摘要
目的：探讨本中心腹膜透析相关性腹膜炎患者的致病菌谱及其耐药状况，以指导临床经验性抗菌治疗。方法：选取我院2012年1月～2013年12月腹膜透析相关性腹膜炎患者61例次（46例），回顾性分析其透析流出液培养结果、耐药情况、初始治疗方案、疗效和转归。结果：61例次腹膜炎患者中42例次透析流出液培养阳性，培养阳性率67.85％，其中革兰阳性菌23例次（54.8％），革兰阴性菌16例次（38.1％），真菌3例次（7.1％）。革兰阳性菌对万古霉素、利奈唑胺、利福平100％敏感；对莫西沙星无耐药，但有3例次（13.0％）不很敏感；对头孢唑啉、苯唑西林、氯洁霉素耐药30.4％；对庆大霉素、克林霉素耐药17.4％；对左氧氟沙星耐药13.0％。革兰阴性菌对哌拉西林／他唑巴坦、阿米卡星、亚胺培南100％敏感；对氨苄西林耐药50％以上；对头孢他啶、氨曲南耐药18.8％；对左氧氟沙星、头孢匹美、头孢唑啉、头孢替坦耐药12.5％。3例真菌为假丝酵母菌。结论：腹膜透析相关性腹膜炎的致病菌谱仍以革兰阳性菌为主；腹膜炎治疗应根据细菌培养、药敏培养选择有效的抗生素；本中心针对腹膜炎的经验性治疗革兰阳性菌可选择万古霉素、左氧氟沙星、头孢唑啉；革兰阴性菌可选择阿米卡星、头孢他啶。对反复发作腹膜炎患者应尽早拔管。
Objective：To investigate the pathogens resulting in peritoneal dialysis-related peritonitis in our medical centre and examine the drug resistance for empiric anti-pathogen management.Methods：Sixty-one events of 46 cases with peritonitis associated with peritoneal dialysis were included between Jan-uary 2012 and December 2013,and the data were retrospectively analyzed regarding findings of the dialysis effluent cultured ,incidences of drug resistance, primary therapy plan,therapeutic efficacies and outcomes.Results：67.85% of the culture from the 61 events of peritonitis were positive,and gram-positive bacteria occurred in 23（54.8%）,Gram-negative bacilli in 16（38.1%） and fungi in 3 （7.1%）.Gram-positive cocci were totally sensitive to vancomy-cin,linezolid and rifampicin.Although the drug resistance was free for moxifloxacin,yet 3 cases （13.0%） were not sensitive.Resistance to cefazolin,oxac-illin and clindamycin was 30.4%,to gentamicin and clindamycin was 17.4%and levofloxacin 13%of the patients.Gram-negative bacilli were 100%sen-sitive to piperacillin,sodium,tazobactam,amikacin and imipenem,but resistant to ampicillin in over 50% of the patients.The drug tolerance to ceftazidime and aztreonam was 18.8%,and to levofloxacin,cefepime,cefazolin and cefotetan was 12.5%.The fungal infection in 3 cases was associated with Candida albicans.Conclusion：Gram-positive cocci were major pathogens for peritoneal dialysis-related peritonitis,and effective antibiotics for peritonitis should comply with the findings of effluent culture and drug sensitive test.Empiric therapy may rely on vancomycin,levofloxacin,cefazolin for gram-positive cocci as well as amikacin and ceftazidime for gram-negative bacilli.However,early removal of dialysis tube is recommended for patients with recurrent peritoni-tis.
出处
《皖南医学院学报》
CAS
2014年第6期531-533,539,共4页
Journal of Wannan Medical College
关键词
腹膜透析
腹膜炎
致病菌
革兰阳性菌
peritoneal dialysis
peritonitis
infecting pathogens
gram-positive cocci
