腹膜透析相关性腹膜炎抗生素初始治疗方案探讨

目的 探讨头孢唑啉联合头孢他啶与万古霉素联合头孢他啶作为腹膜透析相关性腹膜炎初始治疗的效果。 方法 回顾性分析2006年1月至2009年5月在北京大学第三医院收治的合并腹膜透析相关性腹膜炎的患者90例。其中37例次采用头孢唑啉+头孢他啶治疗,97例次采用万古霉素+头孢他啶治疗。比较其初始治疗的有效率、最终转归、细菌培养和药物敏感试验情况。 结果 头孢唑啉+头孢他啶组患者腹膜炎的初始治疗有效率为81.1%,万古霉素+头孢他啶组为86.2%,两组间差异无统计学意义（P > 0.05）;两组患者的G+细菌感染分别为56.8%和50.5%,差异无统计学意义（P > 0.05）;两组患者在发病3周后治愈率分别为91.9%和97.9%,差异无统计学意义（P > 0.05）。 结论 头孢唑啉联合头孢他啶与万古霉素联合头孢他啶均可以作为腹膜透析相关性腹膜炎的初始治疗方案,且疗效相当。     

腹膜透析相关性腹膜炎经验用药分析

目的 研究华山医院及宝山分院腹膜透析（腹透）相关性腹膜炎的致病菌、耐药性及患者转归,为临床经验用药提供依据。 方法 回顾性分析2007年1月至2010年1月上述两医院腹透中心收治的93例腹透相关性腹膜炎的临床表现、致病菌、耐药性及转归。 结果 75例腹透液培养阳性,阳性率为80.2％,其中革兰阳性球菌45例,革兰阴性杆菌21例,真菌2例,革兰阳性杆菌1例,革兰阴性球菌1例,多种菌混合感染5例。革兰阳性球菌主要以凝固酶阴性的葡萄球菌为主,所有革兰阳性球菌对万古霉素均敏感,但对头孢唑林耐药率高达60.0%,而且耐药率有明显的逐年增加趋势。革兰阴性菌对头孢他啶的耐药率达到46.1％,所有革兰阴性杆菌对亚胺培南均敏感。因腹膜炎而退出腹膜透析有16例,退出率为17.2％（16/93）。腹腔使用万古霉素对残肾功能无显著影响。 结论 两院腹透中心腹透相关腹膜炎致病菌以革兰阳性球菌为多数。头孢唑啉耐药性逐年增高,目前不再适合作为初始治疗的经验用药。腹腔使用万古霉素可推荐作为革兰阳性菌致腹膜炎的初始经验用药。     

频发腹膜透析相关性腹膜炎的临床特征及危险因素的探讨

目的探讨频发腹膜透析相关性腹膜炎的临床特征及危险因素。方法回顾性分析2007年1月至2014年12月安徽医科大学附属省立医院腹膜透析置管后行持续性非卧床腹膜透析的尿毒症患者,选择1年内发生腹膜炎≥2次者定义为频发组,1年内仅发生1次腹膜炎者定义为单发组,比较2组临床及实验数据差异,并分析频发腹膜透析相关性腹膜炎的危险因素。结果频发组13例,发生感染性腹膜炎30例次,单发组57例,发生感染性腹膜炎57例次。频发组与单发组相比,患者血压和体质量指数明显升高(P0.05),未及时治疗者[7例(53.85%)比13例(22.81%)]及抗感染疗程不足者[5例(38.46%)比8例(14.04%)]增多(P0.05),无效拔管率[5例(38.46%)比7例(12.28%)]增加(P0.05),血红蛋白、血白蛋白显著降低(P0.05),全段甲状旁腺素水平升高(P0.05)。病原学检查分析频发组革兰阴性菌感染率(33.33%)及真菌感染率(10.00%)均较高,但以革兰阴性菌增加的趋势最明显(P=0.035)。2组间置管时年龄、性别、透析时间、文化程度、腹膜炎诱因、病死率、残余肾功能、外周血白细胞、血钙、血磷、C反应蛋白、血总胆固醇、三酰甘油、首次腹透液白细胞数比较差异均无统计学意义。Logistic回归分析显示高体质量指数、严重高血压、低血红蛋白、低血白蛋白为频发腹膜透析相关性腹膜炎的危险因素。结论营养不良、体质量指数过高、严重高血压为腹膜透析者频发腹膜炎的危险因素,积极纠正低蛋白血症、控制血压、保持标准体质量指数,积极按时规范治疗腹腔内源性感染有助于该病的预防和控制。     

