腹膜透析相关性腹膜炎经验用药分析

目的 研究华山医院及宝山分院腹膜透析（腹透）相关性腹膜炎的致病菌、耐药性及患者转归，为临床经验用药提供依据。 方法 回顾性分析2007年1月至2010年1月上述两医院腹透中心收治的93例腹透相关性腹膜炎的临床表现、致病菌、耐药性及转归。 结果 75例腹透液培养阳性，阳性率为80.2％，其中革兰阳性球菌45例，革兰阴性杆菌21例，真菌2例，革兰阳性杆菌1例，革兰阴性球菌1例，多种菌混合感染5例。革兰阳性球菌主要以凝固酶阴性的葡萄球菌为主，所有革兰阳性球菌对万古霉素均敏感，但对头孢唑林耐药率高达60.0%，而且耐药率有明显的逐年增加趋势。革兰阴性菌对头孢他啶的耐药率达到46.1％，所有革兰阴性杆菌对亚胺培南均敏感。因腹膜炎而退出腹膜透析有16例，退出率为17.2％（16/93）。腹腔使用万古霉素对残肾功能无显著影响。 结论 两院腹透中心腹透相关腹膜炎致病菌以革兰阳性球菌为多数。头孢唑啉耐药性逐年增高，目前不再适合作为初始治疗的经验用药。腹腔使用万古霉素可推荐作为革兰阳性菌致腹膜炎的初始经验用药。

Empiric initial therapy in peritoneal dialysis-related peritonitis

Objective To investigate the pathogens,drug resistance and outcomes of continuous ambulatory peritoneal dialysis (CAPD) patients with peritoneal dialysis-related peritonitis in our peritoneal dialysis (PD) centers. Method Data including clinical manifestations,pathogens,treatment,outcome of 93 CAPD cases with peritoneal dialysis-related peritonitis in our peritoneal dialysis (PD) centers were retrospectively analyzed. Results Dialysate culture of 75cases was positive with a positive rate of 80.2％,including 45 cases of gram-positive cocci,21cases of gram-negative bacilli,2 cases of fungi and 5 cases of mixed infection.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 60.0％ with an increasing tendence year by year.Resistance rate of gram-negative bacilli to ceftazidime was 46.1％.All the gram-negative bacilli were sensitive to imipenem.The withdraw rate of CAPD was 17.2％(16/93) because of peritonitis. No obvious side-effect of peritoneal administration of vancomycin was found.Conclusions Gram-positive cocci are major pathogens in CAPD-related peritonitis.Now cefasolin is not suitable for the empiric initial treatment.Peritoneal administration of vancomycin should be recommended for peritonitis caused by gram-positive cocci.