105例培养阳性腹膜透析相关性腹膜炎经验用药分析

目的研究培养阳性腹膜透析相关性腹膜炎经验用药情况及患者转归,为临床经验性用药提供依据。方法回顾性分析105例次培养阳性腹膜炎患者的临床表现、透出液致病菌、药敏结果,并按初始治疗方案组合分为4组:头孢菌素+万古霉素组、碳氢霉烯类+万古霉素组、阿米卡星+万古霉素组、二代头孢菌素+三代头孢菌素组。比较各组的临床表现、治疗前后透出液WBC变化及转归。结果本组革兰阳性球菌76例,革兰阴性杆菌29例,革兰阳性球菌主要以凝固酶阴性的葡萄球菌为主,所有的革兰阳性球菌对万古霉素敏感,革兰阳性球菌对头孢唑啉耐药率达62.7%;革兰阴性菌对头孢他啶的耐药率达34%,对阿米卡星的耐药率较低,仅6%,对亚胺培南耐药率最低,仅为4%。美罗培南+万古霉素组治疗后透出液WBC数下降显著,症状控制快,与头孢菌素+万古霉素组比较,差异有统计学意义(P<0.05)。结论腹膜透析相关性腹膜炎致病菌多数为革兰阳性球菌。头孢唑啉耐药性增高,目前不再适合作为初始治疗的经验性用药。腹腔应用碳氢霉烯类联合万古霉素治疗腹膜炎症状缓解快且明显,治愈率高,因此推荐两者联合应用作为腹膜透析相关性腹膜炎的初始经验用药。

Experience analysis of drug use in 105 positive cases with peritoneal dialysis related peritonitis

Objective To analyse empirical medication and outcome of 105 cases with peritoneal dialysis related peritonitis for providing the scientific evidence in clinical diagnosis and treatment.Methods 105 cases with peritoneal dialysis-related peritonitis were analyzed.Clinical manifestations,pathogens,antimicrobial resistance,treatment,outcome of these patients were collected.Initial treatments were divided into 4 groups,including cephalosporin plus vancomycin treatment group,the amikacin plus vancomycin treatment group,meropenem plus vancomycin treatment group,the second-generation cephalosporin plus third generation cephalosporin,and compared clinical manifestations of different groups.Results Resistance in the cultivation of drug susceptibility results showed that dialysate culture of 105 cases was positive including 76 cases of gram-positive cocci,29 cases of gram-negative bacilli.Coagulase-negative staphylococci were the most common gram-positive cocci.All the gram-positive cocci were sensitive to vancomycin,but the resistance rate to cefazolin was 62.7%.Ceftazidime resistant rate of gram-negative bacilli was 34%,and imipenem resistant rate of gram-negative bacilli was 4%.Compared with cephalosporin plus vancomycin treatment group,the peritoneal dialysis fluid WBC count of meropenem plus vancomycin treatment group decreased fastly(P < 0.05).Conclusion Gram-positive cocci are major pathogens in CAPD-related peritonitis.As cafazolin is not suitable for the empiric initial treatment for its increasing drug resistance,peritoneal administration of vancomycin plus imipenem can be recommended for the initial empirical therapy in patients with peritonitis.