280例次葡萄球菌腹膜透析相关性腹膜炎的多中心临床研究

A multicenter clinical study of 280 cases of staphylococcal peritoneal dialysis-associated peritonitis

目的分析葡萄球菌腹膜透析相关性腹膜炎(peritoneal dialysis-associated peritonitis,PDAP)的发生率、药物敏感(药敏)特点及治疗效果,为葡萄球菌PDAP的规范化治疗提供临床证据。方法回顾性收集2013年1月1日至2019年12月31日期间吉林大学第二医院、吉林大学第一医院二部、吉林市中心医院和吉林省一汽总医院腹膜透析中心收治且接受随访的PDAP患者临床资料。收集葡萄球菌PDAP患者病原学、药敏反应及耐药性结果。根据透出液培养结果分为金黄色葡萄球菌组(n=48)和凝固酶阴性葡萄球菌组(n=232),根据甲氧西林耐药与否分为耐药组(n=71)和敏感组(n=30),对比各组患者抗生素治疗的疗效与预后。采用Poisson回归法分析葡萄球菌PDAP发生率的变化趋势,线性趋势χ2检验法比较2013—2019年间葡萄球菌药物敏感性及耐药性的变化。结果共625例发生1085例次PDAP,其中280例次葡萄球菌PDAP入选本研究。葡萄球菌PDAP、金黄色葡萄球菌PDAP及凝固酶阴性葡萄球菌PDAP的发生率分别为0.063次/患者年、0.010次/患者年及0.053次/患者年。2013—2019年间葡萄球菌、金黄色葡萄球菌、凝固酶阴性葡萄球菌PDAP的发生率逐年降低(均P<0.05)。葡萄球菌对利福平的敏感率逐年升高,对莫西沙星的敏感率逐年降低,对左氧氟沙星的耐药率逐年升高(均P<0.05)。金黄色葡萄球菌组比凝固酶阴性葡萄球菌组发生难治性PDAP和拔管的比例更高(均P<0.05),且再次发生PDAP中重现的比例也更高(P<0.05)。甲氧西林耐药组使用万古霉素的比例高于敏感组(P<0.05)。结论葡萄球菌PDAP的发生率逐年降低,葡萄球菌的药敏反应特点亦随年代变迁而发生改变。金黄色葡萄球菌PDAP的治疗效果较凝固酶阴性葡萄球菌PDAP差。

Objective To investigate the incidence,drug sensitivity and drug resistance characteristies,and theraputic effect of staphylococcal peritoneal dialysis-associated peritonitis(PDAP),aim to provide clinical evidences for standardizing treatment therapy of staphylococcal PDAP.Methods Clinical data of PDAP patients admitted to the Second Hospital of Jilin University,the First Hospital of Jilin University-the Eastern Division,Jilin Central Hospital and Jilin First Automobile Work General Hospital during January 1,2013 and December 31,2019 were retrospectively collected.The results of etiology,drug sensitivity and drug resistance of staphylococcal PDAP patients were collected.According to the pathogenic bacteria,patients were divided into staphylococcus aureus group(n=48)and coagulase-negative staphylococcus group(n=232).According to the results of methicillin resistance,patients were divided into drug-resistant group(n=71)and drug-sensitive group(n=30).The prognosis of antibiotic therapy in each group were compared.Poisson regression was used to test the changing trend of the incidence of staphylococcal PDAP.The changes of drug sensitivity and drug resistance of staphylococcus were compared between 2013 and 2019 by linear trendχ2 test.Results A total of 1085 cases of PDAP occurred in 625 patients were screened,and 280 cases of staphylococcal PDAP were finally included.The incidences of staphylococcal PDAP,staphylococcus aureus PDAP and coagulase-negative staphylococcal PDAP were 0.063 times per patient year,0.010 times per patient year and 0.053 times per patient year respectively.In addition,the incidence of PDAP caused by staphylococcus,staphylococcus aureus and coagulase-negative staphylococcus decreased year by year(all P<0.05).With the change of years,the sensitivity rate of staphylococcus to rifampicin increased,while the sensitivity rate of staphylococcus to moxifloxacin decreased(both P<0.05).The drug resistance rate of staphylococcus to levofloxacin increased(P<0.05).The staphylococcus aureus group was more prone to refractory PDAP and catheter removal than that in coagulase-negative staphylococcus group,and the recurrence rate was higher than that in coagulase-negative staphylococcus group(all P<0.05).The proportion of vancomycin used during the whole course of antibiotic therapy in drug-resistant group was higher than that in drug-sensitive group(P<0.05).Conclusions The incidence of staphylococcal PDAP decreases year by year,and the drug sensitivity characteristics of staphylococcus also change.The therapeutic outcomes of staphylococcus aureus PDAP are worse than that of coagulase-negative staphylococcus.