莫匹罗星与庆大霉素联合治疗预防腹膜透析相关感染疗效观察

目的探讨莫匹罗星与庆大霉素联合治疗在预防腹膜透析相关感染疗效观察,为减少腹膜透析患者相关感染提供更好的治疗方法。方法选择2010年12月-2012年12月收治需要进行腹膜透析患者120例进行研究,按照数字随机方法将其分为观察组和对照组,每组各60例,其中观察组采用莫匹罗星与庆大霉素联合治疗,对照组采用庆大霉素进行预防性治疗,观察两组患者腹膜炎及导管出口处及隧道感染的发生,并观察两组患者治疗后鼻拭子培养结果。结果观察组腹膜炎发生率为6.67%,显著低于对照组的21.67%,两组相比,差异有统计学意义(P<0.05);且观察组导管出口处及隧道感染率分别为8.33%和5.00%,显著低于对照组的16.67%和13.33%,两组相比,差异有统计学意义(P<0.05);患者鼻拭子病原菌培养结果显示,感染患者中革兰阳性菌以金黄色葡萄球菌及表皮葡萄球菌常见,革兰阴性细菌以大肠埃希菌及鲍氏不动杆菌最为常见,且对照组细菌培养阳性率76.67%,显著高于观察组的21.67%,两组相比,差异有统计学意义(P<0.05)。结论莫匹罗星与庆大霉素联合治疗在预防腹膜透析相关感染疗效显著,明显降低了透析患者腹膜炎、导管出口处及隧道感染率。     

莫匹罗星对大面积烧伤后残余创面感染的疗效

目的 研究莫匹罗星软膏对大面积烧伤后残余创成感染的疗效。方法 应用２％莫匹罗星软膏治疗大面积烧伤后歼余创面３０个，并与１０％聚乙烯吡酮欠膏（ＰＶＰ－１）相比较，观察１～２个疗程后，创面细菌清除率及愈合情况。结果 莫匹办星软膏对烧伤歼余创面的总有效率，创面细菌清除率分别为９０％和８０％，显著高于聚乙烯吡酮磺组的３７．８％（Ｐ〈０．０２５）和１５．４％（Ｐ〈０．０１）。细菌学检查结果提示以金黄色葡萄球     

长腹膜透析龄患者腹膜炎临床特征分析

目的探究长腹膜透析龄患者腹膜炎发生的临床特征。方法纳入2004—2016年间复旦大学附属华山医院发生腹膜炎患者,按初次感染发生在各一倍透析龄3年内及3年后分为两组,比较两组感染菌种及预后差异;同时分析不同透析龄及不同自然年致病菌的变化情况。结果本院2004—2008年间应用普通培养方式寻找致病菌,培养阴性率高达68%～95%,2009—2016年间改用血培养方式,培养阴性率降为18%～0%,血培养方式明显提高了培养阳性率。研究共纳入188人,初次发生感染在透析3年内135人,初次感染发生在透析3年后53人,初次感染发生在透析3年后患者更容易发生混合感染,并转血透及死亡风险更高。透析3年内感染共计204人次,透析3年后感染人次共计118人次,后者感染链球菌及表皮葡萄球菌风险更高,透析3年后感染者培养阴性率更低,死亡风险更高。结论长龄腹膜透析患者初次发生腹膜炎有更高的混合感染风险,其预后较差。     

