多重耐药菌腹膜透析相关性腹膜炎的临床特征和转归分析  

The clinical characteristics and outcome of peritoneal dialysis associated peritonitis by multiple drug resistant organisms

作　　者：杨滨鸿 王秀芬[1] 张涛[1] 李英[1] YANG Bin-hong;WANG Xiu-fen;ZHANG Tao;LI Ying(Department of Nephrology,The Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院肾内科,石家庄050051

出　　处：《中国血液净化》2023年第12期900-904,共5页Chinese Journal of Blood Purification

摘　　要：目的 探讨多重耐药菌腹膜透析相关性腹膜炎(peritoneal dialysis-associated peritonitis,PDAP)的临床特征、细菌谱、耐药率及转归,为多重耐药菌PDAP的规范化治疗提供临床依据。方法 回顾性分析2016—2022年在河北医科大学第三医院腹膜透析中心随访的腹膜透析相关性腹膜炎患者的临床资料,依据腹膜透析液病原学检查结果将其分为多重耐药菌组和非多重耐药菌组,比较2组患者的临床资料与治疗结果。结果 (1)共纳入96例患者,发生123例次PDAP,其中多重耐药菌PDAP为56例次,病原体以革兰氏阳性菌(G^(+))为主,共49例次(87.5%),最常见菌株为凝固酶阴性的葡萄球菌,共41例次(83.7%);革兰氏阴性菌(G^(-))全部为大肠埃希菌。(2)与非多重耐药菌组相比,多重耐药菌组患者平均缓解天数延长(Z=-1.994、-2.341,P=0.046、0.019)。对于G^(+)而言,多重耐药菌组的平均缓解天数比非多重耐药菌组延长2.491天(t=-2.254,P=0.028)。(3)G^(+)2020—2022年对利福平的敏感率较2016—2019年有所升高(χ^(2)=4.416,P=0.042)。(4)在G^(+)菌所致PDAP患者中,多重耐药菌组的重现/再发率高于非多重耐药菌组(P=0.020)。结论 多重耐药菌组的致病菌主要为凝固酶阴性葡萄球菌,且重现/再发的风险较非多重耐药菌组高。多重耐药菌相关性PDAP会导致炎症持续时间延长,需尽早使用敏感抗生素治疗并适当延长抗生素疗程。Objective To investigate the clinical characteristics,bacterial spectrum,drug resistance rate and outcome of peritoneal dialysis-associated peritonitis(PDAP)by multiple drug resistant organisms(MDRO),so as to provide clinical evidences for standardizing therapy of PDAP by MDRO.Methods Clinical data of PDAP patients admitted to The Third Hospital of Hebei Medical University during January,2016and December,2022 were retrospectively reviewed.They were divided into two groups based on the results of bacterial culture in effluent dialysate,PDAP by MDRO group and PDAP not by MDRO group.Clinical data and treatment results were compared between the two groups.Results(1)In the 96 PDAP patients,a total of123 PDAP episodes occurred,of which 56 episodes were PDAP by MDRO.The MDRO were dominated by Gram positive bacteria(49/56,87.5%),in which the most strains were coagulase-negative staphylococci(41/49,83.7%);all Gram negative bacteria were Escherichia coli(E.coli).(2)The average time for significant improvement of PDAP was longer in PDAP by MDRO group than in PDAP not by MDRO group(Z=-1.994 and-2.341;P=0.046 and 0.019);the average time for significant improvement of PDAP caused by Gram positive bacteria was 2.491 days longer in PDAP by MDRO group than in PDAP not by MDRO group(t=-2.254,P=0.028).(3)The sensitivity of Gram positive bacteria to rifampicin increased in 2020~2022 compared to that in2016-2019(χ^(2)=4.416,P=0.042).(4)In the PDAP caused by Gram positive bacteria,the recurrence rate of PDAP was higher in PDAP by MDRO group than in PDAP not by MDRO group(P=0.020).Conclusion The main pathogens in PDAP by MDRO group were coagulase-negative staphylococci.In PDAP patients by MDRO,the recurrence rate of PDAP was higher,the presence of PDAP symptoms was longer,and effective antibiotic therapy should be used earlier and longer.

关 键 词：腹膜透析 腹膜透析相关性腹膜炎 多重耐药菌 预后 

分 类 号：R459.5[医药卫生—治疗学]