本文選題：腹膜透析相關(guān)腹膜炎 + 臨床特征��； 參考：《中南大學(xué)學(xué)報(醫(yī)學(xué)版)》2016年12期

【摘要】：目的:探討某三甲醫(yī)院持續(xù)性非臥床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)相關(guān)性腹膜炎臨床特點、致病菌分布及耐藥性情況,為臨床防治CAPD相關(guān)性腹膜炎總結(jié)經(jīng)驗。方法:回顧性調(diào)查該院2013年1月至2016年6月42個月中,104人126例次CAPD相關(guān)性腹膜炎患者的臨床特點、致病菌分布、耐藥性等情況。結(jié)果:在126例次CAPD相關(guān)性腹膜炎中,患者出現(xiàn)腹痛104例次(82.54%),發(fā)熱56例次(44.44%),腹瀉49例次(38.89%),嘔吐31例次(23.60%)。126例次CAPD相關(guān)性腹膜炎中,發(fā)生一次腹膜炎的88人次,多次和反復(fù)發(fā)作的腹膜炎16人38例次,其中復(fù)發(fā)性腹膜炎2例,腹膜炎重現(xiàn)2例,導(dǎo)管相關(guān)性腹膜炎3例。在103例送檢的腹水標(biāo)本中,培養(yǎng)陽性64例次,陽性率達(dá)62.14%。共分離出致病菌70株,其中革蘭陽性細(xì)菌42株,革蘭陰性細(xì)菌21株,真菌7株。主要的革蘭陽性菌包括表皮葡萄球菌、糞腸球菌、溶血葡萄球菌;主要的革蘭陰性菌包括大腸埃希菌、肺炎克雷伯菌、銅綠假單胞菌;真菌以白假絲酵母菌為主。革蘭陽性菌對慶大霉素、左氧氟沙星、莫西沙星、萬古霉素、利奈唑胺的耐藥率分別為20.00%,36.11%,5.00%,0%,0%;革蘭陰性菌對頭孢哌酮/舒巴坦、慶大霉素、頭孢唑啉、頭孢他啶的耐藥率分別為6.25%,10.53%,64.29%,15.38%,對亞胺培南、阿米卡星、哌拉西林/他唑巴坦的耐藥率均為0%。結(jié)論:革蘭陽性菌是CAPD相關(guān)性腹膜炎的主要致病菌,臨床不僅應(yīng)盡早開始經(jīng)驗性治療,而且要考慮如何通過改善培養(yǎng)方法以提高陽性檢出率;可以根據(jù)藥敏結(jié)果調(diào)整用藥,以促進(jìn)患者CAPD相關(guān)性腹膜炎的治愈和腹膜功能的恢復(fù)。
[Abstract]:Objective: to investigate the clinical characteristics, distribution of pathogenic bacteria and drug resistance of continuous ambulatory peritoneal peritonitis in continuous ambulatory peritoneal dialysis (ambulatory peritoneal dialysissis) in a third class hospital, and to summarize the experience in the prevention and treatment of CAPD associated peritonitis.Methods: the clinical characteristics, distribution of pathogenic bacteria and drug resistance of 126 patients with CAPD associated peritonitis from January 2013 to June 2016 were investigated retrospectively.Results: of the 126 cases of CAPD associated peritonitis, 104 cases had abdominal pain (82.54), 56 cases had fever (44.44g), 49 cases had diarrhea (38.89%), 31 cases had vomiting and 23.600.126 cases had CAPD associated peritonitis, 88 cases had one peritonitis.There were 16 cases of multiple and recurrent peritonitis in 38 cases, including 2 cases of recurrent peritonitis, 2 cases of peritonitis recurrence and 3 cases of ductal peritonitis.Among 103 ascites samples, 64 cases were positive in culture, the positive rate was 62.14%.A total of 70 strains of pathogenic bacteria were isolated, including 42 Gram-positive bacteria, 21 Gram-negative bacteria and 7 fungi.The main gram-positive bacteria include Staphylococcus epidermidis, Enterococcus faecalis, Staphylococcus haemolyticus; the main gram-negative bacteria include Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and the main fungi are Candida albicans.The resistance rates of gram-positive bacteria to gentamicin, levofloxacin, moxifloxacin, vancomycin, and linazolamide were 20.00 and 36.110.The Gram-negative bacteria were resistant to cefoperazone / sulbactam, gentamycin, cefazolin, and cefazolin, respectively.The drug resistance rates of ceftazidime were 6.25 and 64.293.The drug resistance rates to imipenem, amikacin, piperacillin / tazobactam were 0.Conclusion: Gram-positive bacteria are the main pathogenic bacteria of CAPD associated peritonitis. Clinical experience therapy should be started as soon as possible, and how to improve the culture method should be considered to increase the positive rate, the drug can be adjusted according to the results of drug sensitivity.To promote the CAPD-associated peritonitis and the recovery of peritoneal function.
【作者單位】： 敦煌市醫(yī)院感染控制科;中南大學(xué)湘雅醫(yī)院感染控制中心;中南大學(xué)湘雅醫(yī)院腎內(nèi)科;
【基金】：湖南省自然科學(xué)基金(13JJ6013) 中南大學(xué)校級大數(shù)據(jù)基金(2014-33);中南大學(xué)湘雅醫(yī)院院內(nèi)臨床基金(2014-11)~~
【分類號】：R459.5

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