腹膜透析相关性腹膜炎患者感染学特点及预后转归分析

目的 探究腹膜透析相关性腹膜炎（PDAP）患者腹膜透析液中病原菌分布、耐药特征及预后转归,为临床防治PDAP提供合理依据。方法 收集2014年1月 - 2018年8月郑州大学第一附属医院肾内科收治的243例PDAP患者腹腔透析液330份,进行细菌鉴定、药敏试验及统计学分析。结果 腹透液培养阳性217例次,检出230株细菌,阳性率为65.76%。其中革兰阳性菌132株（57.39%）、革兰阴性杆菌68株（29.56%）、真菌30株（13.04%）;主要分离菌依次为表皮葡萄球菌（25.65%）、大肠埃希菌（19.57%）。革兰阳性菌对青霉素的耐药率较高(77.32%),对利奈唑胺、万古霉素敏感。革兰阴性菌对氨苄西林的耐药率最高(92.16%),对哌拉西林他唑巴坦、亚胺培南的耐药率较低。真菌对常用抗真菌药均敏感。革兰阳性球菌感染组的治愈率与真菌组及混合感染组相比、真菌感染组的退出率与其余三组相比、混合感染组的病死率与培养阴性组相比具有统计学差异。结论 我院PDAP患者疗效及转归存在病原体差异;合理选择抗生素对PDAP患者的预后至关重要。     

口服氟康唑对细菌性腹膜炎腹膜透析患者继发真菌性腹膜炎的影响

目的探讨持续非卧床腹膜透析患者细菌性腹膜炎治疗同时,予口服氟康唑对继发真菌性腹膜炎发生的影响。方法选取医院2008年1月-2012年12月160例细菌性腹膜炎患者进行前瞻性队列研究,随机分为干预组和对照组,每组各80例;干预组在腹腔给药抗感染期间同时予氟康唑100mg,每天1次口服,对照组仅单纯给予腹腔给药抗感染治疗,抗感染治疗疗程结束后1⁵个月观察真菌性腹膜炎发生率,以评估预防性治疗的有效性;采用SPSS软件进行统计分析,两样本发病率的比较采用χ2检验。结果干预组仅2例出现继发性真菌性腹膜炎,发生率为2.5%,对照组发生9例继发性真菌性腹膜炎,发生率为11.3%,两组比较差异有统计学意义(P<0.05),同时期发现2例原发性真菌性腹膜炎,所有真菌性腹膜炎均予氟康唑静脉注射抗真菌治疗。结论腹膜透析患者患细菌性腹膜炎时使用抗菌药物易导致继发性真菌性腹膜炎发生;在治疗细菌性腹膜炎疗程中,同时使用氟康唑可显著地减少继发性真菌性腹膜炎的发生。     

莫匹罗星软膏治疗中小面积烧伤患者创面金黄色葡萄球菌感染的临床疗效

目的评价莫匹罗星治疗中小面积烧伤患者金黄色葡萄球菌感染的临床疗效,探讨莫匹罗星软膏的临床应用价值。方法选择2012年3月-2013年10月于医院就诊的64例中小面积烧伤金黄色葡萄球菌感染患者为研究对象,将其分为治疗组和对照组,每组各32例,治疗组采用外用莫匹罗星软膏治疗,对照组采用外用2%磺胺嘧啶银治疗,对比观察治疗5~10d后患者创面感染的细菌清除率、临床疗效及不良反应。结果治疗5~10d后,治疗有效率治疗组为90.6%、对照组为37.5%,两组治疗有效率比较差异有统计学意义(χ2=19.610,P<0.05);治疗组细菌清除率为93.8%,显著高于对照组的28.1%,两组细菌清除率比较差异有统计学意义(χ2=28.948,P<0.05);不良反应结果显示,用药前后患者肝肾功能两组差异无统计学意义。结论莫匹罗星软膏对中小面积烧伤创面金黄色葡萄球菌感染有较好的临床疗效,值得临床推广使用。     

腹膜透析腹膜炎与呼吸道感染的相关性研究

目的：探讨腹膜透析腹膜炎与呼吸道感染之间的相关性。方法：随机从我院2011年1月~2014年12月收治的腹膜透析患者中选取100例进行研究,并根据呼吸道感染情况将其分为对照组（50例,无腹膜炎和呼吸道感染）和观察组（50例,腹膜炎合并呼吸道感染）,对两组患者的临床资料进行回顾性分析,总结呼吸道感染主要致病菌及其危险因素。结果：（1）对照组中只有2例病原菌培养呈阳性,阳性率为4.00%;观察组则有24例为阳性,阳性率为48.00%,组间差异显著,经统计学分析有意义（P<0.05）。在各类致病菌中,大肠埃希菌最多,共6例,约占25.00%。（2）经性别、年龄、糖尿病和低清蛋白症等多因素分析,糖尿病和低清蛋白症是导致腹膜透析患者发生腹膜炎和呼吸道感染的主要危险因素（P<0.05）。结论：大肠埃希菌是导致腹膜透析腹膜炎和呼吸道感染的主要病原菌,而且糖尿病和低清蛋白症是导致腹膜炎和呼吸道感染的主要危险因素。     

