中国感染与化疗杂志
中國感染與化療雜誌
중국감염여화료잡지
CHINESE JOURNAL OF INFECTION AND CHEMOTHERAPY
2015年
3期
236-243
,共8页
赵珉%戴宏%沈继录%张伯科%吴永贵%卢文%徐星铭
趙珉%戴宏%瀋繼錄%張伯科%吳永貴%盧文%徐星銘
조민%대굉%침계록%장백과%오영귀%로문%서성명
腹膜透析%腹膜炎%细菌%耐药性
腹膜透析%腹膜炎%細菌%耐藥性
복막투석%복막염%세균%내약성
peritoneal dialysis%peritonitis%pathogen%drug resistance
目的:探讨腹膜透析相关性腹膜炎的病原菌及其耐药性,为临床治疗腹膜透析相关性腹膜炎提供参考。方法回顾性分析2011年1月1日—2013年12月31日发生的213例次腹膜透析相关性腹膜炎的病原菌及其耐药性。结果腹膜透析液病原菌培养阳性132例次,阴性81例次,培养阳性率62.0%。共培养得细菌140株,其中革兰阳性球菌84株(60.0%),革兰阴性杆菌37株(26.4%),真菌10株(7.1%),革兰阳性杆菌9株(6.4%)。革兰阳性菌中最常见为凝固酶阴性葡萄球菌(44株),革兰阴性菌最常见的为大肠埃希菌(15株)。葡萄球菌属中检出甲氧西林耐药凝固酶阴性葡萄球菌(MRCNS)19株,检出率43.2%,甲氧西林耐药金黄色葡萄球菌(M RS A )1株,检出率14.3%,大肠埃希菌和克雷伯菌属中检出产超广谱β内酰胺酶菌8株,检出率44.4%。革兰阳性球菌对万古霉素、利奈唑胺、替加环素均敏感,对头孢唑林的耐药率最高,达90.0%,其次为氨苄西林(76.7%),苯唑西林(71.2%),青霉素(69.7%),对氯霉素、莫西沙星、利福平等的耐药率低,分别为6.3%、8.5%和9.8%。其中,凝固酶阴性葡萄球菌对万古霉素、利奈唑胺、替加环素、奎奴普丁‐达福普汀、达托霉素均敏感,对头孢唑林和氨苄西林均耐药,对青霉素、苯唑西林耐药率分别为91.9%、82.5%,对利福平耐药率仅7.5%。革兰阴性杆菌对美罗培南、厄他培南、头孢哌酮‐舒巴坦、替加环素耐药率均为0,对氨苄西林和哌拉西林的耐药率高,分别达80.6%、65.5%。其中,大肠埃希菌对美罗培南、厄他培南、哌拉西林‐他唑巴坦均敏感,对氨苄西林(81.3%)和哌拉西林(71.4%)耐药率高。结论革兰阳性菌中的葡萄球菌和革兰阴性菌中的大肠埃希菌仍是腹膜透析相关性腹膜炎的主要病原菌;提高腹透液培养阳性率,针对病原菌合理选择抗菌药物是治愈腹膜透析相关性腹膜炎的关键。
目的:探討腹膜透析相關性腹膜炎的病原菌及其耐藥性,為臨床治療腹膜透析相關性腹膜炎提供參攷。方法迴顧性分析2011年1月1日—2013年12月31日髮生的213例次腹膜透析相關性腹膜炎的病原菌及其耐藥性。結果腹膜透析液病原菌培養暘性132例次,陰性81例次,培養暘性率62.0%。共培養得細菌140株,其中革蘭暘性毬菌84株(60.0%),革蘭陰性桿菌37株(26.4%),真菌10株(7.1%),革蘭暘性桿菌9株(6.4%)。革蘭暘性菌中最常見為凝固酶陰性葡萄毬菌(44株),革蘭陰性菌最常見的為大腸埃希菌(15株)。葡萄毬菌屬中檢齣甲氧西林耐藥凝固酶陰性葡萄毬菌(MRCNS)19株,檢齣率43.2%,甲氧西林耐藥金黃色葡萄毬菌(M RS A )1株,檢齣率14.3%,大腸埃希菌和剋雷伯菌屬中檢齣產超廣譜β內酰胺酶菌8株,檢齣率44.4%。革蘭暘性毬菌對萬古黴素、利奈唑胺、替加環素均敏感,對頭孢唑林的耐藥率最高,達90.0%,其次為氨芐西林(76.7%),苯唑西林(71.2%),青黴素(69.7%),對氯黴素、莫西沙星、利福平等的耐藥率低,分彆為6.3%、8.5%和9.8%。其中,凝固酶陰性葡萄毬菌對萬古黴素、利奈唑胺、替加環素、奎奴普丁‐達福普汀、達託黴素均敏感,對頭孢唑林和氨芐西林均耐藥,對青黴素、苯唑西林耐藥率分彆為91.9%、82.5%,對利福平耐藥率僅7.5%。革蘭陰性桿菌對美囉培南、阨他培南、頭孢哌酮‐舒巴坦、替加環素耐藥率均為0,對氨芐西林和哌拉西林的耐藥率高,分彆達80.6%、65.5%。其中,大腸埃希菌對美囉培南、阨他培南、哌拉西林‐他唑巴坦均敏感,對氨芐西林(81.3%)和哌拉西林(71.4%)耐藥率高。結論革蘭暘性菌中的葡萄毬菌和革蘭陰性菌中的大腸埃希菌仍是腹膜透析相關性腹膜炎的主要病原菌;提高腹透液培養暘性率,針對病原菌閤理選擇抗菌藥物是治愈腹膜透析相關性腹膜炎的關鍵。
목적:탐토복막투석상관성복막염적병원균급기내약성,위림상치료복막투석상관성복막염제공삼고。방법회고성분석2011년1월1일—2013년12월31일발생적213례차복막투석상관성복막염적병원균급기내약성。결과복막투석액병원균배양양성132례차,음성81례차,배양양성솔62.0%。공배양득세균140주,기중혁란양성구균84주(60.0%),혁란음성간균37주(26.4%),진균10주(7.1%),혁란양성간균9주(6.4%)。혁란양성균중최상견위응고매음성포도구균(44주),혁란음성균최상견적위대장애희균(15주)。포도구균속중검출갑양서림내약응고매음성포도구균(MRCNS)19주,검출솔43.2%,갑양서림내약금황색포도구균(M RS A )1주,검출솔14.3%,대장애희균화극뢰백균속중검출산초엄보β내선알매균8주,검출솔44.4%。혁란양성구균대만고매소、리내서알、체가배소균민감,대두포서림적내약솔최고,체90.0%,기차위안변서림(76.7%),분서서림(71.2%),청매소(69.7%),대록매소、막서사성、리복평등적내약솔저,분별위6.3%、8.5%화9.8%。기중,응고매음성포도구균대만고매소、리내서알、체가배소、규노보정‐체복보정、체탁매소균민감,대두포서림화안변서림균내약,대청매소、분서서림내약솔분별위91.9%、82.5%,대리복평내약솔부7.5%。혁란음성간균대미라배남、액타배남、두포고동‐서파탄、체가배소내약솔균위0,대안변서림화고랍서림적내약솔고,분별체80.6%、65.5%。기중,대장애희균대미라배남、액타배남、고랍서림‐타서파탄균민감,대안변서림(81.3%)화고랍서림(71.4%)내약솔고。결론혁란양성균중적포도구균화혁란음성균중적대장애희균잉시복막투석상관성복막염적주요병원균;제고복투액배양양성솔,침대병원균합리선택항균약물시치유복막투석상관성복막염적관건。
