CAJ | 학술논문

目的探讨腹膜透析合并腹膜透析相关性腹膜炎发生的原因及其影响因素,分析其致病菌及药物敏感性,为腹膜炎的防治提供依据.方法回顾性分析2012年本中心随访的腹膜透析相关性腹膜炎患者30例(34例次)临床资料,分析其腹膜炎发生的原因及危险因素、致病菌、药物敏感性及给予头孢唑林和头孢他啶联合初始治疗的有效性.结果腹膜炎发生的主要原因包括:换液操作不规范10例(29.41％);肠道感染9例(26.47％).基础血C反应蛋白(CRP)水平高是腹膜透析相关性腹膜炎发生的独立危险因素.CRP每增加1个单位,患者发生腹膜炎的风险增加1.8％,OR值为1.018,95％可信区间1.005～ 1.030.腹透液培养阳性26例(阳性率76.47％),其中革兰阳性球菌19例(73.08％),革兰阴性杆菌6例(23.08％),真菌1例(3.85％).培养阳性者行致病菌耐药分析,其中革兰阳性球菌对头孢唑林耐药率为16.67％,未发现对万古霉素耐药;革兰阴性杆菌对头孢他啶的耐药率为20.00％,未发现对亚胺培南、美罗培南耐药.每例患者均给予头孢唑林联合头孢他啶作为初始治疗,其中27例(79.41％)初始治疗有效.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,基础CRP水平增高是腹膜透析相关性腹膜炎发生的独立危险因素.腹膜炎的致病菌以革兰阳性球菌为主,革兰阳性球菌对头孢唑林,革兰阴性杆菌对头孢他啶的耐药率均较低,头孢唑林和头孢他啶联合治疗可作为腹膜炎初始治疗的有效方案.
목적 탐토복막투석합병복막투석상관성복막염발생적원인급기영향인소,분석기치병균급약물민감성,위복막염적방치제공의거.방법 회고성분석2012년본중심수방적복막투석상관성복막염환자30례(34례차)림상자료,분석기복막염발생적원인급위험인소、치병균、약물민감성급급여두포서림화두포타정연합초시치료적유효성.결과 복막염발생적주요원인포괄:환액조작불규범10례(29.41％);장도감염9례(26.47％).기출혈C반응단백(CRP)수평고시복막투석상관성복막염발생적독립위험인소.CRP매증가1개단위,환자발생복막염적풍험증가1.8％,OR치위1.018,95％가신구간1.005～ 1.030.복투액배양양성26례(양성솔76.47％),기중혁란양성구균19례(73.08％),혁란음성간균6례(23.08％),진균1례(3.85％).배양양성자행치병균내약분석,기중혁란양성구균대두포서림내약솔위16.67％,미발현대만고매소내약;혁란음성간균대두포타정적내약솔위20.00％,미발현대아알배남、미라배남내약.매례환자균급여두포서림연합두포타정작위초시치료,기중27례(79.41％)초시치료유효.결론 본중심복막투석환자발생복막투석상관성복막염적주요원인위환액조작불규범화장도감염,기출CRP수평증고시복막투석상관성복막염발생적독립위험인소.복막염적치병균이혁란양성구균위주,혁란양성구균대두포서림,혁란음성간균대두포타정적내약솔균교저,두포서림화두포타정연합치료가작위복막염초시치료적유효방안.
Objective To investigate causes and risk factors of peritoneal dialysis-related peritonitis,explore the pathogenic bacteria and drug sensitivity.Methods CAPD patients suffered peritoneal dialysis-related peritonitis were recruited in the First Affiliated Hospital of Nanjing Medical University in 2012.Gender,age and possible risk factors were analyzed by unvaried and multivariate logistic regression analysis.The causes,pathogenic bacteria,drug susceptibility,and validity treated with cefazolin plus ceftazidime were also analyzed.Results Thirty patients suffered peritoneal dialysis-related peritonitis and 129 peritoneal dialysis patients without peritonitis as control were included.The main causes for peritoneal dialysis-related peritonitis were nonstandard operating steps and intestinal infection.Multivariate logistic regression analysis showed that peritoneal dialysis-related peritonitis was significantly associated with higher CRP level.Of the peritoneal fluid culture,26 cases were found positive and the positive rate was 76.47％,19 cases (73.08％) were infected with Grampositive cocci,6 cases (23.08 ％) with Gram-negative bacillus and 1 case (3.85 ％) with fungi.Drug sensitivity test showed that Gram-positive cocci had the resistance rate to cefazolin(16.67％),and was sensitive to vancomycin in all cases.Gram-negative bacilli had the resistance to ceftazidime (20.00％),and was sensitive to imipenem and meropenem in all cases.All patients were given cefazolin plus ceftazidime as initial treatment.Twenty-seven cases were effective and the primary efficiency were 79.41％.Conclusions The main causes of peritoneal dialysis-related peritonitis in our centre were nonstandard operating steps and intestinal infection.The higher CRP level is an independent risk factor of peritoneal dialysis-related peritonitis.Gram-positive cocci are the main pathogenic bacteria leading to peritoneal dialysis-related peritonitis.There is lower resistance rate in Gram-positive cocci to cefazolin and Gram-negative bacilli to ceftazidime.Cefazolin plus ceftazidime can be an effective medicine on initiinal treatment of peritoneal dialysis-related peritonitis.