印度北部腹膜炎的微生物学及预后情况
Microbiology and outcomes of peritonitis in northern India.
作者信息
Prasad Kashi Nath, Singh Kamini, Rizwan Arshi, Mishra Priyanka, Tiwari Dinesh, Prasad Narayan, Gupta Amit
机构信息
Department of Microbiology,1 Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India;
出版信息
Perit Dial Int. 2014 Mar-Apr;34(2):188-94. doi: 10.3747/pdi.2012.00233. Epub 2014 Mar 1.
BACKGROUND
Peritoneal dialysis (PD) is an established treatment modality for end-stage renal disease (ESRD). Peritonitis remains a serious complication in PD patients and an important cause of drop-out from the program. Types of pathogens and their drug resistance patterns may determine the outcome of peritonitis. The present study was undertaken to determine the microbiology of peritonitis in PD patients, antibiotic resistance in commonly isolated bacterial pathogens and clinical outcomes.
METHOD
We enrolled 211 patients with ESRD undergoing PD who developed peritonitis during 2002 to 2011. PD fluids were cultured and antibiotic susceptibility test of the bacterial isolates was performed.
RESULT
A total of 303 peritonitis episodes with an overall incidence of 0.41 episodes per patient-year were recorded. Gram-positive, gram-negative, fungi, Mycobacterium tuberculosis and ≥ 2 organisms were isolated from 102 (33.7%), 89 (29.4%), 41 (13.5%), 11 (3.6%) and five (1.6%) episodes respectively; 55 (18.2%) episodes were culture negative. Coagulase-negative Staphylococcus spp. (CONS) was the most common isolate. Catheter loss and hospital admission in gram-negative peritonitis were significantly higher than in gram-positive peritonitis (36/89 (40.4%) vs 20/102 (19.6%), p < 0.001; and 56/89 (62.9%) vs 42/102 (41.2%), p = 0.004 respectively). Antibiotic susceptibility tests showed 54.3% of Enterobacteriaceae isolates were extended spectrum β-lactamase (ESBL) producers, 23.5% of Acinetobacter species and 11.5% of Pseudomonas aeruginosa were metallo-β-lactamase (MBL) producers; 15.4% of enterococci and 28.6% of staphylococci were resistant to vancomycin and methicillin respectively. Mortality was significantly higher in patients having peritonitis due to vancomycin-resistant enterococci, ESBL- and MBL-producing bacteria.
CONCLUSION
Emerging antimicrobial resistance calls for prompt diagnosis and aggressive empiric therapy based on the local sensitivity data.
背景
腹膜透析（PD）是终末期肾病（ESRD）的一种既定治疗方式。腹膜炎仍然是腹膜透析患者的严重并发症，也是退出该治疗方案的重要原因。病原体类型及其耐药模式可能决定腹膜炎的治疗结果。本研究旨在确定腹膜透析患者腹膜炎的微生物学情况、常见分离细菌病原体的抗生素耐药性以及临床结局。
方法
我们纳入了2002年至2011年期间发生腹膜炎的211例接受腹膜透析的终末期肾病患者。对腹膜透析液进行培养，并对分离出的细菌进行抗生素敏感性试验。
结果
共记录了303次腹膜炎发作，总体发病率为每位患者每年0.41次发作。分别从102次（33.7%）、89次（29.4%）、41次（13.5%）、11次（3.6%）和5次（1.6%）发作中分离出革兰氏阳性菌、革兰氏阴性菌、真菌、结核分枝杆菌和≥2种微生物；55次（18.2%）发作培养结果为阴性。凝固酶阴性葡萄球菌属（CONS）是最常见的分离菌。革兰氏阴性菌腹膜炎患者的导管丢失率和住院率显著高于革兰氏阳性菌腹膜炎患者（分别为36/89（40.4%）对20/102（19.6%），p<0.001；以及56/89（62.9%）对42/102（41.2%），p = 0.004）。抗生素敏感性试验显示，54.3%的肠杆菌科分离菌产超广谱β-内酰胺酶（ESBL），23.5%的不动杆菌属和11.5%的铜绿假单胞菌产金属β-内酰胺酶（MBL）；15.4%的肠球菌和28.6%的葡萄球菌分别对万古霉素和甲氧西林耐药。耐万古霉素肠球菌、产ESBL和产MBL细菌所致腹膜炎患者的死亡率显著更高。
结论
新出现的抗菌药物耐药性要求根据当地的敏感性数据进行及时诊断和积极的经验性治疗。
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