慢性肾衰竭腹膜透析患者发生腹膜炎的病原菌特征及危险因素分析  

Characteristics of pathogens and risk factors for peritonitis in patients with chronic renal failure undergoing peritoneal dialysis

作　　者：王明铭[1] 刘静[1] 鲁华[1] WANG Mingming;LIU Jing;LU Hua(Department of Nephrology,Xingtai People's Hospital,Xingtai Hebei,054001,China)

机构地区：[1]河北省邢台市人民医院肾脏内科,河北邢台054001

出　　处：《中国病原生物学杂志》2025年第5期633-637,共5页Journal of Pathogen Biology

摘　　要：目的本研究旨在探讨慢性肾衰竭腹膜透析患者发生腹膜炎的病原菌特征及其相关危险因素,为临床制定更有效的预防和治疗策略提供科学依据。方法本研究纳入了本院肾内科2020年5月至2024年5月期间接受腹膜透析治疗的98例慢性肾衰竭患者,其中53例发生腹膜炎(观察组),45例未发生腹膜炎(对照组)。通过收集患者的临床资料、实验室检查结果和病原菌培养及药敏试验数据,分析两组患者的病原菌分布特征及其耐药性。采用单因素分析和二元Logistic回归分析,识别腹膜炎发生的独立危险因素。利用受试者工作特征(ROC)曲线分析各指标对腹膜炎发生的预测价值。结果观察组革兰阳性菌检出率显著高于对照组(52.83%vs 26.67%,P<0.05),其中凝固酶阴性葡萄球菌检出率亦显著高于对照组(28.30%vs 13.33%,P<0.05)。真菌的检出率显著高于对照组(15.09%vs 0.00%,P<0.05),且均为念珠菌。耐药性分析发现观察组中,凝固酶阴性葡萄球菌、链球菌、金黄色葡萄球菌、大肠埃希菌、铜绿假单胞菌和肠球菌属均存在一定的耐药率,其中金黄色葡萄球菌的耐药率最高,达到80.00%。单因素分析显示透析龄、血清钾、血清白蛋白、腹膜透出液中性粒细胞比例在腹膜炎患者和无腹膜炎患者间存在显著差异(P<0.05)。二元Logistic回归分析发现透析龄、血清钾、血清白蛋白、腹膜透出液中性粒细胞比例是腹膜炎发生的独立危险因素。ROC曲线分析显示腹膜透出液中性粒细胞比例对腹膜炎发生的预测价值最高(AUC=0.812),其灵敏度为79.23%,特异度为77.81%。结论革兰阳性菌和真菌是腹膜炎的主要病原菌,耐药性问题突出。透析龄、血清钾水平、血清白蛋白水平和腹膜透出液中性粒细胞比例是腹膜炎发生的独立危险因素。腹膜透出液中性粒细胞比例对腹膜炎的发生具有较好的预测价值。Objective This study aims to investigate the characteristics of pathogens causing peritonitis and the related risk factors in patients with chronic renal failure undergoing peritoneal dialysis,providing a scientific basis for the development of more effective prevention and treatment strategies in clinical practice.Methods This study included 98 patients with chronic renal failure who received peritoneal dialysis treatment in the Department of Nephrology of our hospital from May 2020 to May 2024.Among them,53 patients developed peritonitis(observation group)and 45 did not(control group).Clinical data,laboratory test results,and pathogen culture and antibiotic sensitivity test data were collected from the patients to analyze the distribution and drug resistance of pathogens between the two groups.Univariate analysis and binary logistic regression analysis were used to identify independent risk factors for peritonitis.The predictive value of various indicators for peritonitis was assessed using receiver operating characteristic(ROC)curve analysis.Results The detection rate of Gram-positive bacteria in the observation group was significantly higher than that in the control group(52.83%vs.26.67%,P<0.05),with a significantly higher detection rate of coagulase-negative staphylococci(28.30%vs.13.33%,P<0.05).The detection rate of fungi was also significantly higher in the observation group compared to the control group(15.09%vs.0.00%,P<0.05),and all fungi detected were Candida species.Drug resistance analysis revealed that coagulase-negative staphylococci,streptococci,Staphylococcus aureus,Escherichia coli,Pseudomonas aeruginosa,and Enterococcus spp.all exhibited certain resistance rates in the observation group,with the highest resistance rate observed in S.aureus at 80.00%.Univariate analysis showed significant differences in dialysis duration,serum potassium,serum albumin,and the proportion of neutrophils in peritoneal dialysis effluent between patients with and without peritonitis(P<0.05).Binary logistic regression a

关 键 词：慢性肾衰竭 腹膜透析 腹膜炎 病原菌 危险因素 

分 类 号：R692.5[医药卫生—泌尿科学]