细菌种类对腹膜透析相关性腹膜炎患者短期预后的影响

Effect of bacterial species on short-term outcomes in patients with peritoneal dialysis-associated peritonitis

目的分析单中心腹膜透析相关性腹膜炎(peritoneal dialysis associated peritonitis,PDAP)细菌及抗菌谱发布情况,分析细菌种类对临床短期预后的影响。方法回顾本中心2019年1月—2020年12月所有PDAP细菌培养结果,感染后短期临床结局,分析不同细菌谱PDAP指标特点对短期临床结局的影响。结果共124人,发生了166例次,130例培养阳性,G阳性菌占73.1%,G阴性菌占25.4%,真菌占1.54%。G阳性菌以表皮葡萄球菌、金黄色葡萄球菌为主。G阴性菌以铜绿假单胞菌和大肠埃希氏菌为主。二元Logistics回归示:与G阳性菌比较,G阴性菌感染治疗失败风险增高14.90倍,真菌增高42倍。其中铜绿假单胞菌治愈率仅16.7%,重现率27.8%,导致拔管为50%,明显高于其他患者(χ^(2)=40.734,P<0.001),合并严重隧道感染者占55.6%。结论①G阳性菌较G阴性菌及真菌治愈率高。②铜绿假单胞菌的重现,拔管和死亡风险高,与隧道感染明显有关。③口腔共生菌,家禽及环境相关致病菌有增加的趋势,需重视对口腔卫生习惯和家庭环境的评估。

Objective To analysis the bacterial and antibacterial spectrum release of peritoneal dialysis associated peritonitis(PDAP)in a single-center and to analyze the effect of bacterial species on short-term clinical prognosis.Methods To review the results of all PDAP bacterial culture in the center from January 2019 to December 2020,the short-term clinical outcomes after infection,and to analyze the effects of PDAP index characteristics of different bacterial spectrums on short-term clinical outcomes.Results There were a total of 166 cases,of which 130 cases were culture-positive,Gram-positive bacteria accounted for 73.1%,Gram-negative bacteria accounted for 25.4%,fungi accounted for 1.54%.The Gram-positive bacteria are mainly epidermal Staphylococcus,Staphylococcus aureus.Copper-green pseudomonas and E.coli were mainly copper-green pseudomonas in Gram-negative bacteria.Binary logistics regression showed that compared with Gram-positive bacteria,the risk of failure in treatment of Gram-negative bacteria increased by 14.90 times and the risk of fungal infection increased by 42 times.Among them,the cure rate of copper-green pseudomonas was only 16.7%,the reproducibility rate was 27.8%,resulting in a 50%significantly higher than that of other patients(χ^(2)=40.734,P<0.001),and 55.6%of the combined severe tunnel infections.Conclusion①Gram-positive bacteria have a higher cure rate than Gram-negative bacteria and fungi.②The recurrence of copper-green pseudomonas,the high risk of tube extraction and death are obviously related to tunnel infection.③Oral symbiotic bacteria,poultry and environmentally-related pathogenic bacteria have an increasing trend and we need to pay attention to oral hygiene habits and family environment assessment.