腹膜透析相关性腹膜炎患者发生多重耐药菌感染的危险因素与临床结局  

Risk factors and clinical outcomes of multidrug-resistant bacteria infection in peritoneal dialysis associated peritonitis patients

作　　者：李慧[1] 李媛媛[1] 张培[1] 吴永贵[1] Li Hui;Li Yuanyuan;Zhang Pei;Wu Yonggui(Dept of Nephropathy,The First Affiliated Hospital of Anhui Medical University,Hefei 230022)

机构地区：[1]安徽医科大学第一附属医院肾脏内科,合肥230022

出　　处：《安徽医科大学学报》2023年第6期1025-1029,共5页Acta Universitatis Medicinalis Anhui

基　　金：国家自然科学基金(编号:81900697)。

摘　　要：目的分析腹膜透析相关性腹膜炎(PDAP)患者多重耐药(MDR)菌感染的发生率、病原学特点、危险因素及临床结局。方法回顾性收集近3年收治的PDAP患者资料,分析该中心PDAP患者致病菌分布及耐药情况。并根据致病菌是否为MDR菌分为MDR组及非MDR组,比较两组资料,分析发生MDR感染的危险因素及临床结局。结果PDAP患者以革兰阳性菌感染为主,MDR组透出液中最常见的分离病原体是葡萄球菌,占60.6%(43/71),非MDR组为链球菌,占42.0%(21/50)。多因素分析显示,PDAP发病前3个月内使用广谱抗生素5 d以上(OR=3.634,P=0.033)、革兰阳性菌感染(OR=3.741,P=0.031)、较高的脂蛋白(a)水平(OR=1.003,P=0.003)、较高的血小板/白蛋白比值(OR=1.198,P=0.038)是PDAP患者发生MDR感染的独立危险因素。MDR组难治性腹膜炎发生率(29.6%)高于非MDR组(12.0%)(χ2=5.229,P=0.022);重现性腹膜炎发生率(16.9%)也高于非MDR组(4.0%)(χ2=4.773,P=0.029)。结论PDAP患者发生MDR感染以葡萄球菌为主。相对于非MDR组,MDR组具有发病前3个月内使用广谱抗生素5 d以上者比例、革兰阳性菌感染比例较高,脂蛋白(a)水平、血小板/白蛋白比值较高的特点,且发生难治性腹膜炎及重现性腹膜炎风险增加。Objective This study aimed to assess the incidence,etiological characteristic,potential risk factors and clinical outcomes of multidrug-resistant(MDR)infection in patients with peritoneal dialysis associated peritonitis(PDAP).Methods The data of PDAP patients admitted in recent 3 years in our center were collected retrospectively to analyze the distribution of pathogenic bacteria and drug resistance.According to whether the pathogenic bacteria were MDR or not,they were divided into MDR group and non-MDR group.The data of the two groups were compared,and the risk factors and clinical outcomes of MDR infection were analyzed.Results PDAP patients were mainly infected with gram-positive bacteria.Staphylococcus was the most common pathogen isolated from the peritoneal fluid in the MDR group,accounting for 60.6%(43/71),and streptococcus was the most common pathogen isolated in the non-MDR group,accounting for 42.0%(21/50).Multivariate analysis showed that the use of wide-spectrum antibiotics for more than 5 days within 3 months before the onset of PDAP(OR=3.634,P=0.033),gram-positive bacterial infection(OR=3.741,P=0.031),higher lipoprotein(a)level(OR=1.003,P=0.003),and higher platelet-to-albumin ratio(OR=1.198,P=0.038)were independent risk factors for MDR infection in PDAP patients.The incidence of refractory peritonitis in MDR group(29.6%)was higher than that in non-MDR group(12.0%)(χ2=5.229,P=0.022).The incidence of recurrent peritonitis(16.9%)was also higher than that in the non-MDR group(4.0%)(χ2=4.773,P=0.029).Conclusion The main pathogen of MDR infection is staphylococcus in PDAP patients.Compared with the non-MDR group,the MDR group has a higher proportion of wide-spectrum antibiotics used for more than 5 days within 3 months before the onset of PDAP,a higher proportion of gram-positive bacterial infection,higher lipoprotein(a)level,higher platelet-to-albumin ratio,and an increased risk of refractory peritonitis and recurrent peritonitis.

关 键 词：腹膜透析相关性腹膜炎 多重耐药 难治性腹膜炎 

分 类 号：R459.51[医药卫生—治疗学]