Zelenitsky Sheryl A, Howarth Jacy, Lagacé-Wiens Philippe, Sathianathan Christie, Ariano Robert, Davis Christine, Verrelli Mauro
College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
St. Boniface Hospital, Winnipeg, Manitoba, Canada.
Perit Dial Int. 2017 Mar-Apr;37(2):170-176. doi: 10.3747/pdi.2016.00136. Epub 2016 Oct 13.
♦ BACKGROUND: Information related to the microbiology of peritonitis is critical to the optimal management of patients receiving peritoneal dialysis (PD). The goal was to characterize the microbiological etiology and antimicrobial susceptibilities of PD-related peritonitis (PDRP) from 2005 to 2014, inclusive. ♦ METHODS: The distribution of organisms in culture-positive PDRP was described for new episodes and relapse infections, and further detailed for monomicrobial and polymicrobial peritonitis. Annual and overall rates of PDRP were also characterized. Antimicrobial susceptibility rates were calculated for the most common and significant organisms. ♦ RESULTS: We identified 539 episodes of PDRP including 501 new and 38 relapse infections. New episodes of peritonitis were associated with a single organism in 85% of cases, and 44% of those involved staphylococci. Polymicrobial PDRP was more likely to involve gram-negative organisms, observed in 58% versus 24% of monomicrobial infections. Antimicrobial resistance was relatively stable from 2005 to 2014. Methicillin resistance was present in 57% of and 20% of other coagulase-negative staphylococci. Methicillin-resistant (MRSA) accounted for only 11% of peritonitis compared with 2% in our previous study of PDRP from 1991 to 1998. Ciprofloxacin resistance in increased from 3% in our previous study to 24% in 2005 - 2014. ♦ CONCLUSIONS: This study characterizes important differences in the distribution of organisms in new episodes of PDRP and relapse infections, as well as monomicrobial versus polymicrobial peritonitis. It also shows relatively stable rates of antimicrobial resistance from 2005 to 2014, but some increases compared with our previous study.
♦ 背景：与腹膜炎微生物学相关的信息对于接受腹膜透析（PD）患者的最佳管理至关重要。目的是描述2005年至2014年（含）期间与PD相关的腹膜炎（PDRP）的微生物病因及抗菌药物敏感性。♦ 方法：描述新发病例和复发感染中培养阳性的PDRP的微生物分布情况，并进一步详细描述单一微生物和多种微生物引起的腹膜炎。还对PDRP的年发病率和总发病率进行了描述。计算了最常见和最重要微生物的抗菌药物敏感性率。♦ 结果：我们确定了539例PDRP发作，包括501例新发病例和38例复发感染。85%的腹膜炎新发病例与单一微生物有关，其中44%涉及葡萄球菌。多种微生物引起的PDRP更可能涉及革兰氏阴性菌，在单一微生物感染中占58%，而在多种微生物感染中占24%。2005年至2014年抗菌药物耐药性相对稳定。57%的金黄色葡萄球菌和20%的其他凝固酶阴性葡萄球菌存在耐甲氧西林情况。耐甲氧西林金黄色葡萄球菌（MRSA）在金黄色葡萄球菌引起的腹膜炎中仅占11%，而在我们之前1991年至1998年的PDRP研究中占2%。金黄色葡萄球菌对环丙沙星的耐药率从我们之前研究中的3%增至2005年至2014年的24%。♦ 结论：本研究描述了PDRP新发病例和复发感染以及单一微生物与多种微生物引起的腹膜炎在微生物分布上的重要差异。研究还表明，2005年至2014年抗菌药物耐药率相对稳定，但与我们之前的研究相比有所增加。
