腹膜透析患者导管出口感染的微生物特征及治疗转归分析  

Microbiological characteristics and treatment outcome analysis of exit-site infection in peritoneal dialysis patients

作　　者：刘丹阳 张广清 朱露 钟晓红[1] 张婷婷[1] 林炎虹[1] 蒋建平[1] 卢颜 龚妮容[1] Liu Danyang;Zhang Guangqing;Zhu Lu;Zhong Xiaohong;Zhang Tingting;Lin Yanhong;Jiang Jianping;Lu Yan;Gong Nirong(Division of Nephrology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Administrative Office,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院肾内科,广州510515 [2]南方医科大学南方医院院办,广州510515

出　　处：《中华肾脏病杂志》2024年第10期798-803,共6页Chinese Journal of Nephrology

基　　金：广东省医学科学技术研究基金(B2023278);南方医科大学南方医院院长基金(2023H017)。

摘　　要：目的描述腹膜透析(peritoneal dialysis,PD)导管出口感染(exit site infection,ESI)发生率并分析其病原菌特征。方法回顾2020—2022年南方医科大学南方医院PD并发ESI患者的临床资料,描述ESI发生率的动态变化,并分析ESI致病菌的菌种分布、外用抗生素的药敏情况及治疗转归。结果共有159例PD患者发生了187次ESI。革兰阳性菌和革兰阴性菌的感染比例分别为80.7%和18.3%,主要菌株分别为凝固酶阴性葡萄球菌(51.1%,45/88)和铜绿假单胞菌(60.0%,12/20)。利福平(革兰阳性菌敏感率88.9%;革兰阴性菌敏感率100.0%)和庆大霉素(革兰阳性菌敏感率83.6%;革兰阴性菌敏感率93.3%)是主要的外用类敏感药物。137例次(73.3%)的ESI经过治疗可在2周内治愈;50例次(26.7%)难治性ESI中,合并隧道感染比例为22.0%,接受隧道重建术比例为10.0%,拔管比例仅为4.0%。结论ESI的监测与报告是改善PD管理质量的重要内容。通过回顾ESI发生率、病原菌特征及治疗效果,可为相关指南的制定和临床诊疗提供真实可靠的观察性研究数据。Objective To describe the incidence of peritoneal dialysis(PD)catheter exit site infection(ESI)and to analyze its pathogenic bacteria characteristics.Methods The clinical data of PD patients with ESI in Nanfang Hospital of Southern Medical University from 2020 to 2022 was reviewed to describe the dynamic changes in the incidence of ESI,and to analyze the distribution of ESI pathogens,antimicrobial sensitivity analysis of topical antibiotics and treatment outcomes.Results A total of 187 ESI episodes occurred in 159 PD patients.The proportion of gram-positive and gram-negative ESI were 80.7%and 18.3%,respectively.The main gram-positive and gram-negative pathogen were coagulase negative Staphylococcus(51.1%)and Pseudomonas aeruginosa(60.0%).Rifampicin(sensitivity rate of gram-positive organisms was 88.9%;gram-negative organisms was 100.0%)and gentamicin(sensitivity rate of gram-positive organisms was 83.6%;gram-negative organisms was 93.3%)is the main topical sensitive antibiotics.137 cases(73.3%)of ESI were cured within 2 weeks after treatment.Among the 50 cases(26.7%)of refractory ESI,22.0%of cases were associated with tunnel infection,10.0%with tunnel reconstruction,and only 4.0%with removal of PD catheter.Conclusion Monitoring and reporting of ESI is an important part to improve the quality of PD management.By reviewing the incidence of ESI,pathogenic bacteria characteristics and treatment effects,real and reliable observational data for the formulation of relevant guidelines and clinical diagnosis and treatment can be provided.

关 键 词：腹膜透析 感染 细菌感染 微生物敏感性试验 

分 类 号：R692.5[医药卫生—泌尿科学]