国际移植与血液净化杂志
國際移植與血液淨化雜誌
국제이식여혈액정화잡지
INTERNATIONAL JOURNAL OF TRANSPLANTATION AND HEMOPURIFICATION
2015年
4期
5-8
,共4页
腹膜透析%腹膜透析腹膜炎%细菌谱%耐药性
腹膜透析%腹膜透析腹膜炎%細菌譜%耐藥性
복막투석%복막투석복막염%세균보%내약성
Peritoneal dialysis%Peritoneal dialysis related peritonitis%Bacteria spectrum%Drug resistance
目的 探讨腹膜透析相关性腹膜炎的病原学分析.方法 回顾性分析南京医科大学附属江宁医院肾内科腹膜透析中心2008年1月1日至2015年5月20日期间收治的维持性腹膜透析患者中发生腹透相关性腹膜炎的患者共136例次,培养出致病菌96例,阳性率为70.59％;其中有2例患者为混合感染,培养出2种致病菌.致病菌中革兰氏阳性菌78株,占81.25％;革兰氏阴性菌15株,占15.63％;真菌3株,占3.13％.结果 最常见的病原菌为表皮葡萄球菌(27/78)、头状葡萄球菌(15/78);革兰氏阳性菌耐药率最低的为万古霉素、利奈唑胺,其耐药率均为0;革兰氏阴性菌对美罗培南、亚胺培南、阿米卡星、奈替米星、头孢哌酮舒巴坦耐药率最低,耐药率均为0;3例为真菌感染(3/96).治愈率为91.91％.根据年份分组,多重耐药率呈逐年升高趋势.引起腹膜炎的最主要的原因为换液操作不规范以及肠道感染.结论 多重耐药率逐年升高;革兰氏阳性菌仍是腹透相关性腹膜炎的主要致病菌;腹膜炎的治疗应根据细菌培养、药敏结果选择敏感有效的抗生素,腹膜炎经验治疗可选第一代头孢菌素(或万古霉素)加第三代头孢菌素(或氨基糖甙类药物).真菌性腹膜炎治疗效果较差,应尽早拔管.
目的 探討腹膜透析相關性腹膜炎的病原學分析.方法 迴顧性分析南京醫科大學附屬江寧醫院腎內科腹膜透析中心2008年1月1日至2015年5月20日期間收治的維持性腹膜透析患者中髮生腹透相關性腹膜炎的患者共136例次,培養齣緻病菌96例,暘性率為70.59％;其中有2例患者為混閤感染,培養齣2種緻病菌.緻病菌中革蘭氏暘性菌78株,佔81.25％;革蘭氏陰性菌15株,佔15.63％;真菌3株,佔3.13％.結果 最常見的病原菌為錶皮葡萄毬菌(27/78)、頭狀葡萄毬菌(15/78);革蘭氏暘性菌耐藥率最低的為萬古黴素、利奈唑胺,其耐藥率均為0;革蘭氏陰性菌對美囉培南、亞胺培南、阿米卡星、奈替米星、頭孢哌酮舒巴坦耐藥率最低,耐藥率均為0;3例為真菌感染(3/96).治愈率為91.91％.根據年份分組,多重耐藥率呈逐年升高趨勢.引起腹膜炎的最主要的原因為換液操作不規範以及腸道感染.結論 多重耐藥率逐年升高;革蘭氏暘性菌仍是腹透相關性腹膜炎的主要緻病菌;腹膜炎的治療應根據細菌培養、藥敏結果選擇敏感有效的抗生素,腹膜炎經驗治療可選第一代頭孢菌素(或萬古黴素)加第三代頭孢菌素(或氨基糖甙類藥物).真菌性腹膜炎治療效果較差,應儘早拔管.
목적 탐토복막투석상관성복막염적병원학분석.방법 회고성분석남경의과대학부속강저의원신내과복막투석중심2008년1월1일지2015년5월20일기간수치적유지성복막투석환자중발생복투상관성복막염적환자공136례차,배양출치병균96례,양성솔위70.59％;기중유2례환자위혼합감염,배양출2충치병균.치병균중혁란씨양성균78주,점81.25％;혁란씨음성균15주,점15.63％;진균3주,점3.13％.결과 최상견적병원균위표피포도구균(27/78)、두상포도구균(15/78);혁란씨양성균내약솔최저적위만고매소、리내서알,기내약솔균위0;혁란씨음성균대미라배남、아알배남、아미잡성、내체미성、두포고동서파탄내약솔최저,내약솔균위0;3례위진균감염(3/96).치유솔위91.91％.근거년빈분조,다중내약솔정축년승고추세.인기복막염적최주요적원인위환액조작불규범이급장도감염.결론 다중내약솔축년승고;혁란씨양성균잉시복투상관성복막염적주요치병균;복막염적치료응근거세균배양、약민결과선택민감유효적항생소,복막염경험치료가선제일대두포균소(혹만고매소)가제삼대두포균소(혹안기당대류약물).진균성복막염치료효과교차,응진조발관.
Objective To investigate the etiological analysis of peritoneal dialysis related peritonitis.Methods To review 96 cases of drug-resistant bacteria,the positive rate was 70.59％,analysis of a total of 136 undergoing peritoneal dialysis patients during January 1,2008 to May 20,2015 in peritoneal dialysis center of Jiangning Hospital Affiliated to Nanjing Medical University.Two cases of them were mixed infection,cultivated 2 pathogenic bacteria.The gram positive bacteria were 78,accounting for 81.25％.The gram negative bacteria were 15,accounting for 15.63％;3 cases were fungus,accounted for 3.13％.Results The most common pathogens were coagulase negative staphylococci and Staphylococcus a ureus.The lowest resistant rate of gram positive bacteria were vancomycin,linezolid.The lowest resistant rate of gram negative bacteria were meropenem,imipenem,Amikacin,netilmicin,Cefperazone-Sulbactam.3 cases were fungal infection.The cure rate of all the patients was 91.91％.According to the year group,multiple resistant rate rise year by year (P ＜ 0.05).The main cause of peritonitis were non-standard operation of changing fluid and intestinal infection.Conclusion Multiple resistant rate increased year by year.Pathogenic gram positive bacteria remains the main bacteria of peritoneal dialysis related peritonitis.The treatment of peritonitis should be based on bacterial culture and drug sensitivity,then choose sensitive antibiotics.The experience treatment of peritonitis could choose first-generation cephalosporins or vancomycin and third-generation cephalosporins or amino-glycoside.The treatment of fungal peritonitis is poor,should be early extubation.
