【摘要】目的 探讨腹膜透析中心提高腹透液致病菌培养阳性率的改良策略。 方法 收集武汉市第一医院肾病科2007年1月～2014年4月收治的466例次持续性非卧床腹膜透析(CAPD)相关性腹膜炎患者的临床资料，以2010年6月为界，以前为传统组(OR组)采用传统的腹透液细菌培养法，之后为改良组(IM组)采用血培养方法进行腹透液培养，比较2组近期抗生素使用史、腹透液培养阳性率、腹膜炎发生率、致病菌的分布情况。 结果 与传统组相比，改良组腹透液培养阳性率高(81.5%比65.8%，P＜0.01)，培养前抗生素使用史的比率低(7.76%比21.36%，P＜0.01)，在传统组中，未使用抗生素亚组病原菌检出率优于总体检出率(75.00%比65.81%，P＜0.05)。2组腹膜炎致病菌排前3位的细菌均为葡萄球菌、链球菌、大肠埃希菌。 结论 未离心腹透液采用血培养方法进行腹透液培养可以大幅提高致病菌阳性率，培养前患者是否接受抗生素治疗对培养阳性率的影响相当关键。

【Abstract】 Objective To explore the strategy to increase the bacteria discovery rate in peritoneal dialysis fluid in a PD center. Methods A total of 466 peritonitis cases in the CAPD patients in the period of Jan. 2007 to Apr. 2014 were analyzed. Bacterial culture for dialysis fluid was performed using the traditional method for the CAPD patients before Jun. 2010 (original group), and using the method for blood culture for the CAPD patients in the period of Jun. 2010 to Apr. 2014 (improvement group). Antibiotic treatment, positive rate of bacteria, incidence of peritonitis, and causative bacteria were compared between the two groups. Results The ratio of antibiotic treatment before dialysis fluid culture was lower in improvement group than in original group (7.76% vs. 21.36%, P<0.01). The positive rate of bacteria in peritoneal dialysis fluid was 81.5％ in improvement group and was 65.8% in original group (P＜0.01). Conclusion The use of blood culture medium for the culture of dialysis fluid increased the positive rate of bacterial discovery in dialysis fluid. The use of antibiotics before bacterial culture for dialysis fluid profoundly affected the positive rate of bacteria in dialysis fluid.