腹膜透析相关腹膜炎患者预后的相关因素及微生物学特征分析

    Analysis of related influencing factors of prognosis and microbiology in patients with peritoneal dialysis-associated peritonitis

    • 摘要: 目的 探讨腹膜透析相关腹膜炎(peritoneal dialysis-associated peritonitis,PDAP)微生物学特征及影响患者预后的相关因素。方法 回顾2017年1月至2021年6月期间南京医科大学第一附属医院住院的PDAP患者资料、实验室指标和转归情况。根据PDAP患者的预后将其分为三组:治愈组、退出组(拔管)、复发组(治疗后出现腹膜炎复发、再发或重现的患者)。其中治愈组和复发组被认为是技术生存组。退出组被认为是技术失败组。结果 本研究纳入的79例患者共发生125例次腹膜炎,其中治愈组78例、复发组20例、退出组27例。Logistic回归分析显示,低血清铁、初始非一代头孢菌素加三代头孢菌素治疗方案是治疗失败的独立危险因素(P<0.05)。亚组分析发现,与技术生存组相比技术失败组患者体内水含量较低(P<0.05)。革兰阳性菌是PDAP主要致病菌(58.65%,61/104),其中耐甲氧西林凝固酶阴性葡萄球菌(methicillin resistant coagulase negative staphylococci,MRCNS)分离率较高,占67.74%;所有革兰阴性菌对头孢他啶的敏感性为82.61%(19/23)。有消化道症状的患者链球菌感染发生率增加(P<0.05),无消化道症状患者凝固酶阴性葡萄球菌感染率增加(P<0.05)。结论 低血清铁、初始非一代头孢菌素加三代头孢菌素治疗方案是PD相关腹膜炎治疗失败的独立危险因素。消化道症状与不同细菌感染相关。

       

      Abstract: Objective To determine the related factors influencing prognosis and microbiology of patients with peritoneal dialysis-associated peritonitis(PDAP). Methods The basic clinical data, laboratory indicators and outcomes of patients during occurrence of PDAP, who underwent peritoneal dialysis (PD)in our department from January 2017 to June 2021, were analyzed retrospectively. According to the prognosis of PDAP patients, they were divided into three groups:cure group, withdrawal(extubation)group, and relapse(repeat, recurrence or reappearance of peritonitis after treatment)group. The cured group and the relapse group were considered as the technical survival group. The withdrawal group is considered a technical failure group. Results A total of 125 peritonitis cases in 79 selected peritoneal dialysis patients included 78 cases in the cured group, 20 cases in the relapse group, 27 cases in the withdrawal group. Logistic regression analysis indicated that reduced serum iron, initial treatment regimen of non-first-generation cephalosporin plus third-generation cephalosporins were independent risk factors for withdrawal from peritoneal dialysis in patients with peritoneal dialysis(P<0.05). Subgroup analysis found that patients in failure group had lower water levels than those in the survival group(P<0.05). Gram-positive organisms remained major cause of PD-related peritonitis(58.65%, 61/104). Methicillin resistance was noted in 21(67.74%) of 31 coagulase negative staphylococcus isolates. Of 23 gramnegative organisms, 82.61%(19)were susceptible to ceftazidime. We observed trends to an increase in the rates of streptococcal infections in patients with gastrointestinal symptoms and an increase of the incidence of infections by CNS in patients without gastrointestinal symptoms(P<0.05). Conclusions Reduced serum iron, initial treatment regimen of non-first-generation cephalosporin plus third-generation cephalosporins were independent risk factors for withdrawal from peritoneal dialysis in patients with peritoneal dialysis. Gastrointestinal symptoms are associated with different bacterial infections.

       

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