腹膜透析相关性腹膜炎致病菌菌谱分析及治疗体会

目的探讨持续性不卧床腹膜透析时发生腹膜炎的病原学机制及治疗方法。方法对我院84例腹膜透析相关性腹膜炎患者的透出液均做细菌、真菌培养及药物敏感（简称药敏）试验，根据临床表现经验性使用抗生素并根据药敏结果选择抗生素治疗。结果培养出细菌54例，阳性率为64．29％，阳性率最高为G^＋球菌40．74％，其次G^-杆菌37．04％，真菌9．26％，其中大肠埃希氏菌25．93％，表皮葡萄球菌16．67％，金黄色葡萄球菌12．96％，铜绿假单胞茸、G^＋杆菌和近平滑念珠菌均为5．56％，通过经验性治疗并根据药敏试验选择敏感抗生素治疗，治愈率为79．76％，退出率15．48％，病死率4．76％。结论对患者做好宣教及培训，规范操作方法，减少接触污染，注意饮食卫生，对出现腹膜炎症状及体征的患者及早进行透出液的检测及培养，早期经验性使用抗生素以及根据病原学选择合理的抗生素治疗是保证腹膜透析顺利进行的重要因素。

Pathogenic bacteria and therapy experience of peritoneal dialysis-related peritonitis

Objective To research the etiology and treatment of Continuous ambulatory peritoneal dialysis peritonitis.Methods Dialysate of 84 continuous ambulatory peritoneal dialysis peritonitis patients of last five years were collected,which received bacterium-culture eumycete-culture and susceptibility testing.Patients received empirical antibiotics according to clinical manifestation or pathogen-directed treatments according to susceptibility testing results.Results Fifty-four csses were cultured with bacteria,the positive-culture rate is 64.29%,the highest is Gram staining positive coecobacteria,40.74%,the second is Gram staining negative bacillus,37.04%,and fungus is 9.26%.Among those,25.93%is cultured with E.coli,16.67%is Staphylococcus epidermidis,12.96%is Staphylococcus aureus.The culrum rate of Pseudomonas aeruginosa,Gram staining positive bacillus and Candida parapsilosis are all 5.56%.By the application of empirical antibiotics or treatment with sensitive antibiotics according to susceptibility testing results.the cure rate was 79.76%,exit rate Was 15.48%,mortality was 4.76%.Conclusion The education and training of patients,normalization of operation method,reduction of contact pollution,dietary hygiene,early detection and culture of dialysate early application of empirical antibiotics or treatment with appropriate antibiotics according to susceptibility testing results with patients who had peritonitis symptoms and signs were important factors to guarantee peritoneal dialysis carry out successfully.