单中心327例次腹膜透析相关性腹膜炎致病菌及药敏结果分析

目的 探讨持续性非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)相关性腹膜炎的致病菌及其耐药性.方法 回顾性分析2008年1月至2013年5月在我中心就诊的180例327例次CAPD相关性腹膜炎的致病菌及其耐药性.结果 202例次培养阳性,培养阳性率为61.77％.革兰阳性球菌154例次,其中金黄色葡萄球菌及凝固酶阴性葡萄球菌123例次,占病原微生物培养阳性的60.89％;革兰阴性杆菌38例次,其中大肠埃希菌11例次,占病原微生物培养阳性的5.45％;真菌10例次,其中假丝酵母菌7例次,占病原微生物培养阳性的3.47％.革兰阳性球菌对万古霉素耐药率最低,为3.25％,其次为莫西沙星,为5.19％,对利福平、庆大霉素、左氧氟沙星耐药率分别为12.99％、35.71％、45.45％,对青霉素的耐药率最高,达84.42％.革兰阴性菌对哌拉西林/他唑巴坦耐药率最低,为10.53％,其次为头孢他啶,为23.68％,对左氧氟沙星、头孢匹美、庆大霉素耐药率分别为26.32％、28.21％、36.84％,对氨苄西林/舒巴坦的耐药率最高,达50.00％.重复感染54例,共114例次,72例次培养阳性,阳性率为63.16％,其中革兰阳性球菌63例次,占87.50％,革兰阴性杆菌9例次,占12.50％,革兰阳性球菌以金黄色葡萄球菌为主,革兰阴性杆菌以大肠埃希菌为主.结论 本中心CAPD相关性腹膜炎致病菌以革兰阳性球菌为多,接触污染是导致腹膜炎的主要原因.革兰阳性球菌对青霉素耐药率最高,革兰阴性杆菌对氨苄西林/舒巴坦耐药率最高.     

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.     

亚胺培南-西司他丁钠在腹膜透析相关腹膜炎后续治疗的疗效

目的 探讨亚胺培南-西司他丁钠作为腹膜透析相关性腹膜炎后续治疗的疗效.方法 以2007年1月至2010年12月在北京大学第三医院收治的并发腹膜透析相关性腹膜炎患者44例为对象.这些患者经过3d的初始治疗透析液仍未清亮,细菌培养结果是革兰阴性杆菌或阴性,其中13例次采用头孢他啶治疗;36例次采用亚胺培南-西司他丁钠治疗....     

持续非卧床腹膜透析相关腹膜炎的因素分析及护理对策

目的 对腹膜透析相关腹膜炎因素进行分析并提出其相应的护理措施.方法 对83例101例次腹膜透析相关腹膜炎患者的病历资料问卷调查进行分析.结果 操作不规范、透析环境污染及出口处感染是引起腹膜炎的重要因素.结论 医护人员对患者及家属的健康教育、进行规范操作的再培训、加强出口处的护理可以提病腹膜透析的疗效.     

