摘要
目的分析腹膜透析相关腹膜炎(PDAP)病原菌及耐药性,为抗菌药物的合理使用提供临床依据。方法收集2015年7月1日—2021年12月30日苏州大学附属第一医院腹透中心PDAP患者的人口统计学资料,对病原菌、耐药性及预后进行回顾性分析。结果共92例患者发生PDAP150例次。腹透液培养阳性率为61.33%,其中革兰阳性(G^(+))菌65例次(70.65%),以葡萄球菌属和链球菌属为主。革兰阴性(G^(-))菌16例次(17.39%),以大肠埃希菌和阴沟肠杆菌为主。多重感染11例次(11.96%),其中合并真菌感染5例次。G^(+)菌相关PDAP由2016年14例次降至2021年的8例次。G^(+)菌对甲氧西林的敏感性为35.00%,对利奈唑胺、替考拉宁和利福平敏感率均为100.00%,万古霉素敏感率为98.59%。G^(-)菌对头孢他啶、头孢唑肟、阿米卡星的敏感性为86.36%、88.89%、100.00%。2019—2021年万古霉素对葡萄球菌属的最低抑制浓度(MIC)值有上升趋势。PDAP的总体治愈率为81.33%,G^(+)菌的治愈率高于多重感染(89.23%vs.36.36%,P<0.01)。多重感染尤其是合并真菌感染PDAP的预后较差。结论该院腹透中心PDAP发生率近年来有下降趋势,G^(+)菌仍然是导致PDAP的主要病原菌,对甲氧西林耐药性高,应选用万古霉素经验性治疗;G^(-)菌可选择头孢他啶、阿米卡星作为经验性药物治疗。万古霉素对葡萄球菌属MIC值存在漂移现象,需监测万古霉素的MIC值及其变化趋势。
Objective To analyze the pathogenic bacteria and drug resistance of peritoneal dialysis-associated peritonitis(PDAP),and provide a clinical reference for the rational use of antibiotics.Methods The demographic data of PDAP patients admitted to the peritoneal dialysis(PD)Center of the First Affiliated Hospital of Soochow University from July 1,2015 to December 30,2021 were collected,and the pathogens,drug resistance and prognosis were retrospectively analyzed.Results A total of 150 episodes of PDAP occurred in 92 patients.The positive rate of PD fluid culture was 61.33%,including 65 cases(70.65%)of Gram-positive(G^(+))bacteria,mainly Staphylococcus and Streptococcus.Gram-negative(G^(-))bacteria were in 16 cases(17.39%),mainly Escherichia coli and Enterobacter cloacae.There were 11 cases(11.96%)of multiple infections,including 5 cases of combined fungal infection.From 2016 to 2021,the incidence of G^(+)bacteria-related PDAP decreased from 14 to 8 cases.G^(+)strains were resistant to methicillin(35.00%),and were sensitive to linezolid(100.00%),teicoplanin(100.00%)and rifampicin(100.00%).The sensitivity rate to vancomycin was 98.59%.G^(-)strains were sensitive to ceftazidime(86.36%),ceftizoxime(88.89%)and amikacin(100.00%).The MIC of vancomycin against Staphylococcus showed an upward trend in 2019-2021.The overall cure rate of PDAP was 81.33%in patients who responded to antibiotic treatment,and the cure rate of G^(+)bacteria was higher than that of multiple infections(89.23%vs.36.36%,P<0.01).The outcome of patients with multiple infections,especially those with concurrent fungal infection was poor.Conclusion The incidence of PDAP in the PD center has shown a decreasing trend in recent years.G^(+)bacteria are still the main pathogenic bacteria causing PDAP,and they are highly resistant to methicillin,so vancomycin should be used as empirical therapy.For G^(-)bacteria,cefotaxime and amikacin can be chosen as empirical therapy.There is a drift in the MIC values of vancomycin against Staphylococcus in the study period,so
作者
吴月圆
戴小花
徐杰
张险峰
徐德宇
胡坤
沈蕾
卢国元
韩强
杭永付
WU Yueyuan;DAI Xiaohua;XU Jie;ZHANG Xianfeng;XU Deyu;HU Kun;SHEN Lei;LU Guoyuan;HAN Qiang;HANG Yongfu(Center of Clinical Laboratory,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Pharmacy,the First People's Hospital of Zhaoqing City,Guangdong Province,Zhaoqing 526000,China;Department of Nephrology,the First Affiliated Hospital of Soochow University,Suzhou 215000,China;Department of Pharmacy,the First Affiliated Hospital of Soochow University,Suzhou 215000,China)
出处
《医药导报》
北大核心
2024年第2期287-291,共5页
Herald of Medicine
基金
中国药学会-施维雅青年医院药学创新研究资助项目(CPA-B04-ZC-2022-001)
江苏省药学会恒瑞医院药学基金项目:(H202032)。
关键词
腹膜透析相关腹膜炎
耐药性
万古霉素
Peritoneal dialysis-associated peritonitis
Drug resistance
Vancomycin
