腹膜透析相关性腹膜炎单中心8年变化趋势回顾分析

The trend of clinical characteristic changes of CAPD-related peritonitis in a period of 8 years in a single peritoneal dialysis center

目的分析8年间腹膜透析相关腹膜炎的人口学特点、细菌谱、耐药率及转归的变化趋势。方法对北京大学第一医院腹膜透析中心2003年1月至2005年12月及2008年1月至2011年8月腹膜炎进行回顾分析。结果 2008年至2011年腹膜炎人群的透析龄(34.8月比11.7月)和糖尿病患病率(41.8%比28.4%)高于2003年至2005年。两阶段分别发生121例次和258例次腹膜炎,腹膜炎发生率呈下降趋势(1次/44.8患者月比1次/58.9患者月),其中36例次和177例次培养阳性(培养阳性率分别为57.1%和73.4%),革兰氏阳性菌分别为22例次和111例次,革兰氏阴性菌为13例次和49例次。革兰氏阳性菌均以表皮葡萄球菌最多见,革兰氏阴性菌均以大肠埃希菌最多见。对多种药物耐药率均呈现不同程度的上升趋势,但对于头孢哌酮/舒巴坦、万古霉素、亚胺培南、美洛培南始终保持100%敏感。2008年至2011年的腹膜炎退出率高于2003年至2005年(20.5%比14.9%)。结论随着透析中心人群透析龄的延长,以及糖尿病患者比例的显著增加,虽然腹膜炎发生率呈下降趋势,细菌谱也无明显变化,但耐药率和腹膜炎退出率有升高趋势。

objective To investigate the trend of clinical characteristic changes of CAPD related peritonitis in a period of 8 years in a single peritoneal dialysis center. Methods Pathogens, antibiotic-resistance and prognosis of CAPD related peritonitis in stage 1 （from Jan. 2003 to Dec. 2005） and stage 2 （from Jan. 2008 to Aug. 2011） were analyzed. Results Compared to patients in stage 1, patients in stage 2 had longer PD duration （34.8 vs. 11.7 months） and higher proportion of diabetic patients （41.8% vs. 28.4%）, but lower incidence of peritonitis （one episode per 58.9 patient-months vs. one episode per 44.8 patient-months）. Of the 121 episodes in stage 1 and 258 episodes in stage 2, positive culture was obtained in 36 episodes （including Gram-positive bacteria 22 episodes and Gram-negative bacteria 13 episodes）, and 177 episodes （including Gram-positive bacteria 111 episodes and Gram-negative bacteria 49 episodes）, respectively, with the positive rate of 57.1% and 73.4%, respectively. E. coli and Staphylococcus epidermidis were the most common gram-negative bacterium and gram-positive bacterium, respectively, in patients in the two stages. Antibiotic-resistance rate showed an ascending trend for most kinds of antibioiotics, but cefoperazone/sulbactam, vancomycin, imipenem and meropenem remained to be 100% sensitive. The treatment failure rate due to peritonitis was higher in stage 2 than in stage 1 （20.5% vs. 14.9%）. Conclusion In association with the longer PD duration and the increased proportion of diabetic patients on PD, the incidence of peritonitis reduced, the bacteria spectrum changed insignificantly, and the treatment failure rate due to peritonitis showed an ascending trend.