提高腹膜透析相关感染性腹膜炎致病菌培养阳性率的方法学研究

目的探讨改进腹膜透析相关感染性腹膜炎透出液致病菌的培养方法,提高病原菌的培养阳性率。方法收集27例患者45例次腹膜炎透出液标本。腹膜炎患者透出液同时按以下6组方法分别进行致病菌培养：传统平板法、离心平板法、BacT/Alert培养瓶法（PF瓶法、SA瓶法、SN瓶法）和冻融法。结果离心平板组阳性率高于传统平板组,差异具统计学意义（60．0％比44．4％,P＜0．05）;与离心平板组相比,PF瓶组（84．4％）、SA瓶组（82．2％）和SN瓶组（82．2％）阳性率均提高（P均＜0．01）。在检测致病菌生长所需时间（TDG）方面,与离心平板组[（24．31±9．80）h]相比,PF瓶组[（14．25±9．13）h]、SA瓶组[（12．75±7．47） h]和SN瓶组[（9．79±4．14）h]的TDG均缩短（P均＜0．01）;SN瓶组的TDG比PF瓶组和SA瓶组更显著缩短（P均＜0．01）。结论离心法能显著提高培养阳性率。BacT/Alert培养系统与普通平板技术相比,能显著提高培养阳性率并缩短检测致病菌生长所需时间。SN培养瓶法检测致病菌生长所需时间最短。     

腹膜透析相关腹膜炎的防治策略

腹膜透析(腹透)是终末期肾病的有效替代治疗方法之一。然而腹膜炎仍然是腹透最常见的并发症,是导致腹透患者技术失败的主要原因。本文阐述了中国腹透相关腹膜炎流行病学特点;参照国际腹膜透析学会指南并结合作者所在腹透中心的经验,讨论了腹透相关腹膜炎的预防和治疗策略。     

维持性腹膜透析患者腹膜透析相关性葡萄球菌腹膜炎的发生率及危险因素分析

目的 探讨维持性腹膜透析患者腹膜透析相关性葡萄球菌腹膜炎的发生率及相关危险因素.方法 以中山大学附属东华医院腹膜透析中心192例患者为研究对象.根据腹膜透析液培养结果分成腹膜炎组与正常组.采用多因素logistic回归分析腹膜透析相关性葡萄球菌腹膜炎的危险因素.结果 共16例（8.3％）患者发生腹膜透析相关性葡萄球菌腹膜炎.致病菌以表皮葡萄球菌为主,占50.0％（8/16）.治愈12例（75.0％）,死亡1例.高龄（OR=1.35,95％ CI 1.16～7.68,P=0.026）、糖尿病（OR =3.34,95％ CI 1.90～6.54,P＜0.001）、低血红蛋白（OR=1.68,95％ CI 1.21～6.48,P=0.022）及低白蛋白血症（OR=1.04,95％ CI1.02～1.07,P=0.036）是腹膜透析相关性葡萄球菌腹膜炎的相关危险因素.结论 腹膜透析相关性葡萄球菌腹膜炎发生率较高;高龄、低血红蛋白、糖尿病及低白蛋白血症是其相关危险因素.     

Impact of continuous quality improvement on reducing the incidence of peritoneal dialysis-related peritonitis in patients within the first year of peritoneal dialysis initiation

