腹膜透析相关性腹膜炎病原菌分布及耐药性

目的回顾性分析海南医学院第二附属医院腹膜透析相关性腹膜炎(Peritoneal dialysis related peritonitis,PDRP)病原菌连续三年的变化情况,为临床抗感染治疗工作提供研究依据。方法选取2015年3月-2017年12月海南医学院第二附属医院的89例PDRP患者作为研究对象,对其腹膜透析透出液中的病原菌分布、耐药性和临床转归情况进行回顾性分析。结果共发生感染186例次,其中,110例次感染中的透出液病原菌培养结果为阳性,阳性率为59.14%,共检出138株病原菌,2015年度、2016年度、2017年度分别检出50株、47株、41株病原菌,不同年度凝固酶阴性葡萄球菌的构成比差异有统计学意义(P<0.05),2017年度的凝固酶阴性葡萄球菌构成比低于2015年度,差异有统计学意义(P<0.05)。不同病原菌所致PDRP患者的治愈率和死亡率差异均有统计学意义(P<0.05),其中,病原菌培养阴性患者的治愈率高于其他三类病原菌培养阳性的患者(P<0.05),革兰阴性菌感染患者的治愈率高于真菌感染患者(P<0.05)。真菌感染的死亡率高于病原菌培养阴性患者(P<0.05)。结论在PDRP患者透出液的病原菌中,凝固酶阴性葡萄球菌等条件致病菌的比例在近三年内出现下降,金黄色葡萄球菌、肺炎克雷伯菌、真菌等高耐药性病原菌的比例在近三年出现上升,而真菌感染患者的预后较差,临床医生应给予高度关注并及时采取有效的治疗措施,以改善患者的预后。

Distribution and drug resistance of pathogens causing peritoneal dialysis-related peritonitis

OBJECTIVE To retrospectively analyze the change of pathogenic bacteria related to peritoneal dialysis-associated peritonitis(PDRP) in a hospital for three consecutive years, to provide evidence for clinical anti-infective treatments. METHODS Eighty-nine patients with PDRP from Mar. of 2015 to Dec. of 2017 were enrolled. The distribution and the drug resistance of pathogenic bacteria in the peritoneal dialysis dialysate and the clinical outcome of the patients were analyzed retrospectively. RESULTS A total of 186 infections occurred, in which 110 bacterial culture of dialysates of infections were positive, with the positive rate of 59.14%. And 138 strains of pathogenic bacteria were detected, including 50 strains in the years of 2015, 47 strains in 2016 and 41 strains in 2017, respectively. The proportions of coagulase-negative staphylococci in different years were significantly different(P<0.05). The proportion of coagulase-negative staphylococci in 2017 was significantly lower than that in 2015(P<0.05). The curative ratio and mortality in PDRP patients caused by different pathogenic bacteria were significantly different(P<0.05). The cure rate in patients with negative pathogenic bacteria culture was significantly higher than that in patients with positive pathogenic bacteria culture(P<0.05). The cure rate of patients with Gram-negative bacteria infections was significantly higher than that of patients with fungal infections(P<0.05). The mortality of the patients with fungal infections was significantly higher than that with negative pathogenic bacteria culture(P<0.05). CONCLUSION The proportions of the conditional pathogenic bacteria such as coagulase negative Staphylococcus in the dialysate of PDRP patients decreased during the nearly three years, but the proportions of high drug resistance pathogenic bacteria such as Staphylococcus aureus, Klebsiella pneumoniae and fungi increased. The prognosis of patients with fungal infection is poor. Clinicians should pay close attention and take effective treatment measures in time to improve the prognosis of the patients.