林中军 苏勇 郑奕挺 刘绛 罗玲

【摘要】 目的：分析陽江地区腹膜透析相关性腹膜炎（PDAP）的病原菌及耐药性，为腹膜炎的预防和治疗提供依据。方法：选取2018年8月-2020年4月本院肾内科收治的201例腹膜透析患者。按照是否发生PDAP的情况分为腹膜炎组90例与非腹膜炎组111例。分析腹膜炎的病原菌及耐药性情况。结果：两组血红蛋白、血葡萄糖、血肌酐、血清钙、血清镁、血清铁比较，差异均无统计学意义（P>0.05）;腹膜炎组血清白蛋白水平、血清磷均低于非腹膜炎组，差异均有统计学意义（P<0.05）。腹膜炎组90例患者，透出液病原菌培养阳性90例，其中混合感染2例，共检出菌株94株，其中革兰阳性菌65株（69.15%），革兰阴性菌28株（29.79%），真菌1株（1.06%）。革兰阳性菌对青霉素G的耐药性最高，对替加环素、利奈唑胺、万古霉素、利福平的耐药率最低;革兰阴性菌对头孢唑林耐药性最高，对厄他培南、头孢哌酮舒巴坦、阿米卡星的耐药率最低。结论：本病的病原菌主要以革兰阳性菌为主，革兰阳性菌对青霉素G的耐药性高，对替加环素、利奈唑胺、万古霉素、利福平基本不耐药;革兰阴性菌感染的患者建议应用厄他培南、头孢哌酮舒巴坦、阿米卡星进行治疗。

【关键词】 腹膜透析 腹膜炎 病原菌 耐药性

[Abstract] Objective： To analyze the pathogens and drug resistance of peritoneal dialysis associated peritonitis （PDAP） in Yangjiang area， so as to provide basis for the prevention and treatment of peritonitis. Method： A total of 201 peritoneal dialysis patients admitted to the department of nephrology of our hospital from August 2018 to April 2020 were selected. The patients were divided into the peritonitis group （n=90） and the non-peritonitis group （n=111） according to the occurrence of PDAP. The pathogenic bacteria and drug resistance of peritonitis were analyzed. Result： There were no significant differences in hemoglobin， blood glucose， serum creatinine， serum calcium， serum magnesium and serum iron between two groups （P>0.05）. The levels of serum albumin and serum phosphorus in the peritonitis group were lower than those in the non-peritonitis group， with statistical significance （P<0.05）. Of 90 patients in the peritonitis group， 90 cases were positive for pathogenic bacteria culture in the efflux， including 2 cases of mixed infection. A total of 94 strains were detected， including 65 strains （69.15%） of Gram-positive bacteria， 28 strains （29.79%） of Gram-negative bacteria， and 1 strain （1.06%） of fungus. Gram-positive bacteria had the highest drug resistance to Penicillin G， and the lowest drug resistance rate to Ticacycline， Linezolid， Vancomycin and Rifampicin. Gram-negative bacteria had the highest resistance to Cefazolin， and the lowest resistance rate to Ertapenem， Cefoperazone and Sulbactam and Amikacin. Result： The pathogens of this disease are mainly Gram-positive bacteria， Gram-positive bacteria has high resistance to Penicillin G， and are basically resistant to Tigecycline， Linezolid， Vancomycin and Rifampicin. Patients with Gram-negative bacterial infection are recommended for treatment with Ertapenem， Cefoperazone and Sulbactam， and Amikacin.

[Key words] Peritoneal dialysis Peritonitis Pathogenic bacteria Drug resistance

First-authors address： Yangjiang Peoples Hospital， Yangjiang 529500， China

doi：10.3969/j.issn.1674-4985.2021.09.033

近年来，终末期肾脏疾病（end-stage renal disease， ESRD）的发病率逐年升高，已经成为临床肾内科最常见的疾病之一[1]，这一疾病不仅影响着人们的生活质量，甚至威胁人们的身体健康及生命安全[2-3]。针对ESRD这一临床疾病，人们主要是通过腹膜透析（peritoneal dialysis， PD）来维持生命[4-5]。PD治疗不需要场地、贵重的仪器和设备，可居家自行操作[6]，对患者的社会活动影响较小，有利于其自我价值的实现[7]，而且PD有操作简单方便、血流动力学稳定、对心血管系统影响较小等优点[8]，成为ESRD患者肾脏替代治疗的常用方式[9-10]。腹膜透析相关性腹膜炎（peritoneal dialysis associated peritonitis， PDAP）是PD最为常见的并发症[11-13]，如若治疗不及时，引起腹膜粘连、硬化、通透性降低[14-15]，导致患者最终退出PD，是影响患者PD失败和死亡的最主要原因[16]。本文主要研究引起PDAP的病原菌及分析其耐药性，为临床合理化治疗提供借鉴和指导，现报道如下。

1 资料与方法

1.1 一般资料 选取2018年8月-2020年4月本院肾内科收治的201例PD患者。纳入……