肠源性腹膜透析相关性腹膜炎临床特点及危险因素分析

发布时间：2018-04-29 02:15

本文选题：腹膜炎 + 腹膜透析　；参考：《中国全科医学》2016年15期

【摘要】：目的探讨肠源性腹膜透析相关性腹膜炎致病菌种类及耐药情况,分析危险因素,指导临床合理使用抗菌药物。方法选取2010年1月—2014年9月在绍兴市人民医院行规律腹膜透析的患者143例为研究对象。以是否发生肠源性腹膜透析相关性腹膜炎分为腹膜炎组(24例)和对照组(119例)。收集患者一般资料,记录肠源性细菌的鉴定及耐药性分析结果,采用Logistic回归分析肠源性腹膜透析相关性腹膜炎危险因素。结果两组患者年龄、血红蛋白(Hb)水平、血清清蛋白(Alb)水平、超敏C反应蛋白(hs-CRP)水平、合并糖尿病率比较,差异有统计学意义(P0.05)。24例腹膜炎组患者共发生肠源性细菌感染27例次,其中最多见的为大肠埃希菌(13例次,占48.2%),其次为粪肠球菌(5例次,占18.5%)。肠源性细菌对氨苄西林、左氧氟沙星、头孢他啶、头孢唑林、青霉素、红霉素耐药率50.0%,而对丁胺卡那、头孢哌酮舒巴坦、哌拉西林他唑巴坦、替考拉宁耐药率≤20.0%,未发现对亚胺培南、万古霉素耐药的菌株。Logistic回归分析结果显示,年龄大、Alb水平降低、hs-CRP水平升高、合并糖尿病为肠源性腹膜透析相关性腹膜炎的危险因素(P0.05)。结论肠源性细菌以大肠埃希菌和粪肠球菌为主,且其耐药率高;对于存在肠源性腹膜透析相关性腹膜炎危险因素(高龄、Alb水平降低、hs-CRP水平升高、合并糖尿病)的患者,推荐使用万古霉素联合丁胺卡那作为经验性初始治疗方案。
[Abstract]:Objective to investigate the pathogenic bacteria and drug resistance of intestinal peritoneal dialysis associated peritonitis and analyze the risk factors to guide the rational use of antimicrobial agents. Methods 143 patients who underwent regular peritoneal dialysis in Shaoxing people's Hospital from January 2010 to September 2014 were selected as subjects. 24 cases of peritonitis group and 119 cases of control group were divided into two groups according to whether or not intestinal peritoneal dialysis related peritonitis occurred. The general data of patients were collected, the identification of enterogenic bacteria and the results of drug resistance analysis were recorded. The risk factors of peritonitis associated with enterogenous peritoneal dialysis were analyzed by Logistic regression analysis. Results there were 27 cases of enterogenic bacterial infection in the two groups, such as age, HB), serum albumin (Alb) level, hypersensitive C-reactive protein hs-CRP (HS-CRP) level, and the rate of diabetes mellitus. The difference was statistically significant in 24 patients with peritonitis. Among them, 13 cases were Escherichia coli, accounting for 48.2%, and 5 cases were Enterococcus faecalis, accounting for 18.5m. The resistance rate of enterogenic bacteria to ampicillin, levofloxacin, ceftazidime, cefazolin, penicillin and erythromycin was 50. 0%, while to butylamine, cefoperazone sulbactam, piperacillin tazobactam, The resistant rate of teicoplanin was less than 20.0. The results of logistic regression analysis showed that the level of Alb decreased and the level of hs-CRP increased in the older group, and diabetes was the risk factor of enterogenic peritoneal dialysis-related peritonitis (P 0.05). Conclusion Enterogenous bacteria are mainly Escherichia coli and Enterococcus faecalis, and their drug resistance rate is high. Vancomycin combined with amikacin is recommended as an empirical initial regimen.
【作者单位】：浙江省绍兴市人民医院浙江大学绍兴医院肾内科;
【分类号】：R459.5

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