Objective To explore the effect of continuous quality improvement (CQI) on reducing the incidence of peritoneal dialysis (PD)-related peritonitis in patients within the first year of PD initiation. Methods The patients who received catheter placement from January 2006 to December 2016 in our hospital were enrolled in this study. All patients were divided into four groups: pre-CQI group patients who initiated PD treatment from 2006 to 2007 (before CQI phase, group A), CQI Ⅰphrase patients who initiated PD treatment from 2008 to 2010 (group B), CQI Ⅱ phrase patients who initiated PD treatment from 2011 to 2013 (group C), and CQI Ⅲ phrase patients who initiated PD treatment from 2014 to 2016 (group D). The method of plan, do, check and act (PDCA) was conducted to decrease the incidence of PDRP. All the patients were followed up for 12 months or until they withdrew from PD in this period. Poisson analysis was used to compare the incidence of PDRP among the groups. Results There were 2 383 PD patients recruited in this study, including 346 cases in group A, 850 cases in group B, 688 cases in group C and 499 cases in group D, with an age of (47.1±15.8) years, among whom 59.1% of the patients were male, and 21.4% with diabetes. The follow-up time was (10.9±2.8) months. Compared with group A, the incidence of PDRP was lower than that in group C (0.156 episodes/patient year vs 0.234 episodes/patient year, P=0.020); the incidence of gram positive PDRP decreased (0.052, 0.049, 0.054 episodes/patient year vs 0.104 episodes/patient year, all P＜0.05) in group B, C, D; the incidence of gram negative PDRP increased in group B, then decreased in group C and group D (all P＞0.05). Cox regression analysis indicated that CQI was independently associated with the incidence of gram positive PDRP (HR=0.526, 95%CI 0.349-0.792, P=0.002). Conclusion CQI can effectively reduce the incidence of gram positive PDRP in patients within the first year of PD initiation.     

腹膜透析相关性腹膜炎169例次临床分析及转归

目的探讨腹膜透析相关性腹膜炎的致病菌和耐药性,及其与转归之间的关系。方法回顾性分析169例次腹膜透析相关性腹膜炎的临床资料、致病菌与耐药性,探讨其与转归的联系。结果116例次培养阳性,培养总阳性率达68．6％,近5年高达87．7％。致病菌中G^＋球菌占58例次（50％）,G^-杆菌45例次（38．8％）,真菌6例次（5．2％）,G^＋杆菌、G^-球菌及混合感染7例（6％）。G^＋球菌中最常见为葡萄球菌（56．8％）;G^-杆菌中大肠杆菌阳性率最高（62．2％）。从耐药性看,G^-杆菌对氨苄西林的耐药率最高（76．7%）,对阿米卡星和哌拉西林／他唑巴坦的耐药率较低（2．9%、3．4％）。G^＋球菌对万古霉素均敏感,对利福平和哌拉西林／他唑巴坦的耐药率较低（2．1％、7．9％）。腹膜炎致持续非卧床腹膜透析（CAPD）退出率为10．1％（17／169）,以真菌腹膜炎为主。结论近5年本中心培养阳性率较高,及时采用血培养瓶留取标本很关键。G^-杆菌对阿米卡星和哌拉西林／他唑巴坦较敏感,而万古霉素、利福平和哌拉西林／他唑巴坦宜作为抗G^＋球菌的经验用药。真菌性腹膜炎是导致腹膜透析退出的主要原因。     

腹膜透析相关腹膜炎危险因素研究的统计模型筛选

目的筛选适用于腹膜透析相关腹膜炎危险因素研究的统计方法，为腹膜炎的临床研究提供新的思路。 方法选择九种统计模型进行对比分析，包括：不含时间依存性协变量(时依协变量)的Logistic回归、泊松回归、负二项回归、COX回归、AG模型、PWP-CP模型6个模型，含时间依存性协变量的COX回归、AG模型、PWP-CP模型3个模型。统计数据来源于解放军总医院第一医学中心腹膜透析中心2013年1月至2016年12月开始腹膜透析治疗的终末期肾脏病患者，数据收集至2018年12月。分析腹膜炎的临床特点，对比各统计模型拟合情况和统计结果，筛选统计模型。 结果从腹膜炎临床数据构成来看，作为因变量，腹膜炎事件由"发生时间"、"发生次数"、"发生顺序"三个要素构成，作为自变量，大部分协变量是随时间变化的，三维的因变量和变化的自变量共同构成了复杂的临床数据。从"腹膜炎三要素"纳入情况看，只有PWP-CP模型能够全部纳入，最大限度保证了数据的完整性。从统计模型拟合程度看，泊松模型存在过离散，不适用于本研究数据；使用时依协变量的模型较使用基线数据的模型拟合好。从统计结果看，含时间依存性协变量的模型避免了单纯使用基线数据造成的偏差，使统计结果更接近于真实情况。 结论在腹膜炎危险因素的研究中，只有尽可能地保证数据信息的完整性和准确性，才能得到更真实的研究结果。本研究通过剖析腹膜炎的数据构成，对比各模型的统计结果，发现含时依协变量的PWP-CP模型更适用于腹膜炎危险因素的研究。     

