革兰阴性菌所致腹膜透析相关性腹膜炎的耐药性及影响因素研究

Prevalence of Drug Resistance and Risk Factors Associated with Gram-negative Bacteria in Patients with Peritoneal Dialysis-associated Peritonitis

目的探讨革兰阴性(G^-)菌所致腹膜透析相关性腹膜炎(PDAP)的耐药性及影响因素,以期为临床诊治工作提供更多依据。方法回顾性选取2012—2016年昆山市第一人民医院发生PDAP且符合纳入标准的236例患者,根据导致PDAP的细菌类型将患者分为G^-菌组(56例)与革兰阳性(G^+)菌组(180例)。收集患者一般资料和实验室检查结果,观察患者耐药情况,检测超广谱β内酰胺酶(ESBLs)。G^-菌所致PDAP的影响因素分析采用多因素Logistic回归分析。结果 G^-菌所致PDAP中头孢菌素类和喹诺酮类的耐药率逐年上升,酶抑制剂类、碳青霉烯类、氨基糖苷类耐药性变化不大,产ESBLs的G^-菌所致的PDAP逐年增加。两组平均透析时间、肠道感染比例、人为操作原因比例、腹透液有核细胞计数、腹透液中性粒细胞计数、钾、降钙素原比较,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,平均透析时间、人为操作原因、钾、降钙素原是G^-菌所致PDAP的影响因素(P<0.05)。结论 G菌所致PDAP中头孢菌素类和喹诺酮类的耐药率逐年上升;平均透析时间、人为操作原因、钾、降钙素原是发生G^-菌所致PDAP的影响因素。G^-菌所致PDAP可能与患者自身的内在环境因素有关。随着产ESBLs的G^-菌逐年增多,及时治疗G^-菌感染的腹膜炎十分必要。

Objective To investigate the prevalence of drug resistance and explore the risk factors associated with Gram-negative(G-)bacteria in patients with peritoneal dialysis-associated peritonitis(PDAP)in order to improve clinical diagnosis and treatment.Methods We collected and retrospectively analyzed the clinical data of 236 patients with PDAP at the First People's Hospital of Kunshan from 2012 to 2016,who met the inclusion criteria.The patients were divided into two groups based on whether they were infected with G-bacteria group(56 cases)or Gram-positive(G+)bacteria group(180 cases).Patient information and laboratory test results were collected.Drug resistance was measured and extended spectrumβ-lactamases(ESBLs)were detected.Multivariate G-regression analysis was used to analyze the influencing factors of PDAP caused by G-bacteria.Results In G-bacteria-induced PDAP,resistance to cephalosporins and quinones increased every year,whereas resistance to enzyme inhibitors,carbapenems,and aminoglycosides did not change significantly over time.PDAP cases caused by ESBL-producing G-bacteria also increased.Dverage dialysis time,enteric infections,reason for dialysis,nucleated cell court of peritoneal dialysate,nucleated cell court of neutrophil count,serum potassium and procalcitonin were significant differences between the results of G-bacteria group and G+bacteria group(P>0.05).Multivariate Logistic regression suggested that average dialysis time,reason for dialysis,and serum potassium and procalcitonin were risk factors for G-bacteria-induced PDAP(P<0.05).Conclusion In G-bacteria-induced PDAP,resistance to cephalosporins and quinones increased every year;average dialysis time,reason for dialysis,and serum potassium and procalcitonin are the influencing factors of G-bacteria-induced PDAP.G-bacteria-induced PDAP may be associated with patient-related factors.Given the increasing prevalence of ESBL-producing G-bacteria,it is necessary to treat G-bacteria-induced PDAP promptly and effectively.