安多福药浴联合莫匹罗星软膏对早产儿脓疱疮感染的治疗效果分析

目的 探究分析早产儿脓疱疮感染采用安多福药浴联合莫匹罗星软膏治疗疗效及护理方法。方法选择2019年9月-2021年9月本院收治的68例脓疱疮感染早产儿,采用随机数字表法将患儿分为两组,其中对照组34例采用单纯0.5%碘伏消毒常规治疗;观察组34例给予安多福药浴联合莫匹罗星软膏治疗;同时两组均进行全面、科学的护理。治疗结束后对比两组的临床疗效、不良反应以及患儿家属疗效满意度情况,并对比治疗前后炎症因子及免疫功能指标水平。结果 治疗后观察组治疗总有效率100.00%显著高于对照组（P<0.05）;治疗后观察组CRP为（4.13±0.47）mg/L,PCT为（0.24±0.05）ng/mL均显著低于对照组（P<0.05）;治疗期间观察组不良反应发生率5.88%,对照组为8.82%,两组对比差异无统计学意义（P>0.05）。观察组患儿家属的疗效满意度显著高于对照组（P<0.05）。结论 早产儿脓疱疮感染采用安多福药浴联合莫匹罗星软膏治疗,加上全面、科学的护理,可有效降低患儿炎症因子水平,增强其免疫功能,提高疗效满意度,效果确切,值得临床推广采用。     

局部应用莫匹罗星软膏治疗新生儿脐炎104例

脐炎是指与脐带相连组织的感染。严重感染时,局部肿胀、红斑、触痛,甚至脐部发黑,细菌可侵入血液,引起败血症和腹膜炎,亦可导致门静脉炎,并导致肝外性门静脉高压[1]。脐炎还是新生儿化脓性脑膜炎的最常见原因[2]。严重病例可以导致新生儿死亡或神经系统损害,可见脐炎是严重危害新生儿健康的疾病之一。我院选用莫匹罗星软膏治疗脐炎104例,取得显著疗效,现报告如下。1临床资料1·1一般资料我院于1998年1月~2005年8月选用莫匹罗星软膏治疗新生儿脐炎104例。全部病例符合新生儿脐炎诊断标准[3]。其中男78例、女26例;发病日龄<3天者17例、3~7天者…     

血清白蛋白对腹膜透析患者并发腹膜炎的临床研究

目的探讨血清白蛋白与腹膜透析患者并发腹膜炎的相关性。方法选取我院2008年3月至2015年4月收治的76例腹膜透析并发腹膜炎患者为研究对象,根据患者的血清蛋白水平将其分为观察组(血清蛋白含量≤35 g/L)和对照组(血清蛋白含量>35 g/L),各38例。观察腹膜透析液培养结果,并分析腹膜透析并发腹膜炎的原因及预后情况。结果观察组的培养阴性率为60.53%,明显高于对照组的34.21%(P<0.05);两组患者培养阳性中G~+球菌、G-杆菌比例差异不显著(P>0.05)。观察组腹膜透析并发腹膜炎原因中操作污染、原因不清楚的比例均高于对照组(P<0.05),两组患者在导管相关感染、胃肠道疾病、菌血症等方面比较无明显差异(P>0.05)。观察组患者死亡率为10.53%,明显高于对照组的0.00%(P<0.05);两组患者退出拔管(转血透)情况无明显差异(P>0.05)。结论与血清白蛋白含量正常的腹膜透析患者相比,血清白蛋白含量低的患者具有更高的腹膜透析液培养阴性率和患者死亡率。     

Post-transplant peritonitis in patients undergoing continuous ambulatory peritoneal dialysis

Two patients previously managed by continuous ambulatory peritoneal dialysis for end stage renal failure received cadaveric renal transplants. The peritoneal catheter was capped off and left in situ postoperatively. Both patients developed bacterial peritonitis shortly after transplantation. It was felt that the infections were associated with the presence of the indwelling peritoneal catheter as there was no clinical evidence of peritonitis at the time of transplantation.     

