腹膜透析相关性腹膜炎169例次临床分析及转归

目的探讨腹膜透析相关性腹膜炎的致病菌和耐药性，及其与转归之间的关系。方法回顾性分析169例次腹膜透析相关性腹膜炎的临床资料、致病菌与耐药性，探讨其与转归的联系。结果116例次培养阳性，培养总阳性率达68．6％，近5年高达87．7％。致病菌中G^＋球菌占58例次（50％），G^-杆菌45例次（38．8％），真菌6例次（5．2％），G^＋杆菌、G^-球菌及混合感染7例（6％）。G^＋球菌中最常见为葡萄球菌（56．8％）；G^-杆菌中大肠杆菌阳性率最高（62．2％）。从耐药性看，G^-杆菌对氨苄西林的耐药率最高（76．7%），对阿米卡星和哌拉西林／他唑巴坦的耐药率较低（2．9%、3．4％）。G^＋球菌对万古霉素均敏感，对利福平和哌拉西林／他唑巴坦的耐药率较低（2．1％、7．9％）。腹膜炎致持续非卧床腹膜透析（CAPD）退出率为10．1％（17／169），以真菌腹膜炎为主。结论近5年本中心培养阳性率较高，及时采用血培养瓶留取标本很关键。G^-杆菌对阿米卡星和哌拉西林／他唑巴坦较敏感，而万古霉素、利福平和哌拉西林／他唑巴坦宜作为抗G^＋球菌的经验用药。真菌性腹膜炎是导致腹膜透析退出的主要原因。

Clinical analysis and prognosis in 169 cases of continuous ambulatory peritoneal dialysis-related peritonitis

Objective To discuss the pathogens and their resistance, and the relationship between pathogens and outcome on continuous ambulatory peritoneal dialysis （CAPD）-related peritonitis in our peritoneal dialysis （PD） center. Methods Clinical manifestation, pathogens, resistance and outcomes of 109 cases of CAPD-related peritonitis were analyzed retrospectively. Results 116 cases were culture positive with a positive rate of 68. 6%, including 58 cases of gram-positive cocci （50%）, 45 cases of gram-negative bacilli （38. 8%） and 6 cases of fungi （5. 2%）. Fifty-eight cases （87. 7%） were culture positive in the last five years, Among culture positive peritonitis, Staphylococcus peritonitis had the highest incidence in gram-positive cocci （56. 8 %, and Escherichia Coli had the highest incidence in gram-negative bacilli （62. 2 %）. The gram-negative bacilli showed high resistance to ampicillin （76. 7%） and low resistance to amikacin （2. 9%） and piperacillin/tazobactam （3. 4%）. The grampositive cocci showed high resistance to penicillin （64. 2% ） and low resistance to rifampicin （2. 1 % ） and piperacillin/tazobactam （7. 9%）. All gram-positive cocci were sensitive to vancomycin. The total CAPD with drawal rate in peritonitis was 10. 1 % （17/169）, especially in fungi peritonitis （P〈0. 01 ）. Conclusions Timely use of blood culture bottle specimens can increase the culture positive rate. Most of gram-negative bacilli showed more sensitive to amikacin and piperacillin/tazobactam, while vancomycin, rifampicin and piperacillin/tazobactam were recommended for empiric therapy for CAPD-relat- ed peritonitis of gram-positive cocci. Fungal peritonitis is the most important reason for patients dropout.