单中心腹膜透析相关感染性腹膜炎病原菌及耐药性分析.docVIP

单中心腹膜透析相关感染性腹膜炎病原菌及耐药性分析 　　[摘要] 目的 探讨本中心腹膜透析相关性感染性腹膜炎的致病菌及其耐药性。 方法 回顾我中心2008年2月～2014年5月收治的73例腹膜透析相关感染性腹膜炎患者，分析腹膜透析液培养阳性致病菌及其耐药性。 结果 73例腹膜炎患者培养阳性者36例（49.32%），其中革兰阳性菌21例（58.34%），革兰阴性杆菌12例（33.33%），真菌3例（8.33%）。革兰阳性菌对青霉素、红霉素耐药率最高，分别达76.19%、66.67%，而对替考拉宁、利奈唑胺几乎均敏感；革兰阴性菌对氨苄青霉素、头孢唑啉耐药率分别为75%、66.67%，对亚胺培南耐药率仅8.33%，对阿米卡星均敏感。73例次腹膜炎患者中，治愈率84.93%，拔管改血液透析8例，死亡4例。 结论 需进一步改进培养方法提高阳性率。革兰氏阳性菌仍为腹膜炎主要致病菌，而真菌及革兰氏阴性菌感染则治疗效果差，退出率、死亡率高。临床治疗中应重视病原学检测，结合药敏试验选择抗生素提高治愈率。 　　[关键词] 腹膜透析；腹膜炎；病原菌；耐药性 　　[中图分类号] R446.5 [文献标识码] A [文章编号] 2095-0616（2015）16-36-04 　　Analysis of infecting pathogens and drug resistance in peritoneal dialysis related peritonitis in a medical center 　　GUO Lin HE Xiaoxia 　　Department of Nephrology，Jiaozuo Peoples Hospital，Jiaozuo 454000，China 　　[Abstract] Objective To investigate the pathogens and their resistance in peritoneal dialysis related peritonitis. Methods A total of 73 cases with peritoneal dialysis related peritonitis in Peritoneal Dialysis Center in our hospital from February 2008 to May 2014 were reviewed.Pathogens，resistance and outcomes of the 73 cases were analyzed retrospectively. Results Among them，36 cases cultured positive（49.32%），induding 21 gram-positive strains（58.34%），12 gram-negative strains（33.33%）and 3 fungi （8.33%）.Drug sensitivity test showed that gram-positive strains had the higher resistance rate to penicillin and erythromycin，76.19% and 66.67% respectively，but they were sensitive to teicoplanin and linezolid.The drug resistance rate of the gram-negative bacteria to ampicillin and cefazolin was 75%，66.67% respectively，to imipenem and amikacin was 8.33%，0% respectively.The total curative rate of 73 cases of peritonitis patients was 84.93%，8 cases transferred to hemodialysis，4 cases died. Conclusion The most common pathogens causing peritoneal dialysis associated peritonitis is still gram-positive bacteria， while fungi and gram-negative bacteria infection has poor treatment effect，high dropout rate and high mortality.It is necessary to pa