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目的探讨腹膜透析相关性腹膜炎的临床特点,提高患者的临床疗效,从而降低相关性腹膜炎的发生率。方法随机选取医院2009年8月-2013年2月收治的腹膜透析相关性腹膜炎93例患者,对其进行细菌培养,观察多重感染性腹膜炎的例数,采用法国生物梅里埃公司AKB法进行病原菌鉴定及对抗菌药物敏感试验,分析患者的转归,采用SPSS 13.0软件进行数据统计。结果在93例感染患者中发生多重感染性腹膜炎共24例,占25.8%,其中有2例为两种真菌感染、5例为真菌与革兰阳性菌混合感染、2例为真菌与革兰阴性菌混合感染、4例为两种革兰阳性菌感染、3例为单纯两种革兰阴性菌感染、6例为革兰阳性菌与革兰阴性菌混合感染;对革兰阳性菌最敏感的为万古霉素,敏感率达100.0%,其次是利福平和加替沙星,均为94.0%;对革兰阴性菌最敏感的为美罗培南,敏感率为100.0%,常规用药如庆大霉素和头孢他啶的敏感性较低,分别为64.0%和55.0%,抗菌药物对真菌的敏感率均较好;24例多重感染性腹膜炎患者中17例继续进行腹膜透析,占70.8%,5例退出腹膜透析并改为血液透析治疗,占20.8%,2例死亡,病死率8.4%;在其余69例单一性腹膜炎感染患者中,57例继续进行腹膜透析,占82.6%,10例退出腹膜透析改为血液透析继续治疗,占14.5%;2例死亡,病死率2.9%。结论研究腹膜透析相关性多重感染性腹膜炎的临床特点,包括主要致病菌及其对抗菌药物的敏感性、发病患者的转归,可以有效预防腹膜透析相关性多重感染性腹膜炎的发生,且为临床用药提供理论依据。
Objective To investigate the clinical characteristics of peritoneal dialysis-related peritonitis and improve the clinical efficacy of patients, thus reducing the incidence of related peritonitis. Methods Ninety-three patients with peritoneal dialysis-related peritonitis admitted from August 2009 to February 2013 in our hospital were enrolled in this study. Bacteria were cultured and the number of patients with multiple infectious peritonitis was observed. The pathogen was identified by the AMB method And antimicrobial susceptibility testing, analysis of patient outcomes, using SPSS 13.0 software for data statistics. Results A total of 24 multiple infections peritonitis occurred in 93 infected patients, accounting for 25.8%. Two of them were two kinds of fungal infections, five were mixed fungi and Gram-positive bacteria, two were fungi and gram-negative Infections occurred in 4 cases of Gram-positive bacteria, 3 cases of simple Gram-negative bacteria infection, 6 cases of Gram-positive bacteria mixed with Gram-negative bacteria, and the most sensitive to Gram-positive bacteria For vancomycin, the sensitivity rate was 100.0%, followed by rifampicin and gatifloxacin, both 94.0%; the most sensitive to gram-negative bacteria is meropenem, the sensitivity was 100.0%, conventional drugs such as j The sensitivity of ceftazidime to ceftazidime was low, which was 64.0% and 55.0%, respectively. The antibacterials were sensitive to fungi. Peritoneal dialysis was continued in 17 of 24 patients with multiple infectious peritonitis, accounting for 70.8% Peritoneal dialysis and replaced by hemodialysis treatment, accounting for 20.8%, 2 deaths, the case fatality rate of 8.4%; in the remaining 69 patients with unicellular peritonitis infection, 57 patients continued peritoneal dialysis, accounting for 82.6%, 10 patients exited peritoneal dialysis Continue treatment for hemodialysis, accounting for 14.5%; 2 deaths, the mortality rate of 2.9%. Conclusions The study of peritoneal dialysis-related multiple infections peritonitis clinical features, including the main pathogens and their sensitivity to antimicrobial agents, the outcome of patients, can effectively prevent peritoneal dialysis-related multiple infections peritonitis, and is Clinical medication provides a theoretical basis.