Li Philip Hei, Cheng Vincent C C, Yip Terence, Yap Desmond Y H, Lui Sing-Leung, Lo Wai-Kei
Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
Perit Dial Int. 2017 Mar-Apr;37(2):177-182. doi: 10.3747/pdi.2016.00123. Epub 2016 Sep 28.
♦ BACKGROUND: spp. is an important cause of peritoneal dialysis (PD)-related peritonitis, but studies on peritonitis have been scarce. In view of the rising concern of carbapenem-resistant (CRA) and multidrug-resistant (MDRA) infections, we conducted this study on the incidence of peritonitis and the impact of CRA and MDRA on its outcome. ♦ METHODS: We retrospectively evaluated the clinical characteristics, prevalence, antibiotic sensitivity patterns, outcomes, and factors associated with treatment failure over the past 16 years in our patients with PD-related peritonitis. ♦ RESULTS: Out of 2,389 episodes of peritonitis, there were 66 episodes (3%) of peritonitis occurring in 59 patients. Twelve episodes were caused by MDRA (18%), of which 5 were CRA (8%). There was a progressive increase in the incidence of MDRA and CRA infections over the study period. Most isolates were sensitive to sulbactam combinations (ampicillin-sulbactam [95.4%] and cefoperazone-sulbactam [93.9%]), aminoglycosides (amikacin [92.4%], tobramycin [90.9%], and gentamicin [89.4%]), and carbapenems (imipenem [92.2%]). There was 1 case of relapse. Fifteen episodes resulted in catheter removal (23%), and 7 patients died (11%). Hypoalbuminemia (odds ratio [OR] = 0.85, = 0.006) and carbapenem resistance (OR = 18.2, = 0.049) were significantly associated with higher rates of treatment failure. ♦ CONCLUSION: Both carbapenem resistance and hypoalbuminemia were significantly associated with treatment failure. Up to 80% of peritonitis episodes by CRA resulted in catheter loss or mortality. Sulbactam combinations and/or aminoglycosides remained effective for the majority of isolates. There seemed to be an increasing relative incidence of MDRA and CRA infections over the past 16 years.
♦ 背景：[病原体名称]是腹膜透析（PD）相关腹膜炎的重要病因，但关于[病原体名称]腹膜炎的研究较少。鉴于对耐碳青霉烯类（CRA）和多重耐药（MDRA）感染的关注度不断上升，我们开展了这项关于[病原体名称]腹膜炎发病率以及CRA和MDRA对其预后影响的研究。♦ 方法：我们回顾性评估了过去16年中我们的PD相关腹膜炎患者的临床特征、患病率、抗生素敏感性模式、预后以及与治疗失败相关的因素。♦ 结果：在2389例腹膜炎发作中，有66例（3%）发生在59例患者中。12例由MDRA引起（18%），其中5例为CRA（8%）。在研究期间，MDRA和CRA感染的发生率呈逐渐上升趋势。大多数分离株对舒巴坦合剂（氨苄西林 - 舒巴坦[95.4%]和头孢哌酮 - 舒巴坦[93.9%]）、氨基糖苷类（阿米卡星[92.4%]、妥布霉素[90.9%]和庆大霉素[89.4%]）以及碳青霉烯类（亚胺培南[92.2%]）敏感。有1例复发。15例导致导管拔除（23%），7例患者死亡（11%）。低白蛋白血症（比值比[OR]=0.85，P = 0.006）和碳青霉烯类耐药（OR = 18.2，P = 0.049）与较高的治疗失败率显著相关。♦ 结论：碳青霉烯类耐药和低白蛋白血症均与治疗失败显著相关。高达80%的CRA引起的腹膜炎发作导致导管丢失或死亡。舒巴坦合剂和/或氨基糖苷类对大多数分离株仍然有效。在过去16年中，MDRA和CRA感染的相对发病率似乎在增加。