Analysis of microbiological trends and antibiotic susceptibility in 711 episodes of peritoneal dialysis-related peritonitis

Objective To investigate the microbiological trends and antibiotic susceptibility of peritoneal dialysis(PD)-related peritonitis (PDAP). Methods All patients who developed PDAP between 2004 and 2015 in Renji Hospital, Shanghai Jiao Tong University School of Medicine were enrolled. Demographic data, results of dialysate pathogen culture and drug susceptibility test were recorded. The trend of peritonitis incidence was measured by Poisson regression and the chi-square test or Fisher exact test method was used to compare the composition of causative organisms and their antimicrobial susceptibilities over time. Results During the study period, a total of 711 episodes of PDAP were occurred in 386 patients. The culture positive rate of pathogens rose from 52.0% in 2004 to 77.0% in 2015 (P＜0.001). The distribution of causative organisms of the culture positive peritonitis was gram-positive bacteria (270, 59.5%), followed by gram-negative bacteria (129, 28.4%), polymicrobial(39, 8.6%), fungi (15, 3.3%) and mycobacteria (1, 0.2%). From 2004 to 2015, the incidence of peritonitis decreased from 0.214 to 0.160 episodes/patient?year (P=0.034). The incidence of coagulase-negative staphylococcus peritonitis decreased from 0.049 to 0.027 episodes/patient?year (P=0.025), while others had no significant change; A significant decline was observed in the sensitivity of Gram-positive strains to the first generation cephalosporin and ampicillin/sulbactam in 2010-2015 group compared with those in 2001-2009 group (61.3% vs 88.2%, P＜0.001; 61.7% vs 85.5%, P=0.001), whereas the sensitivity to vancomycin remained the same. The sensitivity of Gram-negative strains to ceftazidime and amikacin showed no significant change. As for the gram-positive peritonitis treated with cefradine as empirical treatment, compared with those in 2004-2009 group, in 2010-2015 group the proportion of patients requiring to change their treatment regime was significantly higher, and the treatment course was longer. Conclusions A gradual decline is observed in the incidence of PDAP and the culture positive rate of pathogens improves. Peritonitis caused by coagulase-negative staphylococcus decreases overtime. The present empirical treatment protocols may need re-evaluation considering the decreased rate of the first generation cephalosporin sensitivity in recent years.     

腹膜透析相关性腹膜炎的防治

腹膜透析(PD)相关性腹膜炎是腹膜透析患者的严重并发症,降低腹膜透析相关感染的风险应该是每个PD中心的重要工作目标。对于出现感染者,应在早期进行经验性治疗,并高质量留取标本,进行有效的微生物学诊断和药敏试验,以保证抗感染治疗的准确性和有效性。腹膜透析中心应积极开展团队质量改进,包括持续进行感染监测、分析感染发生的根本原因。建立全面的腹膜炎风险评估机制,尤其要重点加强主动预防理念,在开始腹膜透析治疗的同时,对高龄、糖尿病患者等高危人群进行重点预防,有意识地加强操作正规培训和再培训、积极防止腹泻和(或)便秘以及加强隧道和出口处护理等主动预防措施,尽可能降低腹膜透析相关性腹膜炎的发生概率。     

Utility of a peritoneal dialysis leukocyte test strip in the diagnosis of peritonitis

Expeditious diagnosis of peritonitis remains a significant goal in the management of patients maintained on peritoneal dialysis. Several attempts to use leukocyte esterase reagent strips to diagnose peritonitis have been described. In this study we examined the usefulness of a new reagent strip, the PeriScreen Test Strip, in the diagnosis of peritonitis. A series of 72 peritoneal effluent samples obtained from 22 maintenance peritoneal dialysis patients is reported. In this study, the test strips had a sensitivity of 100% and a specificity of 98.3% as compared to an abnormal leukocyte count. Thus, in the diagnosis of peritonitis we believe that the PeriScreen Test Strip can be used as a simple bedside screening test to exclude peritonitis in peritoneal dialysis patients.     

