延迟拔管的腹膜透析相关性腹膜炎的病原学特点

Etiological Features of Peritoneal Dialysis-associated Peritonitis with Delayed Removal of the Peritoneal Catheter

目的:探讨延迟拔管的腹膜透析相关性腹膜炎(PDAP)的病原学特点。方法:选取延迟拔管的PDAP患者共50例为研究对象(D组),以非难治性PDAP组(B组,n=37例)和难治性PDAP内科保守治疗有效组(C组,n=15例)为对照,进行腹膜透出液细菌、真菌培养。结果:腹膜炎总的培养阳性率为74.5%,其中B、C、D三组培养阳性率分别为81.1%、46.7%、78.0%。与B组比,D组真菌感染、二重感染比例均为23.1%,明显升高(P<0.01)。与B、C组比,D组真菌+二重感染+混合感染比例高达56.4%,明显升高(P<0.01)。D组32例(64.0%)进行动态培养,其中18例病原菌转为阴性,6例G^+或G^-菌转为混合感染、2例真菌菌种不断变化,2例G^+球菌持续阳性,4例病原菌持续阴性。经治疗90 d死亡7例、存活率86.0%。结论:延迟拔管的PDAP病原学以真菌+二重感染+混合感染为主。动态监测病原菌的演变,有助于指导治疗及提高疗效。

Objective:To explore the etiological features of peritoneal dialysis-associated peritonitis(PDAP)with delayed removal of the peritoneal catheter.Methods:50 PDAP patients with delayed catheter removal were identified as research subjects(Group D),as compared to control groups of 37 non-refractory PDAP patients(Group B)and 15 cases of refractory PDAP who internal medicine treatment was effective(Group C).Bacteria and fungi were cultured in peritoneal effusion.Results:Overall,74.5%of PDAP cases were positive in their etiological culture,with Group B,C and D showing 81.1%,46.7%and 78.0%positive respectively.Compared to,The proportion of patients with fungal infection and double infection in Group D were both 23.1%,which was significantly higher than that in Group B(P<0.01).The total rate of fungal infection,double infection and mixed infection in Group D was 56.4%,which was significantly higher than that in group B(P<0.01).In Group D,32 cases(64.0%)had dynamic cultured,Among the 32 cases,18 cases showed pathogenic bacteria transitioning positive to negative,6 cases from G^+or G^-to mixed infection.The type of fungal species constantly changed in 2 cases.G^+bacteria persisted in 2 cases and pathogens was negative all the time in 4 cases.After treatment,7 cases died within 90 days and survival rate of PDAP was 86.0%.Conclusion:The etiology of PDAP with delayed removal of the peritoneal catheter is mainly fungal,double and mixed infections.Dynamic monitoring of the evolving pathogens is helpful for guiding treatment and improving efficacy.