腹膜透析相关性腹膜炎的临床特征及耐药性分析

发布时间：2018-05-12 05:23

本文选题：腹膜透析 + 腹膜炎　；参考：《吉林大学》2014年硕士论文

【摘要】：PD因其自身的一些特点和优越性，被越来越多的人们所接受。随着治疗的不断规范化，，腹膜炎的发生率显著下降，但它仍是腹膜透析最常见的并发症，也是导致患者住院率、死亡率及不能坚持腹膜透析的主要原因。长期大量使用抗菌药物，微生物构成谱不断发生变化，耐药菌株也逐渐增加。所以了解PD相关性腹膜炎的临床特征、致病菌及耐药率变化是临床面临的现实问题。本文对相关因素进行分析，从而指导临床实践针对相应因素采取有效措施，提高医院的感染治愈率，改善患者的生活质量。目的回顾性分析吉林大学第一医院二部近2年持续性不卧床腹膜透析(continuous ambulatory peritoneal dialysis，CAPD)相关性腹膜炎患者的临床资料，总结腹膜炎的一般临床特征、致病菌谱及耐药率变化，为治疗腹膜炎提供临床依据。资料与方法选取2011年6月-2013年6月吉林大学第一医院二部收治的腹膜透析相关性腹膜炎患者，作为研究对象，归为腹膜炎组；同时，选取同期相应的未发生腹膜炎的CAPD患者，归为对照组，分析两组的临床资料，探讨腹膜炎的临床特征、菌群分布及耐药率变化等。结果（1）两组患者的年龄、性别、婚姻、支付方式、透析月、原发疾病构成等基线资料无明显差异。（2）腹膜炎组患者外周血白细胞数高于对照组（P0.01），腹膜炎组中性粒细胞比例亦高于对照组(P0.01)，腹膜炎组血红细胞、红细胞比容、血红蛋白低于对照组(P0.05)。（3）腹膜炎组血清钾、钠、氯、钙水平低于对照组(P0.05)；腹膜炎组磷也低于对照组，但两组间比较无统计学意义（P＞0.05）。（4）腹膜炎组患者血清白蛋白水平明显低于对照组(P0.05)。腹膜炎组前白蛋白也低于对照组，但差异无统计学意义（P0.05）。腹膜炎组铁蛋白水平均明显高于对照组(P0.01)。（5）腹膜炎组与对照组在腹透管出口位置（右/左）方面差异无统计学意义（P＞0.05）；两组在置管医院（我院/外院）方面亦无统计学差异（P＞0.05）；腹膜炎组腹泻/便秘情况高于对照组，两组间比较有统计学意义(P0.01)；腹膜炎组血肌酐低于对照组，两组间比较无统计学意义（P0.05），腹膜炎组尿素氮也低于对照组，但两组间比较有统计学意义(P0.01)。（6）在57例次CAPD腹膜炎患者中，共有42例次培养阳性，阳性率为73.68%，共培养病原菌46株，其中革兰阳性菌19株，构成比为41.30%，革兰阴性菌20株，构成比为43.48%；真菌7株，其构成比为15.22%。其中3例患者为混合感染，2例患者培养出两种致病菌，1例患者培养出三种致病菌。（7）主要的革兰阳性菌对利奈唑胺、替考拉宁、万古霉素的耐药率最低，均为0；其次为呋喃妥因、阿米卡星，分别为7.14%、14.29%；青霉素、苯唑西林的耐药率分别为63.16%、71.43%，红霉素的耐药率最高为72.22%。革兰阴性菌中未发现对阿米卡星、亚胺培南、头孢哌酮耐药的菌株；对头孢他啶、阿莫西林（克拉维酸）的耐药率分别为20%、35.29%；氨苄西林的耐药率最高，为81.25%。（8）腹膜炎组50例患者共有3例死亡，7例拔管改做血液透析，其余患者均治愈，CAPD的退出率为14%，其中，本研究中7例真菌性腹膜炎，4例拔管改血液透析，3例死亡。（9）真菌性腹膜炎患者PD的时间明显长于G+及G-性腹膜炎患者；血白细胞数亦明显高于两种细菌性腹膜炎患者(P0.05)；G-菌性腹膜炎透析液白细胞数明显低于G+菌性腹膜炎病例(P0.05)。结论 1.营养差、贫血、电解质紊乱是腹膜炎的易感因素。 2.腹膜透析相关性腹膜炎致病菌：革兰阴性菌的构成比为43.48%，革兰阳性菌的构成比为41.30%，真菌的构成比为15.22%。 3.腹膜炎患者在经验治疗中，抗生素可继续使用万古霉素和头孢他啶，头孢唑林的耐药率增高。 4.真菌性腹膜炎有较高的死亡率及退出率。
[Abstract]:PD is accepted by more and more people because of its own characteristics and superiority . With the continuous normalization of treatment , the incidence of peritonitis is significantly decreased , but it is the most common complication of peritoneal dialysis .

