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目的分析腹膜透析相关性腹膜炎(peritoneal dialysis associated peritonitis,PDAP)病原菌分布及耐药性变化。方法回顾分析2014年1月—12月行持续非卧床腹膜透析并发生PDAP患者的临床资料,分析其发生PDAP的致病菌、耐药性、转归情况和可能诱因。结果共有64例患者发生了72例次PDAP,病原菌培养阳性36株(50.0%),其中革兰阳性(Gram-positive,G+)菌24株(66.7%),革兰阴性(Gram-negative,G–)菌7株(19.4%),真菌5株(13.9%)。G+菌对万古霉素、利奈唑胺、利福平的耐药率均为0%,对左氧氟沙星、庆大霉素、头孢唑林耐药率分别为14.3%、26.3%、50.0%。G–杆菌对丁胺卡那霉素和亚胺培南耐药率均为0%,对庆大霉素和头孢他啶均为28.6%,对左氧氟沙星、氨苄青霉素耐药率分别为42.9%、100.0%。结论 PDAP病原菌及耐药性已发生很大变化,应根据各中心病原菌及耐药性特点选用抗菌药物,同时需努力提高透出液培养阳性率及PDAP的治愈率。
Objective To analyze the distribution of pathogens and their drug resistance in peritoneal dialysis associated peritonitis (PDAP). Methods The clinical data of PDAP patients who underwent continuous ambulatory peritoneal dialysis from January 2014 to December 2014 were analyzed retrospectively. Pathogenic bacteria, drug resistance, outcome and possible causes of PDAP were analyzed. Results A total of 72 PDAPs were detected in 64 patients and 36 (50.0%) were positive for pathogen culture. Among them, 24 (66.7%) Gram-positive, Gram-negative -) 7 strains (19.4%), 5 fungi (13.9%). The resistance rate of G + to vancomycin, linezolid and rifampicin was 0%, and the rates of resistance to levofloxacin, gentamycin and cefazolin were 14.3%, 26.3% and 50.0% respectively. The resistance rates of G-bacilli to both amikacin and imipenem were 0%, 28.6% for gentamicin and ceftazidime respectively, and 42.9% and 100.0% for levofloxacin and ampicillin, respectively . Conclusion The pathogen and drug resistance of PDAP have undergone great changes. Antimicrobial agents should be selected according to the characteristics of pathogens and drug resistance in each center. At the same time, efforts should be made to improve the positive rate of PDCP and the cure rate of PDAP.