摘要目的 比较两种经验治疗方案(头孢唑啉联合三代头孢抗菌素与万古霉素联合三代头孢抗菌素)治疗腹膜透析(腹透)相关腹膜炎的疗效.方法 回顾性分析2008年1月至2012年12月期间在北京大学第一医院肾内科腹透中心接受规律腹透并发生腹膜炎患者的临床资料,根据经验治疗药物方案的选择分为A组(头孢唑啉联合三代头孢菌素)和B组(万古霉素联合三代头孢菌素),比较两组患者的临床表现特征和生化参数的差异,采用Logistic多元回归模型分析两种治疗方案对腹膜炎患者预后的影响.结果 共有233例腹膜炎患者(361例次)被纳入了研究,A组160例次(44.3％),B组166例次(46％),其他方案治疗组35例次(9.7％).B组患者发生腹膜炎前的血白蛋白[(33.5±6.0)比(35.3±5.2)g/L)]和胆固醇水平[(4.6±1.3)比(4.9±1.1) mmol/L]明显低于A组(P＜0.05).A组革兰阴性菌感染率略低,但差异无统计学意义(16.9％比24.7％,P=0.08).logistic多元回归分析结果提示不同经验抗菌方案不是预测治疗失败的独立危险因素[OR=1.07,95％ CI(0.45,2.56),P=0.87].结论 头孢唑啉和万古霉素均可作为腹膜炎经验治疗中覆盖革兰阳性球菌的首选抗菌素.

abstractsObjective To compare the efficacy of different antibiotics strategy,introperitoneal (IP) cefazolin plus third-generation cephalosporin versus IP Vancomycin plus thirdgeneration cephalosporin on peritoneal dialysis (PD)-related peritonitis.Methods All episodes of PD -associated peritonitis happened in prevalent PD patients between January 2008 and December 2012 were recruited from the PD Center of Peking University First Hospital.According to their empiric antibiotics scheme,episodes were divided into group A (where IP cefazolin plus third-generation cephalosporins were administrated) and group B (where IP Vancomycin plus third-generation cephalosporins were administrated).Multivariable logistic regression model was used to explore the influence of different emnpiric antibiotics scheme on peritonitis outcome.Results Patients in Group B had significantly lower level of serum albumin (33.5±6.0 vs 35.3±5.2 g/L) and cholesterol (4.6±1.3 vs 4.9± 1.1 mmol/L) than those in group A.In group A,the percentage of gram-positive bacteria was similar to group B (43.2％ vs 43.3％,P =0.96),but gram-negative bacteria was numerically lower (16.9％ vs 24.7％,P =0.08).Different empiric antibiotics strategy was not independent predictor of peritonitis outcome [OR =1.07,95％ CI(0.45,2.56),P=0.87].Conclusion Both cefazolin and vancomycin can be selected as first-line empiric antibiotic covering gram-positive organisms in the treatment of PD related peritonitis.