关键词: 腹膜透析, 腹膜炎, 抗菌谱, 耐药性

Abstract: Objective  To analyze the etiology, pathogen distribution and drug resistance of peritoneal dialysisassociated peritonitis (PDAP) in a single peritoneal dialysis center, and to provide reference for PDAP prevention and control.Methods  The general data,  bacterial culture,  drug resistance analysis,  curative effects and prognosis of 94 PDAP patients/times were retrospectively analyzed. Results  Among 94 PDAP patients,  The most common cause of infection was operational contamination (53.19%)  which centered on grampositive bacterial infection,  followed by intestinal infection（27.66%）  which centered on gramnegative bacterial infection. Totally 65 cases of dialysate pathogen culture in 94 patients were positive,  with a positive rate of  69.15%. A total of 67  bacterial strains were separated from 65 cases of dialysate pathogen culture,  including 45 grampositive strains (67.16%)  with Staphylococcus epidermidis as the most common, 20 gramnegative strains (29.85%) with Escherichia coli as most common,  and 2 fungi(2.99%). Grampositive bacteria was highly resistant to penicillin (91.11%), erythromycin (91.11%) and oxacillin (88.89%),  while it  had no resistance to both linezolid and vancomycin.  Gramnegative bacteria was not resistant to imipenem and meropenem,  and its resistance to Ceftazidime (10.00%) and cefepime (5.00%) was relatively low. In addition,  none of the fungi showed resistance to fluconazole,  amphotericin B,  5fluorouracil and itraconazole. Totally 51 cases(78.46%）  of the 65 cases were cured after the treatment,  and 14 cases (21.54%)  withdrew from peritoneal dialysis  of the 14 cases above,  there was one death,  with a fatality rate of  1.54%, and 13 cases were converted to hemodialysis after catheter removal. There were no statistically significant differences in cure rate and withdrawal rate between patients with Grampositive bacterial infection and patients with Gramnegative bacterial infection (P>0.05).  The two cases with fungal infection were converted to hemodialysis after catheter removal. Conclusion  It is necessary to strengthen the health education for patients with PDAP of the peritoneal dialysis center,  and to improve the positive rate of dialysate culture.The main pathogenic bacteria of PDAP centers on grampositive bacteria. The combination of the first and the third generation of cephalosporins can still be used as an initial empirical drug for PDAP in the hospital.

Key words: peritoneal dialysis, peritonitis, antimicrobial spectrum, drug resistance