革兰阴性菌与革兰阳性菌致腹膜透析相关性腹膜炎的临床特征-东南大学学报医学版

革兰阴性菌与革兰阳性菌致腹膜透析相关性腹膜炎的临床特征

单位：1. 南京医科大学鼓楼临床医学院肾内科, 江苏南京 210008;
2. 南京大学医学院附属鼓楼医院肾内科, 江苏南京 210008

分类号：R656.41;R459.5

出版年·卷·期（页码）：2015·34·第三期（411-414）

摘要：

目的:探讨革兰阴性菌(G^-菌)与革兰阳性菌(G⁺菌)所致腹膜透析相关性腹膜炎的临床特点,以期指导腹膜透析,为预防G^-菌腹膜炎的发生及诊疗提供参考.方法:对83例次腹膜透析相关性腹膜炎患者的临床资料进行分析,将G^-菌与G⁺菌感染腹膜炎患者的临床表现、实验室检查、治疗转归作比较.结果:83例次腹膜透析相关性腹膜炎中57例次为细菌性腹膜炎,其中G^-菌腹膜炎(G^-菌组)20例次(占35.1%),G⁺菌腹膜炎(G⁺菌组)37例次(占64.9%),G^-菌组治愈率低(65% vs 89%,P <0.05).两组间血清钾、C反应蛋白、透析龄、透析液有核细胞数及血中性粒细胞比例差异均有统计学意义(P <0.05),而年龄、性别、糖尿病比例、血白蛋白、血尿素氮及血钠、氯、磷、钙差异均无统计学意义(P >0.05).G^-菌组主要致病菌为大肠埃希菌(8例,40%)、肺炎克雷伯菌(4例,20%),阴沟肠杆菌(3例,15%),弗劳地柠檬酸杆菌(3例,15%),对亚胺培南和丁胺卡那的耐药率分别为0和5%;G⁺菌以表皮葡萄球菌、金黄色葡萄球菌及溶血葡萄球菌为主,对万古霉素的耐药率为0.结论:G^-菌所致腹膜透析相关性腹膜炎较G⁺菌炎症反应重,治愈率低,丁胺卡那可作为初始治疗方案的首选用药.

Objective: To compare the clinical characteristics of gram-negative peritonitis with gram-positive peritonitis in order to guide the peritoneal dialysis, prevent gram-negative peritonitis, and to provide evidence for clinical diagnosis and treatment. Methods: The data of eighty-three episodes of peritoneal dialysis peritonitis were retrospectively analyzed. The clinical symptoms, laboratory tests and treatment effect of gram-negative peritonitis were compared with those of gram-positive peritonitis. Results: There were 57 episodes of peritoneal dialysis related peritonitis caused by bacteria during the observation time among the 83 peritonitis, Among them,20(35.1%) episodes were gram-negative cases, 37(64.9%) were gram-positive peritonitis. The cure rate of gram-negative peritonitis was lower than gram-positive peritonitis (65% vs 89%, P <0.05). Serum potassium, C-reactive protein, peritoneal dialysis time and white blood cells in dialysis effluent, polymorphonuclear cells in blood were significantly different between the two groups (P <0.05). There was no difference in age, sex, proportion of diabetes, albumin, blood urea nitrogen and serum natrium, chlorine, phosphorus, calcium between the two groups. The pathogenic bacterium of gram-negative peritonitis were 8 Escherichia coli(40%), 4 Klebsiella pneumoniae(20%), 3 Enterobacter cloacae(15%),and 3 Citrobacter freudii(15%). The drug resistance rate of gram-negative bacteria to imipenem and amikacin was 0 and 5%. Common pathogenic bacterium of gram-positive peritonitis were Staphylococcus epidermidis, Staphylococcus aureus and Staphylococcus haemolyticus, None of them was resistant to Vancomycin. Conclusion: The inflammation of gram-negative peritonitis is more severe than gram-positive peritonitis, The cure rate is low. Amikacin can be an effcective medicine on initial treatment of gram-negative peritonitis.

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