腹膜透析相关性腹膜炎患者感染学特点及预后转归分析

目的 探究腹膜透析相关性腹膜炎（PDAP）患者腹膜透析液中病原菌分布、耐药特征及预后转归，为临床防治PDAP提供合理依据。方法 收集2014年1月 - 2018年8月郑州大学第一附属医院肾内科收治的243例PDAP患者腹腔透析液330份，进行细菌鉴定、药敏试验及统计学分析。结果 腹透液培养阳性217例次，检出230株细菌，阳性率为65.76%。其中革兰阳性菌132株（57.39%）、革兰阴性杆菌68株（29.56%）、真菌30株（13.04%）；主要分离菌依次为表皮葡萄球菌（25.65%）、大肠埃希菌（19.57%）。革兰阳性菌对青霉素的耐药率较高(77.32%)，对利奈唑胺、万古霉素敏感。革兰阴性菌对氨苄西林的耐药率最高(92.16%)，对哌拉西林他唑巴坦、亚胺培南的耐药率较低。真菌对常用抗真菌药均敏感。革兰阳性球菌感染组的治愈率与真菌组及混合感染组相比、真菌感染组的退出率与其余三组相比、混合感染组的病死率与培养阴性组相比具有统计学差异。结论 我院PDAP患者疗效及转归存在病原体差异；合理选择抗生素对PDAP患者的预后至关重要。

Analysis of infection characteristics and prognosis of peritoneal dialysis-associated peritonitis patients

Objective The study was conducted to explore the distribution of pathogenic bacteria, drug resistance and prognosis of peritoneal dialysis-associated peritonitis(PDAP), aiming to provide a reasonable basis for clinical prevention and treatment of PDAP. Methods 330 samples of peritoneal dialysis fluid from 243 patients with PDAP admitted to the department of nephrology, the first affiliated hospital of Zhengzhou University from January 2014 to August 2018 were collected in this study. Pathogenic bacteria culture and drug sensitivity test of 330 PD fluids were performed. Statistical analysis was performed using SPSS 21.0. Results The PD fluid culture was positive in 217 cases, with a positive rate of 65.76%. A total of 230 strains of microorganisms were detected, including 132 Gram-positive strains(57.39%), 68 Gram-negative strains(29.56%) and 30 fungi strains(13.04%). Among all strains, Staphylococcus Epidermidis(25.65%) and Escherichia coil(19.57%) were common pathogens. Gram-positive strains were commonly resistant to penicillin(77.32%) but sensitive to linezolid and vancomycin. The resistance rate of gram-negative bacteria to ampicillin was the highest(92.16%), while the resistance rate to piperacillin, tazobactam and imipenem was lower. Fungi were sensitive to normal antifungal agents. The cure rate of gram-positive compared with fungi and mixed infection、the dropout rate of fungi compared with the remaining three groups、the mortality rate of mixed infection compared with cultured negative had statistical differences. Conclusion Curative effect and prognosis in patients with PDAP are different in terms of different pathogen in our hospital. Rational choice of antibiotics is crucial to the prognosis of patients with PDAP.