肠源性腹膜透析相关性腹膜炎临床特点及危险因素分析  

Clinical Characteristics and Risk Factors of Enterogenous Peritoneal Dialysis-related Peritonitis

作　　者：官继超[1] 龚淑文[1] 汪艳艳[1] 王时敏[1] 

机构地区：[1]浙江省绍兴市人民医院浙江大学绍兴医院肾内科,312000

出　　处：《中国全科医学》2016年第15期1781-1785,共5页Chinese General Practice

摘　　要：目的探讨肠源性腹膜透析相关性腹膜炎致病菌种类及耐药情况,分析危险因素,指导临床合理使用抗菌药物。方法选取2010年1月—2014年9月在绍兴市人民医院行规律腹膜透析的患者143例为研究对象。以是否发生肠源性腹膜透析相关性腹膜炎分为腹膜炎组(24例)和对照组(119例)。收集患者一般资料,记录肠源性细菌的鉴定及耐药性分析结果,采用Logistic回归分析肠源性腹膜透析相关性腹膜炎危险因素。结果两组患者年龄、血红蛋白(Hb)水平、血清清蛋白(Alb)水平、超敏C反应蛋白(hs-CRP)水平、合并糖尿病率比较,差异有统计学意义(P<0.05)。24例腹膜炎组患者共发生肠源性细菌感染27例次,其中最多见的为大肠埃希菌(13例次,占48.2%),其次为粪肠球菌(5例次,占18.5%)。肠源性细菌对氨苄西林、左氧氟沙星、头孢他啶、头孢唑林、青霉素、红霉素耐药率>50.0%,而对丁胺卡那、头孢哌酮舒巴坦、哌拉西林他唑巴坦、替考拉宁耐药率≤20.0%,未发现对亚胺培南、万古霉素耐药的菌株。Logistic回归分析结果显示,年龄大、Alb水平降低、hs-CRP水平升高、合并糖尿病为肠源性腹膜透析相关性腹膜炎的危险因素(P<0.05)。结论肠源性细菌以大肠埃希菌和粪肠球菌为主,且其耐药率高;对于存在肠源性腹膜透析相关性腹膜炎危险因素(高龄、Alb水平降低、hs-CRP水平升高、合并糖尿病)的患者,推荐使用万古霉素联合丁胺卡那作为经验性初始治疗方案。Objective To investigate the species and drug resistance of pathogenic bacteria causing enterogenous peritoneal dialysis - related peritonitis and analyze the risk factors in order to provide guidance for the rational clinical use of antibacterial agents. Methods From January 2010 to September 2014,we enrolled 143 patients who underwent regular peritoneal dialysis in Shaoxing People＆#39; s Hospital. According to whether enterogenous peritoneal dialysis - related peritonitis occurred,the patients were divided into two groups：peritonitis group（n = 24）and control group（n = 119）. The general data of patients were collected; the results of the identification of enterogenous bacteria and drug resistance analysis were recorded. Logistic regression analysis was conducted to explore the risk factors for enterogenous peritoneal dialysis - related peritonitis. Results The two groups were significantly different in age,the levels of Hb,Alb and hs-CRP and the rate of diabetics（P 〈 0. 05）. There were 27 episodes of enterogenous bacterial infection in the 24 patients of peritonitis group;the most common bacterial species was escherichia coli（13 episodes,48. 2% ）,and the second most common bacterial species was enterococcus faecalis（5 episodes,18. 5% ）. The drug resistance rates to ampicillin,levofloxacin,cefazolin,ceftazidime, penicillin and erythrocin were ＆gt; 50. 0% ,and the resistance rates to amikacin,cefoperazone - sulbactam,piperacillin -tazobactam and teicoplanin were ≤20. 0% . None of the strains were resistant to imipenem or vancomycin. Logistic regression analysis showed that higher age,lower Alb level,higher hs-CRP level and the combination with diabetics were risk factors for enterogenous peritoneal dialysis - related peritonitis（P 〈 0. 05）. Conclusion Enterogenous bacteria are mainly escherichia coli and enterococcus faecalis,and their durg resistance rates are high. For patients with risk factors for enterogenous peritoneal dialysis - related peritonitis（higher age,lower Alb

关 键 词：腹膜炎 腹膜透析 肠道细菌 耐药性 危险因素 

分 类 号：R656.41[医药卫生—外科学]