肠源性与非肠源性腹膜透析相关性腹膜炎的临床特点及预后

目的调查肠源性与非肠源性腹膜透析相关腹膜炎的人群特点、细菌谱、耐药率及转归。方法对2008年1月至2011年8月北京大学第一医院腹膜透析中心258例次腹膜炎进行回顾分析。结果有241例次腹膜炎送检腹膜透析液培养,其中177例次阳性（培养阳性率73.4%）,肠源性细菌52例次,最多见为大肠埃希菌（26例次）。非肠源性细菌118例次,最多见为表皮葡萄球菌（42例次）。肠源性细菌与非肠源性细菌耐药谱存在一定的差异,而两者对青霉素、氨苄西林、哌拉西林、头孢呋辛、红霉素的耐药率均高于50.0%,对于头孢哌酮/舒巴坦、万古霉素、亚胺培南、美洛培南均为100%敏感。肠源性细菌性腹膜炎退出率显著高于非肠源性细菌性腹膜炎（26.9%比11.0%,P=0.009）。结论肠源性与非肠源性细菌具有不同的耐药谱,腹膜炎预后也存在差异。

The clinical characteristics and outcome in peritoneal dialysis related enterogenic and non-enterogenic peritonitis

Objective To investigate the antibiotic-resistance and prognosis of CAPD related enterogenic and non-enterogenic peritonitis.Methods We retrospectively analyzed the pathogens,antibiotic-resistance and outcome in 258 episodes of CAPD related peritonitis encountered in Peritoneal Dialysis Center of Peking University First Hospital in the period between January 2008 to August 2011.Results Of the 177 culture-positive episodes（positive rate = 73.4%）,52 episodes were infected by enterogenic bacteria（including 26 episodes by E.coli）,and 118 episodes were infected by non-enterogenic bacteria（including 42 episodes by Staphylococcus epidermidis）.The spectrum of antibiotic-resistance was different between enterogenic bacteria and non-enterogenic bacteria.However,both kinds of bacteria had more than 50% antibiotic-resistance rate to Penicillin,Ampicillin,Piperacillin,Cefuroxime and Erythromycin,but were 100% sensitive to Cefoperazone/sulbactam,Vancomycin,Imipenem,and Meropenem.Enterogenic peritonitis had a higher dropout rate than non-enterogenic peritonitis（26.9% vs.11%,P=0.009）.Conclusion Antibiotic-resistance and prognosis of peritonitis were different between CAPD related enterogenic and non-enterogenic peritonitis.