腹膜透析相关性腹膜炎病原菌及其影响因素

Pathogenic bacteria and influencing factors for peritoneal dialysis-related peritonitis

目的分析腹膜透析(Peritoneal dialysis,PD)患者发生腹膜透析相关性腹膜炎(Peritoneal dialysis-related peritonitis,PDRP)的影响因素及PDRP患者腹透液培养的病原菌及耐药性。方法采用病例对照的研究方式选取无锡市第三人民医院2016年6月-2019年6月收治的腹膜透析发生PDRP患者67例及未发生PDRP的腹膜透析患者136例为研究对象,分析两组患者的临床资料,归纳PD患者发生PDRP的影响因素;对PDRP患者腹膜透析液进行病原菌培养及耐药性分析,并比较根据药敏结果治疗和经验性治疗的PDRP患者的预后情况。结果透析时间、合并糖尿病、ALB、腹膜透析操作总误评分、使用高渗透析液是PD患者发生PDRP的影响因素(P<0.05);67例PDRP患者中有41例的腹透液培养结果为阳性,共检出病原菌46株,其中革兰阴性菌22株占47.83%,革兰阳性菌23株占50.00%,真菌1株占2.17%,主要革兰阳性菌对万古霉素、利奈唑胺、替考拉宁敏感,主要革兰阴性菌对亚胺培南、头孢哌酮/舒巴坦敏感;根据药敏结果治疗的患者完全缓解率为68.29%(28/41)高于经验性治疗患者的34.62%(9/26)(P=0.007)。结论透析时间>18个月、合并糖尿病、ALB<30g/L、腹膜透析操作总误评分≥19.5分、使用高渗透析液均是发生PDRP的高危因素,透析液中病原菌以革兰阳性菌为主,根据药敏结果治疗的预后要明显优于经验性治疗患者。

OBJECTIVE To analyze the influencing factors of peritoneal dialysis-related peritonitis(PDRP)in patients undergoing peritoneal dialysis(PD),as well as pathogens and drug resistance in peritoneal dialysis fluid(PDF)of PDRP patients.METHODS A total of 67PDRP patients and 136non-PDRP patients who underwent PD were admitted to Wuxi Third People's Hospital from Jun.2016to Jun.2019were selected as the research subjects by case-control method.The clinical data in both groups were analyzed and the influencing factors of PDRP in PD patients were summarized.The peritoneal dialysis of PDRP patients was cultured and analyzed for drug resistance,and the prognosis of PDRP patients treated based on drug sensitivity results and empirical treatment was compared.RESULTS Dialysis time,diabetes,ALB,total error score of PD operation and the usage of hyperosmotic fluid were the influencing factors of PDRP in PD patients(P<0.05).Of the 67PDRP patients,41of the peritoneal fluid culture results were positive.A total of 46strains of pathogens were detected,of which,22strains of Gram-negative bacteria accounted for 47.83%,23strains of Gram-positive bacteria accounted for 50.00%and 1 strain of fungus accounted for 2.17%.The main Gram-positive bacteria were sensitive to vancomycin,linezolid and teicoplanin,and the main Gram-negative bacteria were sensitive to imipenem and cefoperazone/sulbactam.The complete remission rate of patients treated according to the drug sensitivity results was 68.29%(28/41),significantly higher than that of patients treated with empirical therapy(34.62%,9/26)(P=0.007).CONCLUSIONDialysis time longer than 18months,diabetes mellitus,ALB lower than 30g/L,total error score of PD operation not lower than 19.5points and usage of hypertonicity PDF were all high-risk factors for PDRP.The pathogenic bacteria in PDF were mainly Gram-positive bacteria.The prognosis of patients treated according to the drug sensitivity results was significantly higher than that of patients with empirical treatment.