中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (04): 251-254.doi: 10.3969/j.issn.1671-4091.2017.04.009

• 临床研究 • 上一篇    下一篇

单中心腹膜透析相关性腹膜炎的临床分析

刘小菁1,岳凌菊1,刘永泉1,李忠心1   

  1. 1. 首都医科大学附属北京潞河医院肾病中心
  • 收稿日期:2016-10-11 修回日期:2017-01-13 出版日期:2017-04-12 发布日期:2017-04-12
  • 通讯作者: 李忠心 13621211613@139.com E-mail:13621211613@139.com

Clinical analysis of peritoneal dialysis-related peritonitis in a single center

  • Received:2016-10-11 Revised:2017-01-13 Online:2017-04-12 Published:2017-04-12

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摘要： 目的探讨腹膜透析相关性腹膜炎的发病原因、致病菌及转归预后情况，为腹膜炎的防治提供依据。方法回顾性分析首都医科大学附属北京潞河医院腹膜透析中心2013 年1 月～2015 年12 月接受腹膜透析治疗并发生腹膜炎患者的临床资料。分析发生腹膜炎的发病原因、致病菌、转归预后情况。结果共收治发生腹膜透析相关性腹膜炎的患者96 例次。腹膜炎发生的主要原因包括：换液操作不规范35 例(36.5%)，肠道感染27 例(28.1%)。腹膜透析液培养阳性63 例，阳性率65.6%。革兰阳性球菌38 例(60.3%)，革兰阴性杆菌18 例(28.6%)，真菌4 例(6.3%),混合菌3 例(4.8%)。培养阳性者行致病菌耐药分析，革兰阳性球菌中，对万古霉素、利奈唑胺均敏感，主要对红霉素(69.2%)和青霉素(68.4%)耐药率高。头孢西丁(46.7%)和头孢唑啉(45.9%)耐药率也较高。革兰阴性杆菌中，对亚胺培南均敏感，对头
孢唑林(53.8%)和头孢他啶(38.5%)的耐药率较高。革兰阳性球菌性腹膜炎治愈率较高，明显高于革兰阴性杆菌(χ2=5.661，P=0.017)、真菌(χ2=26.526，P< 0.001)、混合菌的腹膜炎(χ2=11.907，P=0.001)；真菌性腹膜炎的退出率较高，明显高于革兰阳性球菌(χ2=26.526，P＜0.001)、革兰阴性杆菌(χ2=4.390，P =
0.036)、培养阴性的腹膜炎(χ2=11.485，P=0.010)；真菌性腹膜炎的死亡率较高，明显高于革兰阳性球菌(χ2=26.526，P＜0.001)、革兰阴性杆菌(χ2=6.016，P =0.010)、培养阴性的腹膜炎(χ2=32.918，P＜0.001)。结论本中心腹膜透析患者发生腹膜透析相关性腹膜炎的主要原因为换液操作不规范和肠道感染，致病菌主要为革兰阳性球菌。培养阳性的致病菌对国际腹膜透析协会指南推荐的头孢唑林和头孢他啶有不同程度的耐药。革兰阳性球菌性腹膜炎治愈率较高，预后好；真菌性腹膜炎退出率及死亡率较高，预后差。

关键词: 腹膜透析, 腹膜透析相关性腹膜炎, 致病菌

Abstract: Objective To explore the causes, pathogenic bacteria and outcome of peritoneal dialysis-related peritonitis in order to provide the bases for the prevention of peritonitis. Methods We recruited CAPD patients suffered from peritoneal dialysis-related peritonitis and treated in the Peritoneal Dialysis Center of Beijing Luhe Hospital, Capital Medical University in the period from Jan. 2013 to Dec. 2015. Their causes, pathogenic bacteria and outcome were analyzed. Results A total of 96 patients with peritoneal dialysis-related peritonitis were enrolled in this study. The main causes for peritoneal dialysis-related peritonitis were misconducted manipulation of fluid exchange (35 cases, 36.5%) and intestinal infection (27 cases, 28.1%). Bacterial culture for peritoneal fluid was positive in 63 cases (65.6%), including Gram-positive cocci (38 cases, 60.3%), Gram-negative bacilli (18 cases, 28.6%), fungi (4 cases, 6.3%), and mixed bacteria (3 cases). Drug sensitivity tests showed that Gram-positive cocci were sensitive to vancomycin and linezolid in all strains, and had higher resistance rate to erythromycin (69.2%), penicillin (68.4%), cefoxitin (46.7%) and cefazolin (45.9%). Gramnegative bacilli were sensitive to imipenem in all strains, and had higher resistance rate to cefazolin (53.8%) and ceftazidime (38.5%). The cure rate of gram-positive cocci peritonitis was higher than that of gram-negative bacilli (χ2=5.661, P=0.017), fungi (χ2=26.526, P＜0.001) and mixed bacteria peritonitis (χ2=11.907, P=0.001). The dropout rate of fungal peritonitis was higher than that of gram- positive cocci (χ2=26.526, P＜0.001), gram- negative bacilli (χ2=4.390, P=0.036) and microbial- negative peritonitis (χ2=11.485, P=0.010). The mortality rate of fungal peritonitis was higher than that of gram- positive cocci (χ2=26.526, P＜0.001), gram-negative bacilli (χ2=6.016, P=0.010) and microbial-negative peritonitis (χ2=32.918, P＜0.001). Conclusions The main causes of peritoneal dialysis-related peritonitis in this center were misconducted manipulation of fluid exchange and intestinal infection. Gram-positive cocci were the main pathogenic bacteria. The pathogenic bacteria had various degrees of resistance to cefazolin and ceftazidime that are recommended by the guidelines of International Society for Peritoneal Dialysis (ISPD). The cure rate of gram-positive cocci peritonitis was higher with better prognosis. The dropout rate and mortality rate of fungal peritonitis were higher with relatively poor prognosis.

Key words: Peritoneal dialysis, Peritoneal dialysis-related peritonitis, Pathogenic bacterium