An outbreak of Candida tropicalis peritonitis in patients on intermittent peritoneal dialysis.

An outbreak of Candida tropicalis peritonitis in intermittent peritoneal dialysis patients during a 6-week period is reported from a general hospital. Five patients were involved and there were three deaths. The strains recovered from affected patients were identical to those recovered from the water baths on the basis of biotyping, antimicrobial susceptibility pattern and chromosomal DNA fingerprints. No further cases were identified on subsequent surveillance after the prohibition of wet-warming of peritoneal dialysate in the hospital.     

Fungal peritonitis in children on continuous ambulatory peritoneal dialysis

Between 1979 and 1985, six of 26 patients undergoing continuous ambulatory peritoneal dialysis developed fungal peritonitis. All had received antibacterial therapy with cefamandole and/or netilmicin prior to the diagnosis. The causal organisms were Candida albicans (three), Candida glabrata (one), Cryptococcus laurentii (one) and Saccharomyces cerevisiae (one). Treatment comprised catheter removal preceded by antifungal drugs (flucytosine and/or amphotericin B) in four patients and catheter removal alone in two. All patients were transferred to haemodialysis and five of the six developed extensive intra-abdominal adhesions. The most prudent management of fungal peritonitis in children would seem to be early cannula removal.     

"Pulse" nasal mupirocin maintenance regimen in patients undergoing continuous ambulatory peritoneal dialysis.

OBJECTIVE: To determine, among patients undergoing continuous ambulatory peritoneal dialysis (CAPD) who were Staphylococcus aureus nasal carriers, if periodic brief "pulses" of nasal mupirocin calcium ointment 2% after completion of a mupirocin eradication protocol would maintain these patients free of carriage. DESIGN: Noncomparative, nonblinded study with historical controls. SETTING: A county medical center. PATIENTS: Patients in a CAPD program during the period April 1996 to May 1998. METHODS: All patients in the CAPD program had monthly nasal cultures for S. aureus. After informed consent, S. aureus nasal carriers were administered mupirocin to the nares twice a day for 5 days followed by nasal mupirocin twice monthly. Peritonitis and exit-site infection rates were monitored independently by CAPD nursing staff. Patients were monitored monthly for adverse effects of mupirocin and compliance with the maintenance regimen. RESULTS: Twenty-four patients in the CAPD program were enrolled in the study and had a median duration of follow-up of 8.5 months. Fifteen (63%) of the 24 patients remained free of nasal carriage on follow-up cultures. Of the 9 patients with positive nasal cultures during the study, 8 had only one positive culture. There was no significant difference in the mean yearly peritonitis rate or S. aureus peritonitis rate (January 1995-May 1998). However, there was a significant decrease in the mean yearly exit-site infection rates both overall (from 8.8 episodes per 100 patients dialyzed per month in 1995 to 4.0 in 1998; P = .008) and due to S. aureus (from 5.6 in 1995 to 0.9 in 1998; P = .03). Adverse effects of nasal mupirocin were mild overall; 1 patient was removed from the study due to an allergic reaction to mupirocin. CONCLUSIONS: Among CAPD patients who were S. aureus nasal carriers, periodic brief treatment with nasal mupirocin after an initial eradication regimen kept them free of carriage, for the most part, with few adverse effects. The pulse mupirocin regimen offers simplicity and possibly better compliance, as well as minimizing exposure to this agent, thereby possibly reducing the risk of resistance. Further studies are warranted to compare this regimen to other commonly used mupirocin maintenance regimens in dialysis patients.     

