频发腹膜透析相关性腹膜炎的临床分析

Clinical analysis of frequent peritoneal dialysis associated peritonitis

目的分析频发腹膜透析相关性腹膜炎(PDAP)的临床特征并探讨其影响因素。方法回顾性分析2012年1月2017年11月在吉林大学第二医院治疗的PDAP患者91例。其中,29例在1年内发生≥2次PDAP为频发组,62例仅发生过1次PDAP为偶发组,比较两组患者临床资料,分析影响频发PDAP的因素及预后。结果两组患者置管时血清白蛋白水平比较,差异有统计学意义(P<0.05)。两组患者感染时血清白蛋白水平比较,差异有统计学意义(P<0.05)。频发组G+菌感染率较偶发组高(P<0.05)。两组的G+菌均对青霉素、红霉素、苯唑西林的耐药率较高,对万古霉素、替加环素、利奈唑胺的敏感性较高。两组的G-菌均对氨苄西林、头孢唑啉、头孢呋辛钠、头孢呋新酯的耐药率较高,对美罗培南、亚胺培南、哌拉西林的敏感性较高。结论血清白蛋白水平可能是PDAP的影响因素。频发患者G+菌感染率较高。PDAP患者的G+菌对万古霉素、替加环素、利奈唑胺的敏感性较高,而G-菌对美罗培南、亚胺培南、哌拉西林的敏感性较高。

Objective To investigate the clinical features of frequent peritoneal dialysis associated peritonitis(PDAP)and to explore its influencing factors.Methods The clinical data of 91 PDAP patients treated in our hospital from January 2012 to November 2017 were retrospectively analyzed.Among them,29 cases occurred twice(or more than twice)in one year,and 62 cases occurred only once in one year.The data of two groups were compared to investigate the factors and prognosis of frequent PDAP.Results There was significant difference between the two groups in the level of human serum albumin during catheterization(P<0.05).There was significant difference between the two groups in the level of human serum alb-umin at the time of infection(P<0.05).The infection rate of G+bacteria in frequency group is higher than that in occasional group(P<0.05).The results of drug sensitivity analysis showed G+strains in both groups had higher resistance to penicillin,erythromycin and oxacillin,and were more sensitive to vancomycin,tegacycline and linazolamine.The resistance rate of G-bacteria to ampicillin,cefazolin,cefuroxime sodium and cefuroxime ester was higher,and the sensitivity to meropenem,imipenem and piperacillin was higher in both groups.Conclusions This study found that the level of human serum albumin is an independent influence factor of frequent PDAP.The infection rate of G+bacteria in frequency group is higher than that in occasional group.The G+bacteria in both groups were highly sensitive to vancomycin,tegacycline and linazolamide.The G-bacteria in both groups were highly sensitive to meropenem,imipenem and piperacillin.