腹膜透析患者产ESBLs细菌感染相关性腹膜炎的临床分析

目的探讨产超广谱B内酰胺酶（ESBLs）细菌感染腹膜透析相关性腹膜炎的易感因素、耐药性及治疗转归。方法回顾性分析我院发生产ESBLs细菌感染相关性腹膜炎的腹膜透析患者12例（A组）的临床表现、治疗及转归，并与同期收治非产ESBLs革兰阴性菌感染相关性腹膜炎患者36例（B组）进行比较。结果在年龄、6个月内腹腔／全身抗生素使用率方面2组间有统计学差异（P〈0．05），并且A组发热的发生率显著高于B组（P〈0．05）。产ESBLs菌培养病原菌为大肠埃希菌和肺炎克雷伯菌，其对头孢他啶、环丙沙星等的耐药率为100％、阿米卡星的耐药率为16．7%，亚胺培南的耐药率为0。腹腔局部抗炎治疗后透出液白细胞计数转为阴性的时间，A组显著长于B组（16．5±8．4）d比（5．6±5．2）d，P〈0．051。A组1例改行血液透析，1例死亡，而B组均治愈并继续腹膜透析治疗。结论腹膜透析患者产ESBLs细菌感染相关性腹膜炎的临床症状严重，耐药率高，治疗疗程长，预后不良。

Clinical analysis of peritoneal dialysis-related extended-spectrum β-lactamases producing strains bacterial peritonitis

Objective To investigate the risk factors, clinical characteristics, and outcome of peritoneal dialysis （PD） related extended-spectrum β-lactamases producing strains （ESBLs） bacterial peritonitis. Methods Twelve cases of ESBLs bacterial peritonitis were retrospectively reviewed. The clinical characteristics, pathogens, and outcomes were analyzed and compared with those of non-ESBLs gram negative bacterial peritonitis. Results There was significant difference in the age and history of bacterial peritonitis and/or antibiotic use within 6 month between ELBs positive group and non-ESBLs gram negative group,and the occurrence of fever was obviously higher in ESBLs positive peritonitis ep- isodes than in gram negative bacterial episodes（P〈0. 05）. Escherichia coli and Klebsiella Pneumoniae were the most common causes of ESBLs, which showed high resistant rate of 100% to eeftazidin and Ciprofloxacin, resistant rate of 16. 7% to amikacin,and all were sensitive to imipenem. The treatment time which WBC count in effluent became normal in ESBLs positive groups was longer than non-ES- BLs gram negative groups（16. 5 ± 8.4 clays vs. 5.6 ±5.2 days, P〈0. 05）. There was one death,and one converted to maintenance hemodialysis in ESBLs positive group, and in non-ESBLs gram negative group all patients were cured and received peritoneal dialysis. Conclusion ESBLs-produeing bacterial peritonitis is associated to severe manifestation, high drug resistant rate,long treatment time, and poor prognosis.