频发腹膜透析相关性腹膜炎患者病原菌及危险因素  

Pathogens isolated from patients with frequent peritoneal dialysis-associated peritonitis and risk factors

作　　者：张砚 兰琳 张玲[1] 陈莎 黎何 ZHANG Yan;LAN Lin;ZHANG Ling;CHEN Sha;LI He(Sichuan Provincial People’s Hospital,Sichuan Academy of Medical Sciences,Chengdu,Sichuan 610000,China)

机构地区：[1]四川省医学科学院·四川省人民医院肾脏内科,四川成都610000 [2]四川省医学科学院·四川省人民医院呼吸科,四川成都610000

出　　处：《中华医院感染学杂志》2021年第22期3412-3416,共5页Chinese Journal of Nosocomiology

基　　金：四川省科研基金资助项目(20191211)。

摘　　要：目的探究频发腹膜透析(PD)相关性腹膜炎患者病原菌特点及危险因素。方法选择2018年7月-2020年7月四川省人民医院收治80例PD相关性腹膜炎患者作为研究对象,依据发生次数将单发以及频发感染患者分别纳入对照组与研究组,分别为53例与27例,分析患者病原菌感染特点,频发PD相关性腹膜炎危险因素。结果两组病原菌培养阳性率分别为60.38%和66.18%,阳性率比较无统计学差异;革兰阳性菌主要为表皮葡萄球菌、溶血葡萄球菌,革兰阴性菌主要为肺炎克雷伯菌,革兰阳性菌对红霉素、青霉素、苯唑西林、克林霉素耐药性较高,革兰阴性菌对氨苄西林、头孢唑林耐药性较高;两组患者白蛋白、血红蛋白、血肌酐、透析时间、无效拔管率等因素指标比较存在统计学意义(P<0.05),多元Logistic回归分析结果显示白蛋白水平低、血红蛋白水平低以及透析时间长是频发PD相关性腹膜炎危险因素(P<0.05)。结论白蛋白水平低、血红蛋白水平低以及透析时间长是频发PD相关性腹膜炎发生危险因素,临床需要重点关注。OBJECTIVE To explore the etiological characteristics of the patients with frequent peritoneal dialysis(PD)-associated peritonitis and analyze the risk factors. METHODS A total of 80 PD-associated peritonitis who were treated in Sichuan Provincial People’s Hospital from Jul 2018 to Jul 2020 were recruited as the study subjects, 53 patients who had single infection were assigned as the control group, 27 patients who had frequent infection were assigned as the study group. The etiological characteristics of pathogens and risk factors for the frequent PD-associated peritonitis were observed. RESULTS The positive rates of culture of pathogens were respectively 60.38% and 66.18% in the two groups, and there was no significant difference in the positive rate. Staphylococcus epidermidis and Staphylococcus hemolyticus were dominant among the gram-positive bacteria;Klebsiella pneumoniae was the predominant species of gram-negative bacteria. The positive bacteria were highly resistant to erythromycin, penicillin, and clindamycin;the gram-negative bacteria were highly resistant to ampicillin and cefazolin. There were significant differences in the albumin, hemoglobin, serum creatinine, time of dialysis and rate of invalid extubation between the two groups of patients(P<0.05). The result of multivariate logistic regression analysis showed that low level of albumin, low level of hemoglobin and long time of dialysis were the risk factors for the frequent PD-associated peritonitis(P<0.05). CONCLUSION The low level of albumin, low level of hemoglobin and long time of dialysis are the risk factors for the frequent PD-associated peritonitis, to which the hospital should pay high attention.

关 键 词：频发腹膜透析相关性腹膜炎 病原特点 危险因素 氧化应激 

分 类 号：R459.5[医药卫生—治疗学]