老年腹膜透析相关性腹膜炎革兰阴性菌感染的临床特征及其耐药性

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中文摘要：目的回顾性分析老年腹膜透析相关性腹膜炎(PDRP)革兰阴性(G-)菌的病原菌分布、耐药性变化及相关临床特征，为临床诊疗提供参考依据。方法收集2015年1月—2022年12月某市3所三级甲等医院就诊治疗的老年PDRP患者，对G-菌PDRP的病原菌分布、耐药性、PDRP发病率、临床特征及预后进行分析。结果共有247例老年腹膜透析(PD)患者发生PDRP 406例次;PD老年患者PDRP总发病率和革兰阳性(G+)菌PDRP的发病率均呈逐年下降趋势(均P＜0。05)，而G-菌PDRP发病率随年份变化无明显下降趋势(P＞0。05)。PD老年患者共发生G-菌PDRP 96例(106例次)，以大肠埃希菌为主(38。68％)。与2015-2018年相比，2019-2022年老年PDRP患者分离的G-菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、亚胺培南、美罗培南、阿米卡星敏感率无明显变化，均高度敏感;对头孢噻肟的耐药率增加(P=0。033)。多因素logistic回归分析显示，血清C反应蛋白高、腹膜透析液第1天白细胞计数高、腹膜透析液白细胞计数降至正常的时间长是老年PD患者发生G-菌PDRP的危险因素(均P＜0。05)。G-菌组老年PDRP患者的治愈率(83。96％)低于G+菌组(93。01％)，差异有统计学意义(P＜0。05)。结论 PD老年患者G-菌PDRP发病率无明显下降趋势，氨基糖苷类抗生素可作为G-菌PDRP经验性治疗的首选药物。

外文标题：Clinical characteristics and antimicrobial resistance of Gram-negative bac-terial infection in elderly patients with peritoneal dialysis-related peritonitis

外文摘要：Objective To retrospectively analyze the distribution and antimicrobial resistance changes of Gram-negative(G-)bacteria,as well as related clinical characteristics of peritoneal dialysis-related peritonitis(PDRP)in elderly patients,provide reference for clinical diagnosis and treatment.Methods Elderly PDRP patients in three tertiary first-class hospitals in a city from January 2015 to December 2022 were analyzed,distribution and antimicro-bial resistance of G-bacterial PDRP pathogens,as well as incidence,clinical characteristics and prognosis of PDRP were analyzed.Results A total of 247 elderly peritoneal dialysis(PD)patients developed 406 episodes of PDRP.The overall incidence and incidence of Gram-positive(G+)bacterial PDRP in elderly PD patients showed a down-ward trend year by year(both P＜0.05),while the incidence of G-bacterial PDRP showed no significant down-ward trend(P＞0.05).A total of 96 cases(106 episodes)of G-bacterial PDRP occurred in elderly PD patients,with Escherichia coli being the predominant strain(38.68％).Compared with 2015-2018,there was no significant change in the susceptibility rates of G-bacteria isolated from elderly PDRP patients to piperacillin/tazobactam,cefo-perazone/sulbactam,imipenem,meropenem,and amikacin in 2019-2022,all of which were highly susceptible.The resistance rate to cefotaxime increased(P=0.033).Multivariate logistic regression analysis showed that high serum C-reactive protein,high white blood cell count in PD fluid on the first day,and long time for white blood cell count in PD fluid to return to normal were risk factors for G-bacterial PDRP in elderly PD patients(all P＜0.05).The cure rate of elderly PDRP patients in G-bacterial group(83.96％)was lower than that of the G+bacterial group(93.01％),with statistically difference(P＜0.05).Conclusion There is no obvious downward trend in the incidence of G-bacterial PDRP in elderly PD patients,aminoglycosides can be used as the first choice for empirical treatment of G-bacterial PDRP.

外文关键词：

peritoneal dialysisperitonitisperitoneal dialysis-related peritonitisthe elderlyGram-negative bac-teriainfluencing factorantimicrobial resistance

作者：

朱冬菊、李瑞丰

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作者单位：

攀枝花学院附属医院肾内科,四川攀枝花 617000

攀枝花学院基础医学院,四川攀枝花 617000

关键词：

腹膜透析腹膜炎腹膜透析相关性腹膜炎老年革兰阴性菌影响因素耐药性

基金：

重庆市自然科学基金面上项目攀枝花市医学研究中心科研项目

项目编号：

cstc2021jcyjmsxmX0092PYYZ-2022-01

出版年：

2024

DOI：

10.12138/j.issn.1671-9638.20245081

中国感染控制杂志

中南大学

中国感染控制杂志

CSTPCD北大核心

影响因子：2.112

ISSN：1671-9638

年,卷(期)：2024.23(9)