腹膜透析相关性腹膜炎患者病原菌及相关因素分析

Analysis of risk factors and pathogenic characteristics of infections in patients with peritoneal dialysis associated peritonitis

目的探讨影响腹膜透析相关性腹膜炎(Peritoneal dialysis associated peritonitis,PDAP)患者感染病原菌及相关因素。方法选择2014年12月-2017年6月医院收治的行腹膜透析(Peritoneal dialysis,PD)治疗的患者121例为研究对象,根据是否出现PDAP分为感染组54例和未感染组67例;收集PDAP患者的透出液作为标本送检,对病原菌进行鉴定及药敏试验;分析121例患者临床资料,归纳腹膜透析相关性腹膜炎患者感染的相关因素。结果 PDAP患者病原学检测阳性率为72.22%(39/54),共培养分离病原菌52株,其中革兰阳性菌32株占61.54%,以表皮葡萄球菌为主;革兰阴性菌15株占28.85%,以大肠埃希菌为主;真菌5株占9.62%;主要革兰阳性菌对青霉素、苯唑西林及红霉素的耐药率均>50%,对利奈唑胺、利福平、万古霉素、替考拉宁及对喹奴普汀/达福普汀较敏感;主要革兰阴性菌对头孢噻肟、头孢曲松、头孢他啶耐药率>50%,而对头孢哌酮、亚胺培南、美罗培南、阿米卡星较敏感。年龄、白蛋白(ALB)、合并糖尿病、使用高糖透析液是PDAP发生的相关因素(P<0.05)。结论应针对PDAP发生的相关因素,给予积极干预,同时应根据病原学检测结果给予合理的抗菌药物治疗,以降低患者感染及死亡风险。

OBJECTIVE To investigate the risk factors of infections in patients with peritoneal dialysis associated peritonitis and the pathogenic characteristics of infections.METHODS 121 cases of patients treated with peritoneal dialysis from Dec.2014 to Jun.2017 in the Fifth Hospital Affiliated to Zhongshan University were selected as subjects,and divided into the infection group with 54 cases and the uninfected group with 67 cases,based on the occurrence of PDAP.The dialysis effluent of PDAP patients was collected as the specimen for examination,and the pathogens were identified and drug susceptibility test was carried out.The clinical data of 121 patients were analyzed and the related factors of infection in patients with peritoneal dialysis-related peritonitis were summarized.RESULTS The positive rate of pathogen detection in PDAP patients was 72.22%（39/54）,from which 52 strains were isolated,including 32 strains of gram-positive bacteria（61.54%）dominated by Staphylococcus epidermidis,15 strains of gram-negative bacteria（28.85%）dominated by Escherichia coli,and 5 strains of fungi（9.62%）.Drug sensitivity test showed that the resistance rates of main gram-positive bacteria to penicillin,oxacillin,erythromycin were higher than 50%,whereas they were relatively sensitive to linezolid,rifampin,vancomycin,teicoplanin,dalfopristin/quinupristin.The resistance rates of main gram-negative bacteria to cefotaxime,ceftriaxone,ceftazidime were high than 50%,and they were relatively sensitive to imipenem,meropenem,cefoperazone,amikacin.Age,Albumin（ALB）,diabetes mellitus,and the use of high-glucose dialysis fluid were related factors of PDAP occurrence.CONCLUSIONClinical intervention should be given based on the related factors of PDAP,together with reasonable antibiotic treatment according to the pathogen test results,to reduce the risk of infection and death.