单中心腹膜透析相关感染性腹膜炎的病原菌及耐药性分析
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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。
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 pay attention to the etiological surveillance and reasonably use antibiotics according to the result of drug susceptibility testing so as to improve the clinical therapeutic effect.
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 pay attention to the etiological surveillance and reasonably use antibiotics according to the result of drug susceptibility testing so as to improve the clinical therapeutic effect.
引文
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[5]吴晶晶,刘佳,张莉,等.腹膜透析相关性腹膜炎致病菌及耐药性分析[J].中华医院感染学杂志,2011,21(16):3521-3523.
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[7]Huang ST,Chuang YW,Cheng CH,et al.Evolution of m icrobiological trends and treatment outcomes in peritonea l dialysis-related peritonitis[J].Clin Nephrol,2011,75(5):416-425.
[8]Quintanar Lartundo JA,Palomar R,Dominguez-Diez A,et al.Microbiological profile of peritoneal dialysis per itonitis and predictors of hospitalization[J].Adv Perit Dial,2011,27:38-42.
[9]Badve SV,Hawley CM,Mc Donald SP,et al.Use of aminoglyeosides for peritoneal dialysis-assodated peritonitis does not affect residual renal function[J].Nephrol Dial Transplant,2012,1:381-387.
[10]Fur geson SB,Teitelbaum I.New treatment options and protocolsf or peritonerl dialysis-related peritonitis[J].Contfib Nephrol,2009,163:169-176.
[11]郭群英,陈林,阳晓,等.腹膜透析相关感染性腹膜炎致病菌及菌谱变化-单个腹膜透析中心15年回顾分析[J].中华肾脏病杂志,2006,22(12):719-724.
[12]Chang TI,Kim HW,Park JT,et al.Early catheter removal improves patient survival in peritoneal dialysis patients with fungal peritonitis:results of ninety-four episodes of fungal peritonitis at a single center[J].Perit Dial Int,2011,31(1):60-66.
[13]Betas JS.Infection with antimierobial-resistant microorganisms in dialysis patients[J].Semin Dial,2003,1:30-37.
[2]Szeto CC,Wong TY,Chow KM,et al.The clinical course of culture-negative peritonitis complicating peritoneal dialysis[J].Am J Kidney Dis,2003,42(3):567-574.
[3]Wiggins KJ,Johnson DW,Craid JC,et al.Treatment of peritoneal dialysis-associated peritonitis:a systematic review of randomized controlled trials[J].Am J Kidney Dis,2007,50(6):967-988.
[4]许坤,张炜,吴永贵,等.124株腹膜透析相关性腹膜炎致病菌及耐药性分析[J].临床肾脏病杂志,2013,13(9):394-397.
[5]吴晶晶,刘佳,张莉,等.腹膜透析相关性腹膜炎致病菌及耐药性分析[J].中华医院感染学杂志,2011,21(16):3521-3523.
[6]仲辉,吴普昭.腹膜透析液的细菌培养及耐药性分析[J].国际检验医学杂志,2011,32(13):1430-1432.
[7]Huang ST,Chuang YW,Cheng CH,et al.Evolution of m icrobiological trends and treatment outcomes in peritonea l dialysis-related peritonitis[J].Clin Nephrol,2011,75(5):416-425.
[8]Quintanar Lartundo JA,Palomar R,Dominguez-Diez A,et al.Microbiological profile of peritoneal dialysis per itonitis and predictors of hospitalization[J].Adv Perit Dial,2011,27:38-42.
[9]Badve SV,Hawley CM,Mc Donald SP,et al.Use of aminoglyeosides for peritoneal dialysis-assodated peritonitis does not affect residual renal function[J].Nephrol Dial Transplant,2012,1:381-387.
[10]Fur geson SB,Teitelbaum I.New treatment options and protocolsf or peritonerl dialysis-related peritonitis[J].Contfib Nephrol,2009,163:169-176.
[11]郭群英,陈林,阳晓,等.腹膜透析相关感染性腹膜炎致病菌及菌谱变化-单个腹膜透析中心15年回顾分析[J].中华肾脏病杂志,2006,22(12):719-724.
[12]Chang TI,Kim HW,Park JT,et al.Early catheter removal improves patient survival in peritoneal dialysis patients with fungal peritonitis:results of ninety-four episodes of fungal peritonitis at a single center[J].Perit Dial Int,2011,31(1):60-66.
[13]Betas JS.Infection with antimierobial-resistant microorganisms in dialysis patients[J].Semin Dial,2003,1:30-37.