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中华肾病研究电子杂志 ›› 2022, Vol. 11 ›› Issue (05) : 264 -269. doi: 10.3877/cma.j.issn.2095-3216.2022.05.004

论著

腹膜透析相关性腹膜炎细菌谱变迁及药敏分析
黎金秋1, 韦晓芳1, 王成玉1,()   
  1. 1. 530021 南宁,广西医科大学第一附属医院肾内科
  • 收稿日期:2022-06-14 出版日期:2022-10-28
  • 通信作者: 王成玉
  • 基金资助:
    广西自然科学基金项目(2018GXNSFAA050084)

Analysis of bacteria spectrum change and drug sensitivity for peritoneal dialysis-associated peritonitis

Jinqiu Li1, Xiaofang Wei1, Chengyu Wang1,()   

  1. 1. Department of Nephrology, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
  • Received:2022-06-14 Published:2022-10-28
  • Corresponding author: Chengyu Wang
引用本文:

黎金秋, 韦晓芳, 王成玉. 腹膜透析相关性腹膜炎细菌谱变迁及药敏分析[J/OL]. 中华肾病研究电子杂志, 2022, 11(05): 264-269.

Jinqiu Li, Xiaofang Wei, Chengyu Wang. Analysis of bacteria spectrum change and drug sensitivity for peritoneal dialysis-associated peritonitis[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2022, 11(05): 264-269.

目的

探讨腹膜透析相关性腹膜炎患者感染细菌谱变迁及耐药情况,以指导合理使用抗生素。

方法

收集2012至2021年十年间我院发生的342例次腹透相关性腹膜炎患者的基本资料,比较前、后五年感染细菌谱及耐药性变化,分析不同细菌类型临床特点。

结果

本研究中腹透液培养共有159例次阳性,其中革兰氏阳性(G+)菌的占比最高,但比例随时间逐渐下降,而革兰氏阴性(G)菌比例随时间逐渐上升,后五年较前五年高(P<0.05)。G菌中大肠埃希菌最为常见,后五年较前五年占比更高(P<0.05)。与G+菌组相比,G菌组患者的透析龄更长,住院费用更多,合并插管出口感染更多,因感染拔管比例更高。G菌组患者的血中性粒细胞百分比、C反应蛋白(CRP)水平、降钙素原(PCT)水平、腹透液的多形核细胞百分比也更高(P<0.05)。后五年细菌耐药率增多,大肠埃希菌对头孢类抗生素耐药率升高。

结论

G+菌仍是腹透相关性腹膜炎的主要致病菌,但在后五年占比较前五年下降,而G菌占比逐渐上升,其中大肠埃希菌最常见。细菌的耐药率后五年较前五年高。相比G+菌组,G菌组患者的炎症指标水平更高。

Objective

To explore the change of bacteria spectrum and drug resistance in patients with peritoneal dialysis-associated peritonitis (PDAP) in order to guide the rational use of antibiotics.

Methods

The basic data of 342 cases of PDAP from our hospital in the ten years from 2012 to 2021 were collected. The first and last five years were compared in the bacteria spectrum of infection and drug resistance change, and the clinical characteristics of different bacterial types were analyzed.

Results

In this study, 159 cases of peritoneal dialysate culture were positive, of which the proportion of Gram-positive (G+ ) bacteria was the highest and gradually decreased with time, while the proportion of Gram-negative (G-) bacteria gradually increased with time, and was higher in the last five years than in the first five years (P<0.05). Compared with G+ bacteria group, the G- bacteria group patients had longer dialysis age, higher hospitalization costs, more intubation-outlet infections, and higher rate of extubation due to infection. Compared with G+ bacteria group, the G- bacteria group patients also showed higher percentage of blood neutrophils, higher level of C-reactive protein (CRP), higher level of procalcitonin (PCT), and higher percentage of polymorphonuclear cells in the peritoneal dialysate (P<0.05). In the last five years, the rate of bacterial drug resistance increased, and the drug resistance rate of Escherichia coli to cephalosporins increased.

Conclusion

G+ bacteria were still the main pathogen of PDAP, but the proportion of G+ bacteria in the last five years was lower than in the first five years, while the proportion of G- bacteria gradually increased, among which Escherichia coli was the most common. The drug resistance rate of bacteria in the last five years was higher than that in the first five years. Compared with the G+ bacteria group, the G- bacteria group patients showed higher levels of inflammatory indicators.

表1 前五年和后五年培养阳性菌中各种病原菌构成占比情况[n(%)]
图1 2012至2021年各年份G+及G菌占培养阳性患者比例变化情况
表2 G+及G所致腹膜透析相关性腹膜炎患者基本资料比较
表3 前五年和后五年两个时间段革兰氏阳性菌所致腹膜透析相关性腹膜炎患者药敏情况
表4 前五年和后五年两个时间段革兰氏阴性菌所致腹膜透析相关性腹膜炎患者药敏情况
表5 前五年和后五年两个阶段大肠埃希菌药敏情况比较
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