多频次腹透相关性腹膜炎的临床特点及菌谱分析

目的 探讨多频次腹透相关性腹膜炎的临床特点、病原分布及耐药情况。方法 回顾性分析2013年1月—2017年7月间因腹透相关性腹膜炎入院的腹膜透析患者，入院次数≥2者列为多频次组，仅1次入院者列为单次组。结果 多频次组23例，发生腹膜炎54例次，单次组18例，发生腹膜炎18例次。两组间性别、腹透龄、血压、血肌酐、血尿素氮、血钾、血钙、血磷及病原分布差异无统计学意义（P>0.05）。与单次组相比，多频次组患者的年龄普遍较大、原发病多为糖尿病肾病，而血红蛋白及血清白蛋白水平偏低（P<0.05）。主要致病菌为革兰阴性菌，以大肠埃希菌居多，对氨曲南、头孢唑啉、头孢曲松的耐药率最高，对哌拉西林/他唑巴坦及亚胺培南敏感；革兰阳性菌以表皮葡萄球菌为主，对氨苄青霉素、苯唑西林及克林霉素耐药，对万古霉素和莫西沙星敏感。结论 腹透相关性腹膜炎的反复出现与患者年龄大、有糖尿病、贫血及低白蛋白血症病史相关。

Clinical characteristics and bacterial spectrum of frequent peritoneal dialysis-associated peritonitis

Objective To discuss the clinical characteristics，pathogen distribution and drug resistance of frequent peritoneal dialysis-associated peritonitis（PDAP）．Methods Retrospective analysis was performed on the clinical data of patients with PDAP admitted in our hospital during January 2013 and July 2017．The patients were divided into M group（times of hospitalization>1）or S group（times of hospitalization=1）．Results The 23 patients in M group occurred 54 episodes of peritonitis，while the 18 patients in S group occurred 18 episodes of peritonitis．There were no statistically significant differences between the two groups（P>0.05）in gender，number of years of peritoneal dialysis，blood pressure，blood creatinine，blood urea nitrogen，potassium，calcium，phosphorus and distribution of pathogens．Compared with the S group，the patients in M group were generally elder and had a higher incidence of diabetic nephropathy；their levels of hemoglobin and serum albumin were lower（P<0.05）．The major pathogenic bacteria were Gram-negative bacteria with E. coli ranking the first．They showed the highest drug resistance rates to aztreonam，cefazolin and ceftriaxone，while were sensitive to piperacillin/tazobactam and imioenem．In the Gram-positive bacteria，Staphylococcus epidermis was predominant，which was resistant to ampicillin，benzoxicillin and clindamycin，while sensitive to vancomycin and moxifloxacin．Conclusion The recurrence of PDAP is associated with age and histories of diabetes，anemia and hypoalbuminemia．