腹膜透析相关性腹膜炎病原菌及其危险因素
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吕晶

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R181.3+2

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Pathogens and risk factors of peritoneal dialysisrelated peritonitis
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    摘要:

    目的了解腹膜透析(PD)相关性腹膜炎的细菌谱和耐药情况,为合理使用抗菌药物提供依据。方法回顾性分析某医院 2013 年 1 月—2014 年 12 月收治的 120 例次 PD 相关性腹膜炎患者的临床资料。结果细菌培养阳性 91 例次,阳性率为 75.83%。共培养病原菌 93 株,其中革兰阳性(G+)菌73株(78.49%),革兰阴性(G-)菌13株(13.98%),最常见的菌种G+菌是表皮葡萄球菌(38株,40.86%)和G-菌为大肠埃希菌(3株,3.23%)。G+菌对青霉素(93.65%)、红霉素(69.57%)和苯唑西林(64.41%)有较高的耐药率,对万古霉素(2.90%)和利奈唑胺(1.47%)耐药率较低,对替考拉宁、替加环素和呋喃妥因均敏感。G-菌对头孢唑林(50.00%)、头孢呋辛(37.50%)和氨苄西林(37.50%)有较高的耐药率,对亚胺培南、妥布霉素、哌拉西林均敏感。G+、G-菌对庆大霉素和左氧氟沙星均具有较低的耐药率。换液操作不规范(56.67%)是引起腹膜炎最常见的原因,主要为G+菌感染(79.41%);而腹泻引起的腹膜炎主要为G-菌感染(52.63%)。G+菌、G-菌和细菌培养阴性腹膜炎的治愈率分别为92.96%、76.92%和86.21%,三者治愈率比较差异无统计学意义(χ2=3.39,P=0.18)。结论PD相关性腹膜炎的病原菌以G+菌为主,多由于换液操作不规范使病原菌经腹透管感染。第一代头孢菌素不能作为对G+菌的经验性用药,而万古霉素仍是最佳选择。第三代头孢菌素和氨基糖苷类可作为对G-菌的经验性用药。特殊情况下庆大霉素和左氧氟沙星可单独作为经验性用药。

    Abstract:

    ObjectiveTo investigate the bacterial spectrum and antimicrobial resistance of peritoneal dialysis (PD)related peritonitis, and provide evidence for rational antimicrobial use. MethodsClinical data of 120 patients with PDrelated peritonitis in a hospital from January 2013 to December 2014 were retrospectively analyzed. Results91 cases (75.83%) showed positive result in bacterial culture, 93 pathogenic strains were cultured, including 73 (78.49%) grampositive and 13 (13.98%) gramnegative bacterial strains, the most common grampositive bacteria was Staphylococcus epidermidis (n=38, 40.86%), and the main gramnegative bacteria was Escherichia coli (n=3, 3.23%). Grampositive strains had high resistance rates to penicillin, erythromycin, and oxacillin (93.65%, 69.57%, and 64.41% respectively), while resistance rates to vancomycin and linezolid  were both low (2.90% and 1.47% respectively), and were  sensitive to teicoplanin, tigecycline, and nitrofurantoin. Gramnegative bacteria had high resistance rates to cefazolin, cefuroxime, and ampicillin(50.00%,  37.50%, and 37.50% respectively), but were sensitive to imipenem, tobramycin, and piperacillin. Resistance rates of grampositive and gramnegative bacteria to gentamicin and levofloxacin were both low. Nonstandard operation during dialysate exchange was the most common cause of peritonitis (56.67%), most peritonitis were grampositive bacterial infection(79.41%);while gramnegative bacteria  were the main pathogens of diarrheainduced peritonitis (52.63%). The cure rates of grampositive bacteria, gramnegative bacteria,and negativecultured peritonitis were 92.96%, 76.92%, and 86.21% respectively, difference was not statistically significant(χ2=3.39,P=0.18). ConclusionGrampositive bacteria are major pathogens in PDrelated peritonitis, and are usually caused by the bacteria through  dialysis catheter due to nonstandard operation during dialysate exchange. Firstgeneration cephalosporins are not recommended as empirical therapy against grampositive bacteria, while vancomycin is still the best choice. Thirdgeneration cephalosporins and aminoglycosides are recommended as empirical therapy against gramnegative bacteria. Gentamicin and levofloxacin can be used alone as empirical therapy in special circumstances.

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王静,吕晶,李文冬,等.腹膜透析相关性腹膜炎病原菌及其危险因素[J]. 中国感染控制杂志,2016,15(10):739-743. DOI:10.3969/j. issn.1671-9638.2016.10.005.
WANG Jing, LV Jing, LI Wendong, et al. Pathogens and risk factors of peritoneal dialysisrelated peritonitis[J]. Chin J Infect Control, 2016,15(10):739-743. DOI:10.3969/j. issn.1671-9638.2016.10.005.

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  • 收稿日期:2016-01-28
  • 最后修改日期:2016-04-12
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  • 在线发布日期: 2016-10-26
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