碘伏帽引起的腹膜透析相关性腹膜炎暴发调查

The outbreak of peritoneal dialysis-associated peritonitis caused by iodophor cap

目的调查一起腹膜透析患者腹膜炎暴发的原因。方法采用病例对照研究方法,探讨2019年6月1日—8月17日某三级甲等综合医院肾脏疾病中心患者腹膜透析相关性腹膜炎暴发的危险因素;并进一步通过队列研究验证高危因素。对腹膜炎患者的透析产品进行微生物培养探索可能病原体。结果病例对照研究表明,使用“YW”牌碘伏帽是本次腹膜透析相关性腹膜炎暴发的独立危险因素,校正OR为15.40,95%CI为2.93~80.95。队列研究证实,使用“YW”牌碘伏帽是本次暴发的原因,HR为6.81,95%CI为2.61~17.77。碘伏帽标本和腹膜透析液采样的细菌培养及内毒素检测结果均为阴性,停用“YW”牌碘伏帽腹膜透析相关性腹膜炎发生率降至以往4年的平均水平,确定本次腹膜透析相关性腹膜炎为化学性腹膜炎。结论此次暴发是因腹膜透析患者使用“YW”牌碘伏帽引起的腹膜透析相关性化学性腹膜炎的暴发。

Objective To investigate the cause of an outbreak of peritonitis in peritoneal dialysis patients.Methods A case-control study was conducted to explore the risk factors for the outbreak of peritoneal dialysis-related peritonitis in the renal disease center of a tertiary first-class hospital from June 1 to August 17,2019;high risk factors were further verified by cohort study.Microbial culture of dialysis products of patients with peritonitis was performed to explore possible pathogens.Results The case-control study showed that the use of“YW”brand iodophor cap was an independent risk factor for this outbreak of peritoneal dialysis-related peritonitis,the adjusted OR was 15.40 and the 95%CI was 2.93-80.95.The cohort study confirmed that the use of“YW”brand iodophor cap was the cause of this outbreak,with an HR of 6.81 and the 95%CI of 2.61-17.77.Bacterial culture and endotoxin test results of specimens of“YW”brand iodophor cap and peritoneal dialysate were all negative,stopping the use of“YW”brand iodophor cap,incidence of peritoneal dialysis-related peritonitis decreased to the average level in the past 4 years,and it was determined that this peritoneal dialysis-related peritonitis was chemical peritonitis.Conclusion The outbreak is peritoneal dialysis-related chemical peritonitis in peritoneal dialysis patients due to the use of“YW”brand iodophor cap.