单中心腹膜透析相关性腹膜炎患者的致病菌群分布特点及药敏分析

Distribution Characteristics of Pathogens and Antibiotic Sensitivity Analysis in Patients with Peritoneal Dialysis-Associated Peritonitis: A Single-Center Study

摘要: 目的：通过回顾性分析渝西地区腹膜透析相关性腹膜炎(PDAP)的病例资料、一般实验室指标、腹透液培养结果及其药敏分析，为渝西地区PDAP患者制定治疗方案提供理论依据。方法：通过回顾性筛选2016年5月至2024年12月重庆医科大学附属永川医院维持性腹膜透析因PDAP住院的患者，收集患者的腹膜透析液病原学检测结果，分析致病菌群分布特点及药敏分析。结果：共收集腹膜透析液培养结果共211例，其中腹膜透析液培养阳性结果共149例(阳性率70.62%)。腹膜透析液培养阳性结果中，G+菌共88例(59.06%)，G+菌中以葡萄球菌为主，共41例。G−菌共54例(36.24%)，以大肠埃希菌为主，共13例(8.72%)。真菌6例(4.03%)，其中近平滑假丝酵母2例(1.34%)。分枝杆菌1例(0.6%)。G+菌中，葡萄球菌对利奈唑胺、万古霉素普遍敏感；肠球菌、链球菌对利奈唑胺普遍敏感；大多数葡萄球菌对利福平敏感(97.22%)。G−菌中，肠杆菌科对亚胺培南敏感(96.43%)。结论：本中心腹膜透析患者发生腹膜透析相关性腹膜炎致病菌主要为G+菌，其对青霉素及大环内酯类抗生素耐药率较高，对喹诺酮类、碳青霉烯类、万古霉素等药物敏感性较高。G−菌中，肠杆菌科对亚胺培南敏感，对喹诺酮类抗生素耐药性较高。

Abstract: Objective: To provide a theoretical basis for developing treatment protocols for peritoneal dialysis-associated peritonitis (PDAP) patients in western Chongqing through retrospective analysis of case records, general laboratory indicators, dialysate culture results, and antimicrobial susceptibility testing. Methods: Patients hospitalized for PDAP during maintenance peritoneal dialysis at The Affiliated Yongchuan Hospital of Chongqing Medical University from May 2016 to December 2024 were retrospectively screened. Peritoneal dialysate culture results were collected to analyze pathogen distribution characteristics and antimicrobial susceptibility testing. Results: A total of 211 PDL culture results were collected, with 149 positive cultures (70.62% positivity rate). Among positive cultures: Gram-positive bacteria (G+): 88 cases (59.06%), predominantly Staphylococcus (41 cases). G-negative bacteria were identified in 54 cases (36.24%), predominantly Escherichia coli (13 cases, 8.72%). Fungi were detected in 6 cases (4.03%), including 2 cases of Candida parapsilosis (1.34%). Mycobacteria were identified in 1 case (0.6%). Among G+ bacteria, Staphylococcus species exhibited widespread susceptibility to linezolid and vancomycin; Enterococcus and Streptococcus species showed widespread susceptibility to linezolid; most Staphylococcus species were susceptible to rifampin (97.22%). Among Gram-negative bacteria, Enterobacteriaceae exhibited sensitivity to imipenem (96.43%). Conclusion: Pathogens causing PDAP in peritoneal dialysis patients at our center were predominantly Gram-positive bacteria. These exhibited high resistance rates to penicillin and macrolide antibiotics, while maintaining high sensitivity to quinolones, carbapenems, and vancomycin. Among Gram-negative bacteria, Enterobacteriaceae exhibited sensitivity to imipenem but showed high resistance to fluoroquinolones.