Objective To investigate the pathogens and their antibiotic resistance in patients with peritoneal dialysis‐related peritonitis .Methods The clinical data including pathogens ,antibiotic resistance profile of 213 patients with peritoneal dialysis‐related peritonitis who were treated in our peritoneal dialysis center from January 2011 to December 2013 were analyzed retrospectively .Results Dialysate culture was positive for 132 (62 .0% ) of the 213 cases ,resulting in a total of 140 strains of microorganisms ,including 84 strains of gram positive cocci ,37 strains of gram‐negative bacilli ,10 strains of fungus and 9 strains of gram positive bacilli . Coagulase‐negative Staphylococcus was the most common gram positive bacteria while Escherichia coli was the most common gram negative bacteria isolated from the effluent .The prevalence of methicillin‐resistant S .aureus and methicillin‐resistant coagulase negative Staphylococcus was 14 .3% (1/7) and 43 .2% (19/44) ,respectively . About 44 .4% (8/18) of the E .coli and K . pneumoniae isolates produced extended spectrum beta‐lactamases .All the gram‐positive cocci were sensitive to vancomycin and linezolid and slightly resistant to chloramphenicol (6 .3% ) , moxifloxacin (8 .5% ) , and rifampicin (9 .5% ) , but highly resistant to cefazolin (90 .0% ) ,followed by ampicillin (76 .7% ) ,oxacillin (71 .2% ) and penicillin (69 .7% ) . Coagulase negative Staphylococcus isolates were sensitive to vancomycin , linezolid , tigecycline , quinupristin‐dalfopristin and daptomycin ,but all resistant to cefazolin and ampicillin ,and highly resistant to penicillin (91 .9% ) and oxacillin (82 .5% ) .All the gram‐negative bacilli were sensitive to meropenem ,ertapenem ,cefoperazone‐sulbactam and tigecycline .About 80 .6% and 65 .5% of the gram‐negative bacilli were resistant to ampicillin and peperacillin ,respectively .E .coli isolates were sensitive to meropenem ,ertapenem and piperacillin‐tazobactam but highly resistant to ampicillin (81 .3% ) and piperacillin (71 .4% ) . Conclusions Gram‐positive cocci especially Staphylococcus and gram negative bacteria E .coli are major pathogens in peritoneal dialysis‐related peritonitis .Adequate microbiological culture and suitable antimicrobial therapy are key to successful treatment of the peritonitis associated with peritoneal dialysis .