单中心腹膜透析相关性腹膜炎6年91例次回顾性分析  

Peritoneal dialysis associated peritonitis in a single center:A retrospective analysis of 91 occasions in 6 years

作　　者：滕兰波[1] 常明[1] 刘书馨[1] 宋佳妮 张运刚[1] 王凌溪[1] TENG Lan-bo;CHANG Ming;LIU Shu-xin;SONG Jia-ni;ZHANG Yun-gang;WANG Ling- xi(Department of Nephrology , Dalian Municipal Central Hospital, Dalian 116033, China)

机构地区：[1]大连市中心医院肾内科,辽宁大连116033

出　　处：《哈尔滨医科大学学报》2018年第1期36-41,共6页Journal of Harbin Medical University

摘　　要：目的分析本中心腹膜透析患者发生腹透相关性腹膜炎(PDAP)的临床特征,为腹膜炎的防治和预后判断提供依据。方法本研究为回顾性研究,收集大连市中心医院腹透中心2010年1月~2015年12月间发生PDAP的所有患者的临床资料,分析腹膜炎的发病率、病原菌构成及菌谱变迁、药敏结果、转归及影响转归的危险因素,并根据感染菌种的不同进行亚组分析。结果 6年间共有66例患者发生91例次PDAP,腹膜炎的发病率为1次/70患者月。透出液病原菌培养阳性率为72.53%;其中革兰氏阳性菌(G^+菌)占60.61%,革兰氏阴性菌(G^-菌)占31.82%;菌谱变迁提示G^-菌感染呈上升趋势。药敏试验提示G^+菌对万古霉素及利奈唑胺的耐药率最低(0%),对头孢唑林的耐药率最高(73.33%);G^-菌对头孢哌酮/舒巴坦的耐药率最低(0%),对头孢他啶的耐药率为36.84%。亚组分析提示G^+菌组及培养阴性组的治愈率显著高于G^-菌组及真菌组(87.50%、88.00%比57.14%、20.00%,P=0.000),而G^-菌组的病死率高于其他三组(28.57%比2.5%、0%、0%,P=0.001);透出液白细胞计数在G^-菌组明显高于其他三组[5220(2235.00,7700.00)比1700.00(815.00,3937.50)、478.00(122.25,2145.25)、677.00(181.00,1740.00),P=0.000]。血中性粒细胞比例在G^-菌组明显高于G^+菌组及培养阴性组[85.19±8.76比73.99±8.87、75.30±8.94,P=0.000]。Logistic回归分析显示真菌感染是影响患者拔管或死亡的的独立危险因素(P=0.031)。结论应提高本中心透出液病原菌培养阳性率;应关注病原菌菌谱的变迁并重视G^-菌感染的治疗。应结合药敏试验及本中心实际情况选择敏感抗生素,进一步提高PDAP的治愈率。Objective To provide guide for prevention and cure of peritonitis by analyzing the clinical features of peritoneal dialysis associated peritonitis(PDAP） in our center. Methods All patients who developed PDAP between January 2010 and December 2015 in Dalian municipal central hospital were included. Morbidity,outcomes and related risk factors,pathogens and bacteria spectrum changes,laboratorial antimicrobial susceptibilities were analyzed. According to different pathogens,subgroup analysis were performed. Results Peritonitis occurred 91 occasions in 66 patients during the study period. The average peritonitis rate was 1 episode per every 70 patient-months. The dialysate pathogens culture was positive with a positive rate of 72. 53%,including 40 cases（60. 61%） of gram-positive(G^＋） bacteria,21 cases（31. 82%）of gram-negative(G^-） bacteria. There was an increasing proportion of peritonitis caused by Gbacteria. Laboratorial drug sensitive experiment showed that the drug-resistant rate of G^＋bacteria to vancomycin and linezolid were the lowest(0%）,but to cefazolin was the highest（73. 33%）. The drug-resistant rate of G^-bacteria to cefperazone/sulbactam was the lowest（0%）,but to ceftazidime was 36. 84%. Subgroup analysis showed that the cure rate of G^＋bacteria and microbial negative peritonitis group were significantly higher than G^-bacteria and fungi group(87. 50%,88. 00% vs 57. 14%,20. 00%,P = 0. 000）. The mortality of Gbacteria group was significantly higher than other groups（28. 57% vs 2. 5%,0%,0%,P =0. 001）. Dialysate leukocyte count of G^-bacteria group was higher than other groups[5220（2235. 00,7700. 00） vs 1700. 00（815. 00,3937. 50）,478. 00（122. 25,2145. 25）,677. 00（181. 00,1740. 00）,P = 0000]. The percentage of blood neutrophils in G^-bacteria group was higher than G^＋bacteria and microbial negative groups [85. 19 ± 8. 76 vs 73. 99 ± 8. 87,75. 30 ± 8. 94,P = 0000]. Logistic analysis showed that fungi infection was independent predictor for peritonitis-re

关 键 词：腹膜透析相关性腹膜炎 预后 病原菌 药敏 抗生素 

分 类 号：R459.5[医药卫生—治疗学] R572.2[医药卫生—临床医学]