CAJ | 학술논문

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.
목적 조사지속성비와상복막투석(CAPD)상관성복막염적병원균분포급내약성특점,이기지도림상합리사용항균약물.방법 회고성분석2009년1월1일지2013년6월30일재소주대학부속제이의원신내과복막투석중심접수CAPD,차병발복막투석상관성복막염환자236례차복막투출액배양결과,통계병원균적분포정황급기대상견항균약물적내약성.결과 236례차CAPD상관성복막염환자중복막투출액배양양성185례차,양성솔78.39％.공분리출병원균193주,기중혁란양성(G+)균138주(71.50％),혁란음성(G-)균44주(22.80％),진균11주(5.70％);혼합감염8례,2충치병균균위G+균5례,G+균여G-균혼합감염3례.G+균대만고매소、체고랍저、리내서알내약솔위0;G균대정알잡나매소、아알배남、미락배남、두포고동/서파탄내약솔위0.분리적세균대림상상견항균약물정현다중내약.236례차환자중공유9례사망,기중진균감염3례,G-감염3례,G+균감염2례,배양음성1례,병사솔3.81％.13례수발관개혈액투석치료,기중진균감염6례,총발관솔5.51％;10례방기치료,치유솔86.44％.결론 CAPD상관성복막염치병균이G+균위주,전통일대두포연합삼대두포류항균약이불괄합CAPD상관성복막염적치료,추천만고매소연합두포고동/서파탄혹정알잡나매소작위복막염적경험성치료약물.
Objective 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.