摘要目的 调查持续性非卧床腹膜透析(CAPD)相关性腹膜炎的病原菌分布及耐药性特点,以期指导临床合理使用抗菌药物.方法 回顾性分析2009年1月1日至2013年6月30日在苏州大学附属第二医院肾内科腹膜透析中心接受CAPD,且并发腹膜透析相关性腹膜炎患者236例次腹膜透出液培养结果,统计病原菌的分布情况及其对常见抗菌药物的耐药性.结果 236例次CAPD相关性腹膜炎患者中腹膜透出液培养阳性185例次,阳性率78.39％.共分离出病原菌193株,其中革兰阳性(G+)菌138株(71.50％),革兰阴性(G-)菌44株(22.80％),真菌11株(5.70％);混合感染8例,2种致病菌均为G+菌5例,G+菌与G-菌混合感染3例.G+菌对万古霉素、替考拉宁、利奈唑胺耐药率为0;G菌对丁胺卡那霉素、亚胺培南、美洛培南、头孢哌酮/舒巴坦耐药率为0.分离的细菌对临床常见抗菌药物呈现多重耐药.236例次患者中共有9例死亡,其中真菌感染3例,G-感染3例,G+菌感染2例,培养阴性1例,病死率3.81％.13例需拔管改血液透析治疗,其中真菌感染6例,总拔管率5.51％;10例放弃治疗,治愈率86.44％.结论 CAPD相关性腹膜炎致病菌以G+菌为主,传统一代头孢联合三代头孢类抗菌药已不适合CAPD相关性腹膜炎的治疗,推荐万古霉素联合头孢哌酮/舒巴坦或丁胺卡那霉素作为腹膜炎的经验性治疗药物.

abstractsObjective To investigate the microbial spectrum and antibiotic resistance of continuous ambulatory peritoneal dialysis (CAPD) related peritonitis and guide the clinical rational use of antimicrobial agents.Methods A retrospective analysis was made of CAPD related peritonitis in 236 cases with peritoneal dialysate culture results in the Second Hospital Affiliated to Soochow University from Jan 1,2009 to Jun 30,2013.Distribution of pathogenic bacteria and its resistance to common antibiotics were analyzed.Results Among 236 cases of peritoneal dialysate cultured cases,185 cases were positive (78.39％).A total of 193 strains were cultured,including 138 Gram-positive strains (71.50％),44 Gram-negative strains (22.80％) and 11 fungi (5.70％).Eight cases of polyinfection were found and 2 strains were cultured.The isolated organisms included Simple Gram-positive organisms in 5 cases,mixed Gram-positive and Gram-negative organisms in 3 cases.Drug sensitivity test of the Gram-positive strains showed that antibiotics with the lowest resistance were vancomycin (0),Teicoplanin(0),linezolid(0).Drug sensitivity test of the Gram-negative bacteria showed that antibiotics with the lowest resistance were amikacin(0),imipenem(0),meropenem(0),Cefoperazone/sulbactam(0).The isolated bacteria were resistant to multiple antibiotics.A total of 236 cases of 9 patients died in 236 cases,including 3 cases of fungal infection,3 cases of Gram-negative bacteria infection,2 cases of Gram-positive bacteria infection,one cases of culture-negative.Peritonitis related mortality rate was 3.81％; 13 cases transferred to hemodialysis,including 6 cases of fungal infection.The total catheter removal rate was 5.51％.10 cases gave up treatment,the others were cured.The cure rate was 86.44％.Conclusions The main pathogen of CAPD related peritonitis is Gram-positive bacteria.Traditional treatment of peritonitis with first generation combined third generation cephalosporins is not suitable for CAPD related peritonitis.The empiric initial treatment of peritonitis recommended the use of vancomycin combined Cefoperazone/sulbactam or amikacin.