持续性腹膜透析患者感染性腹膜炎的病原菌分析

目的探讨持续性非卧床腹膜透析(CAPD)感染性腹膜炎患者的病原菌分布特点、耐药性及对预后的影响,为临床合理使用抗菌药物提供依据。方法回顾性分析2007年1月-2013年1年的30例CAPD感染性腹膜炎患者的临床资料,对病原菌检测检结果、耐药性和预后进行分析。结果 30例CAPD感染性腹膜炎患者中病原菌检测阳性19例,阳性率为63.3%;共检出病原菌25株,其中革兰阳性菌11株、革兰阴性菌8株、真菌6株,分别占44.0%、32.0%、24.0%;革兰阳性菌对亚胺培南/西司他丁、万古霉素100.0%耐药,革兰阴性菌对氨苄西林/舒巴坦、庆大霉素、头孢他啶的耐药率达50.0%,而真菌对抗真菌药物均敏感;病原菌培养阳性组治愈率、拔管率和病死率分别为78.9%、15.3%和5.3%,阴性组分别为63.3%、27.2%和9.1%,两组比较差异无统计学意义;但合并真菌感染者治愈率低于感染革兰阳性菌者和革兰阴性菌者,差异有统计学意义(P<0.05)。结论革兰阳性菌是CAPD感染性腹膜炎患者最常见病原菌,且对临床常用抗菌药物均有不同程度耐药,合并真菌感染者预后差,应加强CAPD感染性腹膜炎患者培训和随访,以降低腹膜炎发生率。     

Nutritional effects of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients

Peritonitis, a major complication of end-stage renal disease patients treated with continuous ambulatory peritoneal dialysis (CAPD), enhances peritoneal protein losses by increasing protein and energy requirements while simultaneously decreasing appetite, usually causing a negative nitrogen balance. The influence of peritonitis on the nutritional status of CAPD patients was evaluated. Fourteen end-stage renal disease patients being treated with CAPD and presenting with peritonitis were randomized to one group with and one without a nutritional supplement. Four CAPD patients without peritonitis served as controls. Anthropometric measurements, laboratory determinations, dietary protein intake, and protein catabolic rate were obtained. The control group lost an average of 9.6 gm protein per 24 hours in the peritoneal fluid vs. an average of 15.1 gm protein per 24 hours lost by patients with peritonitis (p less than .01). Serum albumin did not decrease except in two diabetic patients in whom it dropped an average of 42% and remained low. Nitrogen balance remained positive in all patients except one with diabetes who had very low daily protein intake and caloric intake. The catabolism produced by short uncomplicated peritonitis did not create a negative nitrogen balance in patients eating at least 1 gm protein per kilogram ideal body weight (IBW) and 25 kcal/kg IBW.     

Controlled trial of a Y-set dialysis delivery system to prevent peritonitis in patients receiving continuous ambulatory peritoneal dialysis.

Peritonitis rates were compared in patients receiving continuous ambulatory peritoneal dialysis (CAPD) via either a Y-set dialysate delivery system or a standard system. Forty patients in each arm of the trial were matched for age (range 20-67 years, mean 49 years), and remained in the study for similar periods (range 3-36 months, mean 14.1 months). The observation time was 564 patient-months for each arm of the trial. There were 22 episodes of peritonitis in nine out of 40 patients using the Y-set and 57 episodes in 21 out of 40 patients using the standard system (P = 0.005 Wilcoxon signed rank test for episodes, P = 0.02 McNemar's chi 2 test for patients). Peritonitis rates were one episode per 25 patient-months in the Y-set group, and one episode per 9.7 patient-months in the standard group. In the Y-set group there were significantly fewer episodes caused by coagulase-negative staphylococci and Acinetobacter spp. There was no difference in the rate of episodes caused by Staphylococcus aureus, streptococci, enterococci, corynebacteria, enterobacteria or pseudomonads. There was no difference in the incidence of catheter exit wound infections. The Y-set dialysis delivery system is effective in reducing peritonitis rates in CAPD patients caused by organisms derived from the commensal skin flora, principally coagulase-negative staphylococci, but does not reduce peritonitis caused by other organisms.