心特异性原则选择合适的抗生素。致病菌的差异是影响预后的重要因素。
Objective: To investigate the spectrum and drug resistance of causative pathogens in peritoneal dialysis associated peritonitis for rational anti-pathogen management. Methods: 102 episodes of 77 patients with peritoneal dialysis associated peritonitis were included between January 2012 and June 2015 in our hospital. The data was retrospectively analyzed regarding findings of the dialysis effluent cultured, drug resistance, therapeutic efficacy and outcomes. Results: (1) The dialysis effluents were cultured positive in 81 of 102 peritonitis episodes, and the culture positive rate was 79.4%. 56 (69.1%) peritonitis episodes were caused by gram-positive organisms, 20 (24.7%) by gram-negative organisms, 2(2.5%) by fungi, and 3(3.7%) by polymicrobes. (2) Of Gram positive bacilli, 78.6% were resistant to penicillin, while 42.9% were resistant to oxacillin. And all Gram positive bacilli were sensitive to vancomycin. Of Gram negative bacilli, 65.0% were resistant to cefazolin, and 10.0% were resistant to imipenem. Meanwhile the rates of resistance to ceftazidime and amikacin were 20% and 25% respectively. Among Gram positive bacilli, the most species was staphylococcus. And staphylococcus had the highest rate of resistance to oxacillin, while all were sensitive to vancomycin. (3) The curative rate of peritoneal dialysis associated peritonitis was 82.4%. The withdrawal rate in fungal or accompanying with fungal peritonitis episodes was significantly high compared with those in Gram positive bacilli, Gram negative bacilli and culture-negative peritonitis episodes. Conclusion: Gram positive bacilli were the major pathogens for peritoneal dialysis associated peritonitis. The empiric antibiotics therapy for peritonitis should rely on centre-speciality. Discrepancy on microbes was an important prognostic factor.
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