持续性不卧床腹膜透析相关性腹膜炎患者的临床特征及致病菌分析

Clinical Features and Pathogenic Bacteria in Patients with Continuous Ambulatory Peritoneal Dialysis Related Peritonitis

目的分析持续性不卧床腹膜透析(CAPD)相关性腹膜炎患者的临床特征及致病菌谱。方法采用系统性回顾法分析2012年1月-2016年5月我院腹膜透析中心收治的182例CAPD患者作为研究对象,根据是否发生相关性腹膜炎将其分为A组(CAPD相关性腹膜炎患者50例)和B组(未发生相关性腹膜炎的CAPD患者132例),比较两组患者一般临床资料及相关实验室检查结果,统计归纳CAPD相关性腹膜炎患者的临床特征,并通过分析其临床资料,探讨其致病菌谱及药敏情况。结果 A组患者其年龄较B组大,透析时间较B组长,且其BMI,HGB和Alb水平及文化程度均较B组低,且A组中原发疾病为慢性肾小球肾炎最多,2组比较差异间均具有统计学意义(P<0.05);在本组CAPD相关性腹膜炎患者中,革兰阳性菌感染率(72.00%)较革兰阴性菌感染率(24.00%)明显高,真菌感染较少(4.00%),且革兰阳性菌中表皮葡萄球菌感染最为常见(44.44%),革兰阴性菌中大肠杆菌感染较为多见(41.67%)(P<0.05);药敏试验结果表明,在抗革兰阳性菌药物中,青霉素耐药率最高(72.22%),头孢唑林次之(50.00%);在抗革兰阴性菌药物中,氨苄青霉素耐药率最高(83.33%),其次为庆大霉素(66.67%)(P<0.05)。结论 CAPD相关性腹膜炎好发于年龄较大、透析时间较长及BMI较低的CAPD患者,应密切观察其病情变化并及时予以完善检查,降低CAPD相关性腹膜炎发生率。

Objective To analyze the clinical features and pathogenic spectrum of persistent peritoneal dialysis（ CAPD）-related peritonitis.Methods The clinical data about a total of 182 patients with CAPD admitted to our hospital between January2012 and May 2016 was analyzed retrospectively.The patients were divided into two groups according to whether they had peritonitis： Group A（ 50 cases with CAPD-related peritonitis） and Group B（ 132 cases of CAPD patients without associated peritonitis）.The clinical data of patients with CAPD related peritonitis was statistically analyzed by comparing their clinical data and laboratory test results.The pathogenic bacteria spectrum and drug susceptibility were also explored.Results Patients in Group A were older than those of Group B,and the duration of dialysis was longer. The levels of BMI,HGB,Alb and education were lower in Group A than those in Group B.In patients with CAPD-related peritonitis,the gram-positive bacteria infection rate（ 72. 00%）was significantly higher than that（ 24. 00%） of patients with gram-negative bacteria infection（ P〈0.05）.The prevalence rate of staphylococcus（ 44.44%） was the highest in gram-positive bacteria infections while gram-negative bacteria were more common in E.coli（ 41.67%）（ P〈0.05）.The drug sensitivity test showed that among drugs against gram-positive bacteria,the resistance rate to penicicin was the highest（ 72. 00%）,followed by cefazolin（ 50. 00%）,and that among drugs against gram-negative bacteria,the drug resistance rate to ampicilin was the highest（ 83. 33%）,followed by gentamicin（ 66. 67%）（ P〈0.05）.Conclusion CAPD-associated peritonitis occurs in elder patients with a longer duration of dialysis and a lower body mass index.Close observation of the disease and completed examinations can reduce the chance of CAPD related peritonitis.