铜绿假单胞菌所致腹膜透析相关性腹膜炎临床特征及预后  

Clinical characteristics and prognosis of Pseudomonas aeruginosa peritoneal dialysis-associated peritonitis

作　　者：王志刚[1] 耿瀛洲 王晓培 李昭 梁嫦娜 路万虹[1] 吕晶 WANG Zhigang;GENG Yingzhou;WANG Xiaopei;LI Zhao;LIANG Changna;LU Wanhong;LYU Jing(Department of Nephrology,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院肾内科,陕西西安710061

出　　处：《中国感染控制杂志》2025年第3期381-387,共7页Chinese Journal of Infection Control

基　　金：陕西省重点研发计划项目(2021SF-070);西安交通大学第一附属医院临床科研课题面上项目(XJTU1AF-CRF-2019-017)。

摘　　要：目的分析铜绿假单胞菌腹膜透析相关性腹膜炎(PaeP)临床特征及转归。方法回顾性分析2019年1月—2020年12月某院肾脏内科门诊随访的腹膜透析相关性腹膜炎(PDAP)患者,根据细菌培养结果分为PaeP组和非PaeP组,分析PaeP患者的临床特征及铜绿假单胞菌药敏试验结果,比较两组患者的临床表现、实验室检查结果及预后情况。结果共纳入腹膜透析患者124例,发生腹膜炎164例次,PaeP组16例,非PaeP组148例。铜绿假单胞菌感染11例,16例次,占PDAP患者的8.9%,其中4例患者伴腹膜透析置管隧道口感染,重现5例次,1例治愈,1例死亡,9例拔管。拔管患者中,1例停止透析,3例血液透析过渡后再次置管,5例永久转为血液透析(HD),技术失败率为54.5%。与非PaeP组比较,PaeP组患者透析时间较短(13.83±4.92 VS 38.53±35.77个月);感染期间C反应蛋白较高(96.61±66.17 VS 45.87±44.65 mg/L),清蛋白水平较低(25.62±4.42 VS 29.46±8.25 g/L);起始感染时腹膜透析液多核细胞比例较高;治疗第5天腹膜透析液白细胞计数转阴率较低;差异均有统计学意义(均P<0.05)。PaeP组患者治愈率低于非PaeP组,技术失败率高于非PaeP组,差异均有统计学意义(均P<0.05)。两组患者病死率比较,差异无统计学意义(P>0.05)结论PaeP患者临床表现较重,临床治疗效果差,重现率及拔管率高。对于反复重现的患者,拔管后重置并更换隧道,是降低技术失败的有效手段。Objective To analyze the clinical characteristics and prognosis of Pseudomonas aeruginosa peritoneal dialysis-associated peritonitis(PaeP).Methods Peritoneal dialysis-associated peritonitis(PDAP)patients who were followed up in the nephrology outpatient department of a hospital from January 2019 to December 2020 were analyzed retrospectively.According to bacterial culture results,patients were divided into the PaeP group and non-PaeP group.Clinical characteristics of PaeP patients and antimicrobial susceptibility testing results of Pseudomonas aeruginosa were analyzed,clinical manifestations,laboratory test results,and prognosis of two groups of patients were compared.Results A total of 124 peritoneal dialysis patients were included in analysis,164 cases of peritonitis occurred,16 cases were in the PaeP group and 148 in the non-PaeP group.11 patients developed 16 episodes of Pseudomonas aeruginosa infection,accounting for 8.9%of PDAP patients.Among them,4 patients had peritoneal dialysis catheter exit-site infection,with 5 recurrence cases,1 case cured,1 case died,and 9 cases were extubated.Among the extubated patients,1 withdrew dialysis,3 were recovered to peritoneal dialysis after hemodialysis,5 changed to permanently hemodialysis,with a technical failure rate of 54.5%.Compared with the non-PaeP group,patients in the PaeP group had a shorter dialysis time(13.83±4.92 vs 38.53±35.77 months).During the infection period,C-reactive protein levels were higher(96.61±6.17 vs 45.87±44.65 mg/L),while albumin levels were lower(25.62±4.42 vs 29.46±8.25 g/L).At the onset of infection,the proportion of polymorphonuclear cells in peritoneal dialysis fluid was relatively higher.On the 5th day of treatment,the negative conversion rate of white blood cell count in peritoneal dialysis fluid was relatively low.Differences were all statistically significant(all P<0.05).The cure rate of patients in the PaeP group was lower than that in the non-PaeP group,the technical failure rate was higher than that in the non-PaeP group,bo

关 键 词：腹膜透析相关性腹膜炎 铜绿假单胞菌腹膜透析相关性腹膜炎 铜绿假单胞菌 经验性治疗 技术失败 

分 类 号：R656.41[医药卫生—外科学]