摘要
目的分析腹膜透析相关性腹膜炎(peritoneal dialysis associated peritonitis,PDAP)病原菌分布及耐药性变化。方法回顾分析2014年1月—12月行持续非卧床腹膜透析并发生PDAP患者的临床资料,分析其发生PDAP的致病菌、耐药性、转归情况和可能诱因。结果共有64例患者发生了72例次PDAP,病原菌培养阳性36株(50.0%),其中革兰阳性(Gram-positive,G+)菌24株(66.7%),革兰阴性(Gram-negative,G–)菌7株(19.4%),真菌5株(13.9%)。G+菌对万古霉素、利奈唑胺、利福平的耐药率均为0%,对左氧氟沙星、庆大霉素、头孢唑林耐药率分别为14.3%、26.3%、50.0%。G–杆菌对丁胺卡那霉素和亚胺培南耐药率均为0%,对庆大霉素和头孢他啶均为28.6%,对左氧氟沙星、氨苄青霉素耐药率分别为42.9%、100.0%。结论 PDAP病原菌及耐药性已发生很大变化,应根据各中心病原菌及耐药性特点选用抗菌药物,同时需努力提高透出液培养阳性率及PDAP的治愈率。
Objective To investigate the change of pathogenic distribution and drug resistance in peritoneal dialysis associated peritonitis （PDAP）. Methods The clinical data of all the patients undergoing continuous ambulatory peritoneal dialysis and suffered from PDAP between January and December in 2014 was retrospectively coUected, and the pathogens, drug resistance, outcomes and underlying causes were analyzed. Results A total of 64 patients had 72 cases of PDAP. Only 36 strains （50.0%） had positive culture results, among which 24 strains （66.7%） were Gram-positive bacteria strains, 7 strains （19.4%） were Gram-negative bacteria strains, and 5 strains （13.9%） were fungi. For Gram-positive bacteria strains, the resistance rates to vancomycin, linezolid and rifampicin were all 0%; the resistance rate to levofloxacin, gentamycin and cefazolin was 14.3%, 26.3% and 50.0%, respectively. For Gram-negative bacteria strains, the resistance rates to amikacin and imipenem were both 0%; the resistant rate to gentamycin, ceftazidime, levofloxacin and ampicfllin was 28.6%, 28.6%, 42.9% and 100.0%, respectively. Conclusions The pathogenic spectrum and drug resistance in PDAP have been markedly changed. Selection of antibiotics should be chosen according to the characteristic of the pathogenic spectrum and drug resistance of each center. Great effort is still needed to improve the culture positive rate of the effluent dialysate and to improve the recovery rate of peritonitis.
作者
周雪丽
秦敏
任英
李莉
刁永书
唐晓红
钟慧
李孜
ZHOU Xueli QIN Min REN Ying LI Li DIAO Yongshu TANG Xiaohong ZHONG Hui LI Zi(Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China)
出处
《华西医学》
CAS
2017年第8期1221-1224,共4页
West China Medical Journal
基金
四川省科技厅支撑项目(2011SZ0216)
关键词
腹膜透析
腹膜炎
耐药性
Peritoneal dialysis
Peritonitis
Drug resistance
