腹膜透析相关感染性腹膜炎致病菌及耐药性的单中心分析

目的分析腹膜透析(简称腹透)相关感染性腹膜炎患者病原菌分布及耐药性变化。方法回顾中南大学湘雅二医院近5年来腹透相关感染性腹膜炎患者一般情况、细菌培养及药敏试验、疗效及转归,并进行统计学分析。结果①46例次病原菌培养阳性24例次(52.2%),其中G+菌9例次(37.5%),G-菌8例次(33.3%),真菌7例次(29.2%)。②G+菌对头孢类抗生素耐药率高,对万古霉素、替考拉宁等的耐药率低。G-菌对替卡西林/棒酸、阿米卡星、环丙沙星、左氧氟沙星、泰能等耐药率低。③G+菌、G-菌、培养阴性腹膜炎患者治愈率分别为88.9%、75%、73%;真菌性腹膜炎患者均拔管。结论腹膜透析相关感染性腹膜炎病原菌及耐药性已发生很大变化,需努力提高腹透液培养阳性率及腹膜炎的治愈率。

Characteristics of pathogens and antimicrobial susceptibilities in peritoneal dialysis-related peritonitis:a retrospective analysis from a single medical center

Objective To analyze the changes of pathogens and antimicrobial susceptibilities in peritoneal dialysis-related peritonitis. Methods We recruited the peritoneal dialysis-related peritonitis patients treated in the recent 5 years in our department, and retrospectively analyzed their general condition, pathogens, antimicrobial susceptibilities, and prognosis. Results ① In the 46 samples for microbial culture, 24 samples （52.2%） were positive for pathogens, in which Gram-positive bacteria were found in 9 cases （37.5%）, Gram-negative bacteria in 8 cases （33.3%）, and fungi in 7 cases （29.2%）. ② In the isolated Grampositive bacteria, the antibiotic resistance rate to cephalosporins was high, and the rates to vancomycin and teicoplanin were low. In the isolated Gram-negative bacteria, the antibiotic resistance rates to ticarcillin/clavulanic acid, amikacin, ciprofloxacin, levofloxacin and tienam were still low. ③ The recovery rate was 88. 9%, 75%, and 73% in Gram-positive, Gram-negative, and microbial-negative peritonitis patients, respectively. Peritoneal dialysis discontinued in fungal peritonitis patients. Conclusion Pathogens and their antimicrobial susceptibilities have changed greatly in peritoneal dialysis-related peritonitis. We should make efforts to improve the positive rate of dialysate culture and the recovery rate of peritonitis patients.