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| 腹膜透析相关性多重感染性腹膜炎的临床分析 |
| 薄其凤1,梅小斌1,2*,郭志勇1,2,李娟1,赖学莉1,张鹂1,汪海燕1,王铁云1,王明珠2 |
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(1. 第二军医大学长海医院肾内科,上海 200433
2. 浙江省海宁市人民医院肾内科,海宁 314400
*通信作者) |
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| 摘要: |
| 目的 探讨腹膜透析相关性多重感染性腹膜炎的临床分析多重感染性腹膜炎的致病菌、抗生素敏感性及转归,为防治多重感染性腹膜炎提供参考。方法 回顾性分析2008年1月至2010年9月间第二军医大学长海医院收治的81例腹膜透析相关性多重感染性腹膜炎的临床分析腹膜炎住院患者共151例次感染中多重感染性腹膜炎的致病菌、抗生素敏感性及转归。结果 151例次腹膜透析相关性腹膜炎培养阳性98例次,培养阳性率64.9%。多重感染性腹膜炎20例次,占腹膜透析相关性腹膜炎的13.2%, 其中单纯2种及以上G+菌感染3例次(15%)；单纯2种G-菌感染1例次(5%)；G+菌和G-菌混合感染6例次(30%)；细菌和真菌混合感染9例次(45%),G+菌和真菌混合感染6例次(30%)；单纯2种真菌感染1例次(5%)。多重感染性腹膜炎中G+菌抗生素敏感性为万古霉素100%、左氧氟沙星61%、头孢唑林52%；多重感染性腹膜炎中G-菌抗生素敏感性为美罗培南100%、头孢哌酮/舒巴坦100%、庆大霉素70%、头孢他啶 60%。多重感染性腹膜炎20例次,治愈的15例次继续腹膜透析(75%),4例拔除腹膜透析管改永久血液透析(20%),1例死亡(5%)。结论 本腹膜透析中心多重感染性腹膜炎主要由G+菌和G-菌混合感染、G+菌和真菌混合感染引起；多重感染性腹膜炎G+菌敏感抗生素为万古霉素,G-菌敏感抗生素为美罗培南、头孢哌酮/舒巴坦,可作为多重感染性腹膜炎经验用药参考。对于真菌性腹膜炎或难治性腹膜炎,需及时拔除腹膜透析管。 |
| 关键词: 腹膜透析 腹膜炎 多重感染 致病菌 |
| DOI：10.3724/SP.J.1008.2012.00646 |
| 投稿时间：2011-10-19修订日期：2012-03-29 |
| 基金项目: |
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| Clinical analysis of dialysis-associated polymicrobial peritonitis |
| BO Qi-feng1,MEI Xiao-bin1,2*,GUO Zhi-yong1,2,LI Juan1,LAI Xue-li1,ZHANG Li1,WANG Hai-yan1,WANG Tie-yun1,WANG Ming-zhu2 |
(1. Department of Nephropathy, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
2. Department of Nephropathy, People’s Hospital of Haining, Haining 314400, Zhejiang, China
*Corresponding author.) |
| Abstract: |
| Objective To investigate pathogens, antibiotics sensitivity and prognosis of dialysis-associated polymicrobial peritonitis, so as to provide evidence for prevention and treatment of polymicrobial peritonitis. Methods A total of 151 peritoneal peritonitis episodes in 81 patients, who received dialysis in our department between January 2008 and September 2010, were analyzed in the present study. The causative pathogens, antibiotics sensitivity and prognosis of polymicrobial peritonitis were retrospectively reviewed in these patients. Results Pathogenic culture of effluent peritoneal dialysate was positive in 98(64.9%) of the 151 peritoneal peritonitis episodes, and 20(13.2%) epidoses were polymicrobial peritonitis. The organisms isolated from the effluent peritoneal dialysate included mixed Gram-positive and Gram-negative organisms (30%), mixed Gram-positive and fungi (30%), mixed Gram-negative and fungi (15%), pure Gram-positive organisms (15%), pure Gram-negative organisms infection (5%), and pure fungi (5%). The sensitive rates of Gram-positive organisms in the polymicrobial peritonitis were 100% to vancomycin, 61% to cefazolin sodium, and 52% to levofloxacin; and those of Gram-negative organisms were 100% to meropenem, 100% to cefoperazone-sulbactam, 70% to gentamycin, and 60% to ceftazidime. Fifteen (75%) of the 20 polymicrobial peritonitis episodes were cured and continuously received peritoneal dialysis. One (5%) patient died and 4 (20%) were converted to permanent hemodialysis. ConclusionPolymicrobial peritonitis in our group has been mainly caused by mixed infection of Gram-positive and Gram-negative organisms, mixed infection of Gram-positive organisms and fungi. The Gram-positive organisms are sensitive to vancomycin, and Gram-negative organisms are sensitive to meropenem and cefoperazone-sulbactam. Earlier catheter removal is necessary for fungal peritonitis or refractory peritonitis. |
| Key words: dialysis peritonitis polymicrobial bacteria |