Predictors of the outcome following peritoneal dialysis-related bacterial-complicating peritonitis

Objective To investigate the risk factors predicting the outcome of peritoneal dialysis (PD)-related bacterial-complicating peritonitis. Methods In this retrospective study, all the episodes of PD-related bacterial peritonitis presenting during Jan 2009 to Dec 2013 in our center were reviewed. Clinical and laboratory parameters at the onset of peritonitis, including patient demographic information, age, gender, duration of PD, residual renal function, local and systemic inflammation state, daily exchange number, peritoneal glucose exposure and so on, were recorded. Patients episodes were divided into three groups according to the outcome: complete cure (complete resolution of peritonitis without relapse or recurrence or repeat), peritonitis-related catheter removal/death group, and relapse (relapse or recurrence or repeat) group. Results 187 CAPD patients with 27.15(11.15, 53.13) PD duration were enrolled in the study. Total of 347 episodes of bacterial peritonitis in these patients were analyzed, with 130 episodes of gram-positive bacterial infection, 71 episodes of gram-negative bacterial infection, 15 episodes of polymicrobial and 131 episodes of cultured negative. Compared to the complete cure group and the relapse group, gram negative bacterial infection was more prevalent in the peritonitis-related catheter removal/death group. Furthermore, patients in the peritonitis-related catheter removal/death group showed longer PD age (P﹤0.01) and higher serum hs-CRP (P﹤0.01). Compared to the complete cure group, the serum albumin concentration was lower in the peritonitis-related catheter removal/death group (P﹤0.01). Kt/V was significantly lower in the relapse group than that in the complete cure group (P﹤0.05). Logistic analysis indicated age, non gram positive bacterial infection and increased hs-CRP were independent predictors for peritonitis-related catheter removal or death. Conclusions Age, non gram positive bacterial infection and hs-CRP are risk factors predicting peritonitis-related catheter removal or death in CAPD patients.     

Effects of seasonal changes on peritoneal dialysis associated peritonitis in peritoneal dialysis patients

Objectives To investigate the effects of seasonal changes on peritoneal dialysis associated peritonitis (PDAP) in patients on peritoneal dialysis (PD), and to provide evidence for clinical prevention and treatment of PDAP. Methods All episodes of PD-related peritonitis during clinic follow-up in maintenance PD patients from Jan 1st, 2007 to Dec 31st, 2015 in Peking University People's Hospital were reviewed. The incidence of peritonitis, laboratory indexes, pathogens and clinical outcomes in different seasons were recorded and analyzed. One-way ANOVA and chi square test were employed to compare the incidence of PDAP and related data in different seasons, and Pearson correlation was used to analyze correlations between PDAP rate and monthly mean temperature and mean humidity. Results During nine years, a total of 119 PD patients occurred 190 times of peritonitis during home PD. The PDAP rate in summer was the highest, 0.21 episodes/year, followed by spring (0.16 episodes/year) and autumn (0.16 episodes/risk year), but there was no significant difference among peritonitis rates in four seasons. There were significant positive correlation between monthly mean temperature, monthly mean humidity and the peritonitis rate (mean temperature: r=0.828, P＜0.01; mean humidity r=0.657, P＜0.05). (2) As for bacteria, in Summer the PDAP rate caused by Staphylococcus aureus and Coagulase negative staphylococcus (CoNS), and Gram-negative bacteria was higher than that in other seasons, but there was no statistical difference. There were significant positive correlation between monthly mean temperature, mean humidity and the rate of CoNS peritonitis (mean temperature: r=0.704, P＜0.05; mean humidity: r=0.607, P＜0.05). (3) There were no statistical difference among results of PD related peritonitis in different seasons about general situation, clinical manifestation, causes of peritonitis and laboratory index before peritonitis episodes. PD procedure-related problems were the main cause of peritonitis in summer and autumn. (4) The cure rate of all peritonitis was 90%. The highest cure rate was in autumn and winter, while the lowest cure rate was in summer, but no statistical difference. Among the peritonitis episodes with treatment failure, 52.6% occurred in summer. Conclusions There is some correlation between the rate of PDAP and seasons. Higher temperature and higher humidity were significantly correlated with higher peritonitis rate, especially the rate of CoNS peritonitis. The prognosis of PDAP in summer was relatively poor, with higher proportion of hospitalization and lower cure rate.     

