慢性肾衰竭行腹膜透析患者导管感染的相关因素及病原学分析
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摘要
目的了解慢性肾衰竭腹膜透析患者导管感染相关因素及感染病原学特点,为预防导管相关感染及治疗提供依据。方法回顾性分析持续腹膜透析治疗患者临床资料,单因素及多因素logistic回归分析患者发生导管感染的影响因素,对导管感染患者采集临床标本进行病原菌培养与鉴定。结果 135例腹膜透析患者发生导管感染,感染患者共培养病原菌140株,革兰阳性菌99株(70.71%),革兰阴性菌36株(25.71%),真菌5株(3.57%)。金黄色葡萄球菌与凝固酶阴性葡萄球菌对替考拉宁、呋喃妥因、利奈唑胺敏感,对青霉素、氨苄西林耐药率高,铜绿假单胞菌对多种药物耐药率均较高,其中氨苄西林耐药率最高,对左氧氟沙星、亚胺培南耐药率较低。高龄(≥60岁)、透析时间长(>2年)、BMI≤20kg/m2、文化程度较低、高血压、糖尿病为持续腹膜透析治疗患者导管感染的影响因素。结论腹膜透析患者导管感染率较高,主要病原菌以革兰阳性菌为主。
OBJECTIVE To understand the related factors and etiological characteristics of catheter-related infection in chronic renal failure patients undergoing peritoneal dialysis so as to provide guidance for prevention of the catheter-related infection.METHODS A total of 236 patients who received continuous peritoneal dialysis(for more than1 year)in the hospital from Jan 2016 to Jun 2017 were recruited as the study objects,135 patients who had catheter-related infection were assigned as the study group,and 101 patients who did not have catheter-related infection were assigned as the control group.The clinical data of the patients who received the peritoneal dialysis were retrospectively analyzed,the univariate analysis and multivariate logistic regression analysis were performed for influencing factors for the catheter-related infection,the clinical specimens were collected from the patients with the catheter-related infection,and the isolated pathogens were identified.RESULTS Totally 140 strains of pathogens were isolated from the 135 patients with the catheter-related infection,99(70.71%)of which were gram-positive bacteria,36(25.17%)were gram-negative bacteria,and 5(3.57%)were fungi.Staphylococcus aureus and coagulase-negative Staphylococcus strains were highly susceptible to teicoplanin,nitrofurantoin and linezolid but were highly resistant to penicillin and ampicillin;Pseudomonas aeruginosastrains were highly resistant to multiple antibiotics,the drug resistance rate to ampicillin was the highest,and the drug resistance rates to levofloxacin and imipenem were low.The advanced age(no less than 60 years of age),long-term dialysis(more than 2 years),BMI no more than 20 kg/m2,low education level,hypertension and diabetes mellitus were the influencing factors for the catheter-related infection in the patients undergoing the continuous peritoneal dialysis.CONCLUSION The incidence of the catheter-related infection is high in the peritoneal dialysis patients.The gram-positive bacteria are dominant among the pathogens.
OBJECTIVE To understand the related factors and etiological characteristics of catheter-related infection in chronic renal failure patients undergoing peritoneal dialysis so as to provide guidance for prevention of the catheter-related infection.METHODS A total of 236 patients who received continuous peritoneal dialysis(for more than1 year)in the hospital from Jan 2016 to Jun 2017 were recruited as the study objects,135 patients who had catheter-related infection were assigned as the study group,and 101 patients who did not have catheter-related infection were assigned as the control group.The clinical data of the patients who received the peritoneal dialysis were retrospectively analyzed,the univariate analysis and multivariate logistic regression analysis were performed for influencing factors for the catheter-related infection,the clinical specimens were collected from the patients with the catheter-related infection,and the isolated pathogens were identified.RESULTS Totally 140 strains of pathogens were isolated from the 135 patients with the catheter-related infection,99(70.71%)of which were gram-positive bacteria,36(25.17%)were gram-negative bacteria,and 5(3.57%)were fungi.Staphylococcus aureus and coagulase-negative Staphylococcus strains were highly susceptible to teicoplanin,nitrofurantoin and linezolid but were highly resistant to penicillin and ampicillin;Pseudomonas aeruginosastrains were highly resistant to multiple antibiotics,the drug resistance rate to ampicillin was the highest,and the drug resistance rates to levofloxacin and imipenem were low.The advanced age(no less than 60 years of age),long-term dialysis(more than 2 years),BMI no more than 20 kg/m2,low education level,hypertension and diabetes mellitus were the influencing factors for the catheter-related infection in the patients undergoing the continuous peritoneal dialysis.CONCLUSION The incidence of the catheter-related infection is high in the peritoneal dialysis patients.The gram-positive bacteria are dominant among the pathogens.
引文
[1]余乐.腹膜透析治疗急性肾损伤现状[J].肾脏病与透析肾移植杂志,2016,25(1):82-85,76.
[2] Ho LT.Infectious complications of peritoneal dialysis[M]//Surgical Aspects of Peritoneal Dialysis.Springer International Publishing,2017:153-158.
[3]张鹏远,翟小琳,孟庆庆,等.腹膜透析病人退出原因分析[J].内蒙古医学杂志,2017,49(1):50-51.
[4]陈香美.腹膜透析标准操作规程[M].北京:人民军医出版社,2012:92-95.
[5]王成玉,罗宇珍,黄昱铭,等.持续性非卧床腹膜透析死亡患者透析龄及其相关因素研究[J].中国全科医学,2016,19(36):4447-4450.
[6] Bragg-Gresham J,de Campos LG,Han Y,et al.Lower hemoglobin(HB)levels negatively impact quality of life(QOL)among peritoneal dialysis(PD)patients:results from a national representative cohort study in Brazil(BRAZPD)[J].Value Health,2017,20(9):A896.
