大肠埃希菌腹膜透析相关性腹膜炎的发生与当次治疗失败的危险因素分析  

Risk factors for the occurrence and treatment failure of peritoneal dialysis-associated E.coli peritonitis

作　　者：程思宇 杨立明[2] 朱学研[3] 张晓暄 孟令飞[1] 郭师正 庄小花[1] 白晓莹 罗萍[1] 崔文鹏[1] Cheng Siyu;Yang Liming;Zhu Xueyan;Zhang Xiaoxuan;Meng Lingfei;Guo Shizheng;Zhuang Xiaohua;Bai Xiaoying;Luo Ping;Cui Wenpeng(Department of Nephrology,Second Hospital of Jilin University,Changchun,130041;Department of Nephrology,Second Department of Jilin University First Hospital,Changchun,130031;Department of Nephrology,Jilin Central Hospital,Jilin,132011;Department of Nephrology,FAW General Hospital of Jilin Province,Changchun,130011)

机构地区：[1]吉林大学第二医院肾病内科,长春130041 [2]吉林大学第一医院二部肾病内科,长春130031 [3]吉林市中心医院肾病内科,132011 [4]吉林省一汽总医院肾病内科,长春130011

出　　处：《中华临床感染病杂志》2021年第3期173-178,共6页Chinese Journal of Clinical Infectious Diseases

基　　金：吉林省卫生厅项目(2017Q024,2018FP031)。

摘　　要：目的探讨大肠埃希菌引起的腹膜透析相关性腹膜炎(Peritoneal dialysis-associated peritonitis,PDAP)的临床特点及发生与当次治疗失败的危险因素。方法回顾性分析2013至2019年吉林省4家三甲医院PDAP患者资料,根据腹膜透出液培养出的致病菌种类,将患者分为大肠埃希菌组和非大肠埃希菌组。观察大肠埃希菌PDAP发生率变化,对比两组患者临床特点和当次治疗结果,采用Logistic分析大肠埃希菌PDAP发生和当次治疗失败的危险因素。结果共纳入693例次PDAP,大肠埃希菌组100例次,非大肠埃希菌组593例次。2013至2019年,4家医院大肠埃希菌PDAP发生率呈下降趋势。与非大肠埃希菌组相比,大肠埃希菌组合并糖尿病的比例和血白蛋白水平较低(χ^(2)=5.006,Z=-2.992,P<0.05),而难治性腹膜炎的比例较高,当次抗生素治疗时间较长(χ^(2)=6.350,Z=-2.779,P<0.05)。多因素Logistic回归结果显示,PDAP病史(OR=1.577,95%CI:1.015~2.448)、基线血白蛋白低(OR=0.958,95%CI:0.923~0.995)是发生大肠埃希菌PDAP的独立危险因素,合并糖尿病是发生大肠埃希菌PDAP的独立保护因素(OR=0.538,95%CI:0.330~0.876);长透析龄是大肠埃希菌PDAP当次治疗失败的独立危险因素(OR=1.047,95%CI:1.018~1.076)。结论吉林省近7年大肠埃希菌PDAP发生率有所下降,但较为难治;PDAP病史、血白蛋白低是大肠埃希菌PDAP发生的独立危险因素,合并糖尿病是大肠埃希菌PDAP发生的独立保护因素;长透析龄是大肠埃希菌PDAP当次治疗失败的独立危险因素。Objective To investigate the clinical characteristics of E.coli peritoneal dialysis-associated peritonitis(PDAP)and the risk factors for its occurrence and treatment failure.Methods The clinical data of patients with episodes of PDAP in four general hospitals in Jilin Province from 2013 to 2019 were retrospectively reviewed.According to the pathogenic bacteria,the patients were divided into E.coli and non-E.coli groups.The incidence of E.coli PDAP in the last seven years was calculated and the clinical characteristics were compared between two PDAP groups.Logistic regression was used to analyze the risk factors for the occurrence and treatment failure of E.coli PDAP.Results A total of 693 PDAP episodes/cases were enrolled in this study,including 100 episodes/cases in the E.coli group and 593 episodes/cases in the non-E.coli group.The incidence rate of E.coli PDAP in the four hospitals showed a decreasing trend during 2013 to 2019.Compared with the non-E.coli group,the proportion of diabetic patients and the average blood albumin levels in the E.coli group were lower(χ^(2)=5.006,Z=-2.992,P<0.05),while the proportion of refractory peritonitis was higher,and the duration of antibiotic therapy was longer(χ^(2)=6.350,Z=-2.779,P<0.05).Multivariate Logistic regression analysis showed that history of PDAP(OR=1.577,95%CI:1.015-2.448)and low baseline serum albumin level(OR=0.958,95%CI:0.923-0.995)were independent risk factors for the development of E.coli PDAP,while concomitant diabetes was an independent protective factor for E.coli PDAP(OR=0.538,95%CI:0.330-0.876).Moreover,long-term dialysis was an independent risk factor for treatment failure of E.coli PDAP(OR=1.047,95%CI:1.018-1.076).Conclusion The incidence rate of E.coli PDAP in study institutions has declined in the past 7 years,but the rate of refractory PDAP is still high.The history of PDAP and low blood albumin level are independent risk factors for the occurrence of E.coli PDAP,while concomitant diabetes is an independent protective factor for the occurrence

关 键 词：大肠杆菌 腹膜透析 腹膜炎 

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