腹膜透析相关性葡萄球菌腹膜炎的临床特征

目的 回顾性分析中山大学附属第一医院腹膜透析中心2006年1月至2010年12月腹膜透析相关性葡萄球菌腹膜炎的临床特征,为临床诊治提供依据.方法 选取近5年我院葡萄球菌腹膜炎的持续性不卧床腹膜透析(CAPD)患者,作为研究对象,归为腹膜炎组；同时,选取相应的未发生腹膜炎的CAPD患者,作为一对一配对观察目标,归为对照组.探讨葡萄球菌腹膜炎的易感因素、菌群分布、耐药性和预后.结果 腹膜炎组和对照组各纳入74例患者,两组患者基线资料差异无统计学意义.腹膜炎组患者Kt/V低于对照组(1.74±0.03比2.61±0.48,P＜0.01),腹膜炎组营养学指标、血红蛋白(91.70±25.43) g/L比(111.50±19.59) g/L,P＜0.01]、钾(3.43±0.70)mmol/L比(3.78±0.73) mmol/L,P=0.002]、钠(137.09±5.06)mmol/L比(140.57±3.55)mmol/L,P＜0.01]、氯(98.31±6.14) mmol/L比(101.52±4.58) mmol/L,P=0.001]、钙(2.23±0.24) mmol/L比(2.31±0.22) mmol/L,P=0.04]水平均明显低于对照组.葡萄球菌腹膜炎5年总体发病率为0.030例/腹透年,表皮葡萄球菌为主要菌种,其次是金黄色葡萄球菌.各类葡萄球菌对万古霉素、替考拉宁、利奈唑胺均敏感.葡萄球菌腹膜炎近5年总体治愈率为89.19％,病死率为4.05％；表皮葡萄球菌复发率高于其他菌种,为40％.结论 营养差、透析不充分、随诊周期长、贫血、电解质失衡是葡萄球菌腹膜炎的易感因素.我院葡萄球菌腹膜炎在近5年总体发病率、病死率较前下降低,表皮葡萄球菌复发率高,需加强防治.

Clinical characters of peritoneal dialysis-related staphylococcus peritonitis

Objective To provide evidence for clinical diagnosis and treatment of staphylococcus peritonitis through retrospective analysis of peritoneal dialysis related clinical characters. Methods Patients who experienced staphylococcus peritonitis were observed as peritonitis group. Patients did not experience peritonitis were observed as one-to-one control group in order to investigate predictors of staphylococcus peritonitis, bacteria spectrum, antimicrobial resistance and clinical outcomes. Results There were 74 patients enrolled in either group. For patients in peritonitis group, Kt/V(1.74±0.03 vs 2.61±0.48, P<0.01), CrCL(55.82±2.22) ml/min vs (76.13±17.42) ml/min, P<0.01], GFR (1.32±0.55) ml/min vs (3.08±0.75) ml/min, P<0.01], nutrition index, hemoglobin(91.70±25.43) g/L vs (111.50±19.59) g/L, P<0.01], potassium(3.43±0.70) mmol/L vs (3.78±0.73) mmol/L, P=0.002], sodium(137.09±5.06) mmol/L vs (140.57±3.55)mmol/L, P<0.01], chloride(98.31±6.14) mmol/L vs (101.52±4.58) mmol/L, P=0.001] and calcium (2.23±0.24) mmol/L vs (2.31±0.22) mmol/L, P=0.04] in serum were significantly lower than those in control group. The morbidity of staphylococcus peritonitis was 0.030 episode per year in recent five years. The major strains were Staphylococcus epidermidis, followed by Staphylococcus aureus. Staphylococci were all sensitive to vancomycin, teicoplanin and linezolid. The cure rate was 89.19%, and mortality was 4.05%. Relapse rate of Staphylococcus epidermidis peritonitis was higher (40%) than other strains. Conclusions Poor nutrition, insufficient dialysis, longer follow-up interval, anemia, electrolytic imbalance are the risk factors of Staphylococcus peritonitis. The morbidity and mortality are lower than before. Staphylococcus epidermidis peritonitis has higher relapse rate and requires more attention to prevention and treatment.