[7] Nicoara O,Somers MJG,Chand DH.Infectious complications of peritoneal dialysis in children with end-stage renal disease[J].J Pediatr Infect Dis,2016,11(3):93-98.
[8]王萍.2016ISPD关于腹膜透析相关腹膜炎防治指南的解读[J].肾脏病与透析肾移植杂志,2017,26(3):282-286.
[9] Li PKT,Szeto CC,Piraino B,et al.ISPD peritonitis recommendations:2016update on prevention and treatment[J].Perit Dial Int,2016,36(5):481-508.
[10] Campbell D,Mudge DW,Craig JC,et al.Antimicrobial agents for preventing peritonitis in peritoneal dialysis patients[J].Cochrane Database Syst Rev,2017,4:CD004679.
[11] Sampaio J,Machado D,Gomes A,et al.Deciphering the contribution of biofilm to the pathogenesis of peritoneal dialysis infections:characterization and microbial behaviour on dialysis fluids[J].PLoS One,2016,11(6):e0157870.
[12]韩辉,周巧玲.慢性肾衰竭患者医院感染的病原学特点及危险因素分析[J].中国医学前沿杂志(电子版),2017,9(5):127-130.
[13] Higuchi C,Ito M,Masakane I,et al.Peritonitis in peritoneal dialysis patients in Japan:a 2013retrospective questionnaire survey of Japanese Society for Peritoneal Dialysis member institutions[J].Renal Repl Therapy,2016,2(1):2-5.
[14] Wu H,Huang R,Yi C,et al.Risk factors for early-onset peritonitis in Southern Chinese peritoneal dialysis patients[J].Perit Dial Int,2016,36(6):640-646.
[15]万玉红,刘红梅,杨玉红,等.预防性护理对腹膜透析患者导管感染率的影响[J].实用临床医药杂志,2017,21(10):158-160.
[16]刘莹,韩庆烽,唐雯,等.腹膜透析患者生活质量的相关影响因素分析[J].中国血液净化,2016,15(6):367-370.
[17]李阳,王海云,王颖,等.老年腹膜透析患者长期生存分析[J].中华肾脏病杂志,2017,33(1):1-7.
[18]王永红,姜埃利.置管后开始腹膜透析时间对老年终末期肾病患者生存率、肾脏功能及并发症的影响[J].中国老年学杂志,2017,37(14):3580-3582.
[2] Ho LT.Infectious complications of peritoneal dialysis[M]//Surgical Aspects of Peritoneal Dialysis.Springer International Publishing,2017:153-158.
[3]张鹏远,翟小琳,孟庆庆,等.腹膜透析病人退出原因分析[J].内蒙古医学杂志,2017,49(1):50-51.
[4]陈香美.腹膜透析标准操作规程[M].北京:人民军医出版社,2012:92-95.
[5]王成玉,罗宇珍,黄昱铭,等.持续性非卧床腹膜透析死亡患者透析龄及其相关因素研究[J].中国全科医学,2016,19(36):4447-4450.
[6] Bragg-Gresham J,de Campos LG,Han Y,et al.Lower hemoglobin(HB)levels negatively impact quality of life(QOL)among peritoneal dialysis(PD)patients:results from a national representative cohort study in Brazil(BRAZPD)[J].Value Health,2017,20(9):A896.
[7] Nicoara O,Somers MJG,Chand DH.Infectious complications of peritoneal dialysis in children with end-stage renal disease[J].J Pediatr Infect Dis,2016,11(3):93-98.
[8]王萍.2016ISPD关于腹膜透析相关腹膜炎防治指南的解读[J].肾脏病与透析肾移植杂志,2017,26(3):282-286.
[9] Li PKT,Szeto CC,Piraino B,et al.ISPD peritonitis recommendations:2016update on prevention and treatment[J].Perit Dial Int,2016,36(5):481-508.
[10] Campbell D,Mudge DW,Craig JC,et al.Antimicrobial agents for preventing peritonitis in peritoneal dialysis patients[J].Cochrane Database Syst Rev,2017,4:CD004679.
[11] Sampaio J,Machado D,Gomes A,et al.Deciphering the contribution of biofilm to the pathogenesis of peritoneal dialysis infections:characterization and microbial behaviour on dialysis fluids[J].PLoS One,2016,11(6):e0157870.
[12]韩辉,周巧玲.慢性肾衰竭患者医院感染的病原学特点及危险因素分析[J].中国医学前沿杂志(电子版),2017,9(5):127-130.
[13] Higuchi C,Ito M,Masakane I,et al.Peritonitis in peritoneal dialysis patients in Japan:a 2013retrospective questionnaire survey of Japanese Society for Peritoneal Dialysis member institutions[J].Renal Repl Therapy,2016,2(1):2-5.
[14] Wu H,Huang R,Yi C,et al.Risk factors for early-onset peritonitis in Southern Chinese peritoneal dialysis patients[J].Perit Dial Int,2016,36(6):640-646.
[15]万玉红,刘红梅,杨玉红,等.预防性护理对腹膜透析患者导管感染率的影响[J].实用临床医药杂志,2017,21(10):158-160.
[16]刘莹,韩庆烽,唐雯,等.腹膜透析患者生活质量的相关影响因素分析[J].中国血液净化,2016,15(6):367-370.
[17]李阳,王海云,王颖,等.老年腹膜透析患者长期生存分析[J].中华肾脏病杂志,2017,33(1):1-7.
[18]王永红,姜埃利.置管后开始腹膜透析时间对老年终末期肾病患者生存率、肾脏功能及并发症的影响[J].中国老年学杂志,2017,37(14):3580-3582.