84例次腹膜透析相关性腹膜炎单中心致病菌及耐药性分析

目的：分析单中心的腹膜透析相关性腹膜炎致病菌分布及其耐药情况，指导腹膜炎治疗中抗生素的合理使用。方法回顾性分析2012年3月1日至2015年3月31日陕西省人民医院肾内科腹膜透析中心接受治疗的62例(84例次)腹膜透析相关性腹膜炎患者的临床资料，统计腹膜炎相关致病菌的分布及耐药情况，分析重现性和复发性腹膜炎的病原菌特点。结果84例次致病菌中培养阳性71例次，阳性率为84.50%，其中革兰氏阳性菌49例次，革兰氏阴性菌18例次，混合菌感染2例次，真菌感染2例；革兰氏阳性菌中最多为表皮葡萄球菌，占51.85%，革兰氏阴性菌中最多者为大肠埃希菌，占50.00%；真菌感染2例次，包括近平滑念珠菌1例及光滑念珠菌1例。革兰氏阳性菌对替考拉宁、万古霉素均敏感，对头孢唑林的耐药率为41.67%，革兰氏阴性菌对头孢哌酮舒巴坦、头孢他啶耐药率均较低，分别为5.56%、16.67%。重现性和复发性腹膜炎的病原菌以表皮葡萄球菌为主。结论腹膜透析相关性腹膜炎致病菌以革兰氏阳性菌为主，头孢唑啉因为耐药率高已不适合作为初始治疗用药，推荐万古霉素代替头孢唑啉，并与头孢他啶或头孢哌酮舒巴坦联合作为腹膜炎的初始治疗药物。

Analysis of microbial spectrum and drug resistance in 84 patients of peritoneal dialysis-related peritonitis in a ;medical center

Objective To investigate the microbial spectrum and drug resistance of peritoneal dialysis-related peritonitis, and to provide guidance for the clinical rational use of antimicrobial agents. Methods A retrospective analy-sis was made in 62 patients with peritoneal dialysis-related peritonitis (84 cases) in Shaanxi Provincial People's Hospital from Mar. 1, 2012 to Mar. 31, 2015. Distribution of pathogenic bacteria and its resistance to common antibiotics were an-alyzed, as well as the characteristics of pathogenic bacteria of reproducible and recurrent peritonitis. Results Among 84 cases of samples, 71 cases were positive of pathogenic bacteria, with the positive rate of 84.50%, including 49 cases of Gram-positive strains, 18 cases of Gram-negative strains, 2 cases of co-infection, and 2 cases of fungi (1 case of Can-dida parapsilosis and 1 case of Candida glabrata). Staphylococcus epidermidis was the most common Gram-positive patho-gen (51.85%), and Escherichia coli was the most common Gram-negative pathogen (50.00%). Gram-positive bacteria were resistant to cefazolin (41.67%) and susceptible to vancomycin and teicoplanin. Gram-negative bacteria were resis-tant to ceftazidime (16.67%) and cefoperazone-sulbactam (5.56%). Staphylococcus epidermidis was the most important pathogen in reproducible and recurrent peritonitis. Conclusion The main pathogen of peritoneal dialysis-related perito-nitis is Gram-positive bacteria. Because of the high resistance rate of cefazolin, vancomycin combined with cefopera-zone-sulbactam or ceftazidime is recommended for the empiric initial treatment of peritonitis.