腹膜透析相关性腹膜炎临床特点和病原学及其预后

Clinical characteristics, distribution of pathogens and prognosis of patients with peritoneal dialysis-related peritonitis

目的对比单发性与多发性腹膜透析相关性腹膜炎(PDRP)的临床特点、病原菌分布及预后,为透析患者继发感染的预防和治疗提供研究依据。方法选择2011年6月-2017年12月的120例PDRP患者,单发性PDRP患者80例,多发性PDRP患者40例。对两类患者的临床特点、病原菌分布及预后情况进行对比和分析。结果两类PDRP患者的年龄、血清血红蛋白水平、白蛋白水平、首次发病至透析开始时间、合并糖尿病、透析为他人操作等差异均有统计学意义(P<0.05)。单发性PDRP患者检出病原菌75株,其中,革兰阳性菌37株占49.33%,革兰阴性菌30株占40%,真菌8株占10.67%;多发性PDRP患者检出病原菌43株,其中,革兰阳性菌17株占39.53%,革兰阴性菌12株占27.91%,真菌14株占32.56%。两类患者病原菌构成比的差异有统计学意义(P<0.05)。单发性PDRP患者与多发性PDRP患者的预后转归情况的差异无统计学意义。结论多发性PDRP患者存在一定临床特征,病原菌以革兰阳性菌为主,积极治疗后不会导致患者出现明显的预后恶化。

OBJECTIVE To investigate the clinical characteristics of single and multiple peritoneal dialysis-related peritonitis(PDRP) and analyze the distribution of pathogens and prognosis so as to provide guidance for prevention and treatment of secondary infection in the dialysis patients. METHODS A total of 120 PDRP patients who were treated in the hospital from Jun 2011 to Dec 2017 were enrolled in the study, including 80 cases of single PDRP and 40 cases of multiple PDRP. The clinical characteristics, distribution of pathogens and prognosis were observed and compared between the two types of patients. RESULTS There were significant differences in the age, serum hemoglobin level, albumin level, interval between first onset of peritonitis and start of dialysis, complication of diabetes mellitus, and dialysis performed by others between the two types of PDRP patients(P<0.05). Totally 75 strains of pathogens were isolated from the patients with single PDRP, 37(49.33%) of which were gram-positive bacteria, 30(40%) were gram-negative bacteria, and 8(10.67%) were fungi. Totally 43 strains of pathogens were isolated from the patients with multiple PDRP, 17(39.53%) of which were gram-positive bacteria, 12(27.91%) were gram-negative bacteria, and 14(32.56%) were fungi. There were significant differences in the constituent ratios of pathogens between the two types of patients(P<0.05). There was no significant difference in the prognosis between the patients with single PDRP and the patients with multiple PDRP. CONCLUSION The patients with multiple PDRP show certain clinical characteristics, the gram-positive bacteria are dominant among the pathogens, and active treatment may not lead to the significant deterioration of prognosis.