Purpose

The clinical data of continuous ambulatory peritoneal dialysis ( CAPD ) - related peritonitis in the first hospital of Jilin University was analyzed retrospectively , and the general clinical characteristics , pathogenic bacteria spectrum and drug resistance rate of peritonitis were summarized , which provided clinical basis for the treatment of peritonitis .

data and methods

From June 2011 to June 2013 , the patient of peritoneal dialysis - related peritonitis in the first hospital of Jilin University was selected as the study object , which was classified as peritonitis group ;
At the same time , the CAPD patients who didn ' t have peritonitis in the same period were selected as the control group , and the clinical data of the two groups were analyzed , and the clinical characteristics , flora distribution and drug resistance rate of peritonitis were discussed .

Results

( 1 ) There was no significant difference in the baseline data of age , sex , marriage , payment method , dialysis month and primary disease constitution of the two groups .

( 2 ) The number of white blood cells in the patients with peritonitis was higher than that in the control group ( P0.01 ) . The proportion of neutrophils in the peritonitis group was higher than that in the control group ( P0.01 ) . The red blood cells , the hematocrit and the hemoglobin in the peritonitis group were lower than those in the control group ( P0.05 ) .

( 3 ) The levels of serum potassium , sodium , chlorine and calcium in the peritonitis group were lower than those in the control group ( P0.05 ) .
The phosphorus in the peritonitis group was lower than that of the control group , but there was no significant difference between the two groups ( P > 0.05 ) .

( 4 ) The levels of serum albumin in the peritonitis group were significantly lower than those in the control group ( P0.05 ) . The levels of serum albumin in peritonitis group were significantly higher than those in the control group ( P0.05 ) . The iron protein level in peritonitis group was significantly higher than that in the control group ( P0.01 ) .

( 5 ) There was no significant difference between peritonitis group and control group ( P > 0.05 ) .
There was no statistical difference between the two groups ( P > 0.05 ) .
The incidence of diarrhea / constipation in the peritonitis group was higher than that in the control group , and there was significant difference between the two groups ( P0.01 ) .
In the peritonitis group , the serum creatinine was lower than that of the control group , there was no significant difference between the two groups ( P0.05 ) , and the urea nitrogen in the peritonitis group was lower than that of the control group , but there was statistical significance between the two groups ( P0.01 ) .

( 6 ) Of the 57 cases of CAPD , 42 were positive , the positive rate was 73.68 % , and 46 strains were co - cultured . Among them , 19 strains were Gram - positive bacteria , 20 strains of Gram - negative bacteria and 43.48 % of Gram - negative bacteria .
Of the 7 strains , the proportion of 7 strains was 15.22 % . Among them , 3 patients were mixed infection , 2 patients developed two pathogenic bacteria , and one patient developed three pathogenic bacteria .

( 7 ) The drug resistance of the main Gram - positive bacteria to linezolid , teicoplanin and vancomycin was the lowest , all of them were 0 ;
The second was furacine , amikaine , 7.14 % and 14.29 % , respectively .
The drug resistance of penicillin and benazosin was 63.16 % , 71.43 % and 72.22 % , respectively .
The drug resistance rates of ceftazidine and amoxicillin were 20 % and 35.29 % , respectively .
The drug resistance rate of ampicillin was the highest , which was 81.25 % .

( 8 ) In the peritonitis group , there were 3 cases of death , 7 cases underwent hemodialysis and the rest were cured . The withdrawal rate of CAPD was 14 % . Among them , 7 cases of fungal peritonitis in the study , 4 out of extraction and hemodialysis , 3 cases died .

( 9 ) The time of PD in patients with fungal peritonitis was significantly longer than those in G + and G - peritonitis ;
The number of white blood cells was also significantly higher than that in the patients with bacterial peritonitis ( P0.05 ) .
The number of white blood cells of G - bacterial peritonitis was significantly lower than that in G + bacteria peritonitis ( P0.05 ) .

Conclusion

1 . Poor nutrition , anemia and electrolyte disturbance are the susceptible factors of peritonitis .

2 . The proportion of Gram - negative bacteria was 43.48 % , the proportion of Gram - positive bacteria was 41.30 % , and the proportion of fungi was 15.22 % .

3 . In patients with peritonitis , antibiotics can continue to use vancomycin and ceftazidine in the treatment of peritonitis , and the resistance rate of ceftizazole is increased .

4 . fungal peritonitis has a high mortality rate and withdrawal rate .

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R656.41;R692.5

【参考文献】