Risk factors for peritoneal dialysis withdrawal due to peritoneal dialysis-related peritonitis

BackgroundPeritoneal dialysis has become commonly used for renal replacement therapy; however, some patients withdraw from peritoneal dialysis due to complications, including peritoneal dialysis-related peritonitis, resulting in the low number of patients on peritoneal dialysis. Risk factors for peritoneal dialysis withdrawal due to peritoneal dialysis-related peritonitis are less certain. This retrospective study aimed to investigate these risk factors.MethodsWe retrospectively analyzed clinical characteristics, laboratory data, and causative microorganisms of 204 episodes of peritoneal dialysis-related peritonitis between 2007 and 2018 at our institution.ResultsOf the 204 episodes, 38 resulted in withdrawal from peritoneal dialysis due to peritoneal dialysis-related peritonitis. The number of peritonitis episodes per patient-year and the incidence of cardiovascular disease were significantly higher in the withdrawal group. Similarly, this group had low levels of serum creatinine, urea nitrogen, serum albumin, alanine aminotransferase, cholinesterase and high C-reactive protein, and second dialysate cell counts after antibiotic administration. Multivariate logistic regression analysis revealed that serum albumin (odds ratio: 0.465; 95% confidence interval: 0.249–0.868; P = 0.016) and cardiovascular disease (odds ratio: 2.508; 95% confidence interval: 1.184–5.315; P = 0.016) exhibited significant differences.ConclusionsThe results of this study suggest that hypoalbuminemia and the presence of cardiovascular disease were independent risk factors for withdrawal from peritoneal dialysis due to peritoneal dialysis-related peritonitis.     

124株腹膜透析相关性腹膜炎致病菌及耐药性分析

目的探讨腹膜透析相关性腹膜炎（PDAP）致病菌的耐药性。方法回顾性分析2008年7月-2012年7月我院腹膜透析中心PDAP患者的临床资料及药敏结果。结果（1）203例次PDAP培养阳性率为59．1％,共培养出致病菌124株。124株致病菌中革兰阳性球菌68株,占54．8％;革兰阴性杆菌28株,占22．6％;革兰阳性杆菌12株,占9．7％;奈瑟茵属5株,占4．0％;真菌11株,占8．9%。其中耐药菌株54株,包括多药耐药菌50株,泛耐药菌4株,本中心PDAP患者尚未培养出全耐药菌。（2）药敏结果：对革兰阳性球菌敏感性较高的前3种药物为：利奈唑胺100％,莫西沙星95．8％,万古霉素95．2％。对革兰阴性杆菌敏感性较高的前3种药物为：阿米卡星85．7％,亚胺培南82．1％,左氧氟沙星75．0％。（3）转归：PDAP患者总治愈率为77．3％。结论PDAP致病菌耐药性的产生导致临床上可供选择的药物减少,临床医牛府采取多种措施延缓致病菌耐药件。