124株腹膜透析相关性腹膜炎致病菌及耐药性分析

目的探讨腹膜透析相关性腹膜炎（PDAP）致病菌的耐药性。方法回顾性分析2008年7月-2012年7月我院腹膜透析中心PDAP患者的临床资料及药敏结果。结果（1）203例次PDAP培养阳性率为59．1％，共培养出致病菌124株。124株致病菌中革兰阳性球菌68株，占54．8％；革兰阴性杆菌28株，占22．6％；革兰阳性杆菌12株，占9．7％；奈瑟茵属5株，占4．0％；真菌11株，占8．9%。其中耐药菌株54株，包括多药耐药菌50株，泛耐药菌4株，本中心PDAP患者尚未培养出全耐药菌。（2）药敏结果：对革兰阳性球菌敏感性较高的前3种药物为：利奈唑胺100％，莫西沙星95．8％，万古霉素95．2％。对革兰阴性杆菌敏感性较高的前3种药物为：阿米卡星85．7％，亚胺培南82．1％，左氧氟沙星75．0％。（3）转归：PDAP患者总治愈率为77．3％。结论PDAP致病菌耐药性的产生导致临床上可供选择的药物减少，临床医牛府采取多种措施延缓致病菌耐药件。

Analysis of the pathogens and drug resistance on 124 strains of peritoneal dialysis-associated peritonitis

Objective To investigate the drug resistance pathogens in peritoneal dialysis-associ- ated peritonitis （PDAP）. Methods The clinical data and the drug susceptibility of the PDAP were retrospectively in Peritoneal Dialysis Center in our hospital from July 2008 to July 2012. Results （ 1 ） The culture positive rate, the pathogen spectum and the drug resistance., the positive rate was 59. 1 %, and there were cultivated 124 strains, including Gram-positive cocci （68 strains, 54. 8%）, Gram-nega- tive bacilli （28 strains, 22. 6%）. Gram-positive bacilli （12 strains, 9. 7%）, Neisseria （5 strains, 4. 0 %）, and fungus（ 11 strains, 8. 9 %）. Among of them, there were 54 strains of drug resistant patho- gens, including 50 strains of multidrug-resistant pathogens,and 4 strains of extensively drug-resistant pathogens. There was no pandrug-resistant pathogen in this peritoneal dialysis center; （2）The drug susceptibilties： the top three antibiotics sensitively treating Gram-positive cocci were Linezolid （ 100 %）, Moxifloxacin （95.8 %）, Vancomycin （95.2 %） ; the top three antibiotics sensitively treating Gram-negative bacilli were Amikacin （85.7 %）, Imipenem （82. 1%）, and Levofloxacin （75.0 % ） ; （3） The outcome： the total curative rate of PDAP patients was 77. 3%. Conclusions The drug resistant pathogens lead to the decreased choices of antibiotics effectivelly treating PDAP, the physicians should make measures to delay the resistance.