摘要
目的旨在对单中心腹膜透析相关性腹膜炎临床分离病原菌及相关因素进行分析,总结护理对策。方法收集安徽省某三甲医院2016年1月~2020年12月,腹膜透析相关性腹膜炎患者临床资料,并对其进行统计分析。结果在149例腹膜透析相关性腹膜炎患者中,2次及2次以上感染者68例(45.64%)。首年感染的患者49例次(32.89%),1年以上感染的患者显著增加,为100例次(67.11%)。透析液致病菌培养阳性69例次(46.31%),其中革兰氏阳性菌45株(65.22%),主要为表皮葡萄球菌(19株)与金黄色葡萄球菌(15株);革兰氏阴性菌17株(24.64%),主要为大肠埃希菌(12株);混合感染2例(2.90%),真菌5株(7.24%),其中7~9月份腹膜炎发病率明显增高(30.87%)。革兰氏阳性菌对万古霉素、喹奴普汀-达福普汀、替加环素敏感,革兰氏阴性菌对厄他培南,阿米卡星敏感,对头孢唑啉(90.00%),氨苄西林(93.33%),氨苄西林舒巴坦(60.00%),头孢曲松(46.67%)耐药性高。结论本中心分离的致病菌以革兰氏阳性菌最常见,存在着首年感染及二次感染率高的特点,以7~9月份为感染高发季节,需要我们在日常护理工作中加强宣教,减少腹膜透析相关性腹膜炎患病率。腹透液致病菌培养阳性率较低,需要改进培养方法,加强患者宣教,提高培养阳性率。万古霉素可作为本中心针对革兰氏阳性菌腹膜炎的治疗首选,革兰氏阴性菌可选择厄他培南、阿米卡星。
Objective To analyze the clinical isolation of pathogenic bacteria and related factors of peritonitis associated with single-center peritoneal dialysis,and summarize the nursing strategies.Methods The clinical data of patients with peritonitis associated with peritoneal dialysis from January 2016 to December 2020 in a tertiary hospital in Anhui Province were collected and statistically analyzed.Results Among the 149 patients with peritonitis associated with peritoneal dialysis,68(45.64%)were infected twice or more.There were 49 infections in the first year(32.89%)and a significant increase of 100 infections in patients over 1 year(67.11%).There were 69 infections(46.31%)of dialysate pathogenic bacteria,among which 45 were G+sex bacteria.Strains(65.22%),mainly staphylococcus epidermidis(19 strains)and staphylococcus aureus(15 strains);17 strains of G-sex bacteria(24.64%),mainly escherichia coli(12 strains);mixed infection 2 cases(2.90%),5 strains of fungi(7.24%),of which the incidence of peritonitis increased significantly from July to September(30.87%).G+bacteria versus vancomycin,quinupristin-dafopristin,tigecycline sensitive,G-bacteria were sensitive to ertapenem,amikacin,cefazolin(90.00%),ampicillin(93.33%),ampicillin and sulbactam(60.00%),ceftriaxone(46.67%)high drug resistance.Conclusion The most common pathogenic bacteria isolated in this center are G+bacteria,which have the characteristics of high first-year infection and secondary infection rate.From July to September is the high infection season,and we need our daily care strengthen publicity and education in the work to reduce the prevalence of peritonitis associated with peritoneal dialysis.The positive rate of pathogenic bacteria in peritoneal dialysis fluid is low,and it is necessary to improve the culture method,strengthen patient publicity and education,and increase the positive rate of culture.Vancomycin can be used as the center for G+the first choice for the treatment of peritonitis,G-bacteria can choose ertapenem and amikacin.
作者
廖茂蕾
朱敏
王连梅
宋霞
陶明芬
LIAO Maolei;ZHU Min;WANG Lianmei(Department of Nephrology,Yijishan Hospital,Wannan Medical College,Wuhu 241000,China)
出处
《华北理工大学学报（医学版）》
2021年第6期432-437,共6页
Journal of North China University of Science and Technology：Health Sciences Edition
基金
安徽省教育厅高校人文社会科学研究重点项目(编号:SK2019A0220)。
关键词
腹膜透析
腹膜炎
病原菌
耐药性
Peritoneal dialysis
Peritonitis
Pathogenic bacteria
Drug resistance
