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持续性非卧床腹膜透析相关性腹膜炎患者的临床分析

[Clinical analysis for patients with continuous ambulatory peritoneal dialysis associated peritonitis].

作者信息

Liu Jian, Huang Xun, Liu Yao, Xu Hui, Gong Rui'e, Li Chunhui

机构信息

.Department of Infection Control, Dunhuan Municipal Hospity, Dunhuang Gansu 736200, China.

Department of Infection Control, Xiangya Hospital, Central South University, Changsha 410008, China.

出版信息

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2016 Dec 28;41(12):1328-1333. doi: 10.11817/j.issn.1672-7347.2016.12.013.

Abstract

To analyze the clinical characteristics of continuous ambulatory peritoneal dialysis (CAPD) associated peritonitis in the tertiary hospitals and to discuss the preventive and therapeutic strategy.
 Methods: The clinical characteristics, pathogens, resistance and outcomes of 126 CAPD associated peritonitis in 104 patients from Jan, 2013 to June, 2016, were retrospectively analyzed.
 Results: Among the patients, the incidence rates of abdominal pain, fever, diarrhea and emesis were 104 (82.54%), 56 (44.44%), 49 (38.89%), and 31 (23.60%), respectively. Among them, 88 patients suffered peritonitis once, other 16 patients suffered multiple peritonitis or recurrent peritonitis for 38 times. Among the 38 times, the numbers for recurrent, repeated or catheter-associated peritonitis were 2, 2, or 3, respectively. Peritoneal fluids from 103 cases were cultured, and 64 cases were positive in bacteria, with a rate of 62.14%. A total of 70 strains of bacteria were separated, including 42 strains of gram-positive bacteria, 21 strains of gram-negative bacteria, and 7 strains of fungus. The most common gram-positive pathogens were Staphylococcus epidermidis, Enterococcus faecalis and Staphylococcus haemolyticus, while Escherichia coli, Klebsiella pneumoniae and Klebsiella pneumoniae were the most common gram-negative bacteria. Candida albicans was the major fungal pathogens. Gram-positive cocci showed resistance to gentamycin, levofloxacin, moxifloxacin, vancomycin and linezolid, with a rate at 20.00%, 36.11%, 5%, 0%, and 0%, respectively. The gram-negative bacilli were resistent to cefoperazone/sulbactam, gentamycin, cephazolin, and ceftazidime, with a rate at 6.25%, 10.53%, 64.29%, and 15.38%, respectively. There were no imipenem, amikacin, piperacillin/tazobactam-resistant strains were found.
 Conclusion: The most common pathogen causing CAPD associated peritonitis is gram-positive bacteria. It is crucial to take the anti-infection therapy for CAPD associated peritonitis early. The positive rates for bacterial culture need to be enhanced through improvement of methods. At the same time, doctors could improve the outcome of CAPD associated peritonitis by adjusting the medication according to the drug sensitivity results.

摘要

分析三级医院持续性非卧床腹膜透析(CAPD)相关腹膜炎的临床特点,并探讨其防治策略。方法:回顾性分析2013年1月至2016年6月期间104例患者发生的126例CAPD相关腹膜炎的临床特点、病原体、耐药情况及转归。结果:患者中,腹痛、发热、腹泻、呕吐的发生率分别为104例(82.54%)、56例(44.44%)、49例(38.89%)、31例(23.60%)。其中,88例患者发生过1次腹膜炎,另外16例患者发生多次或反复腹膜炎共38次。在这38次中,复发性、再发性或导管相关性腹膜炎的次数分别为2次、2次、3次。对103例患者的腹水进行培养,64例细菌培养阳性,阳性率为62.14%。共分离出70株细菌,其中革兰阳性菌42株,革兰阴性菌21株,真菌7株。最常见的革兰阳性病原体为表皮葡萄球菌、粪肠球菌和溶血葡萄球菌,最常见的革兰阴性菌为大肠埃希菌、肺炎克雷伯菌和肺炎克雷伯菌。白色念珠菌是主要的真菌病原体。革兰阳性球菌对庆大霉素、左氧氟沙星、莫西沙星、万古霉素和利奈唑胺的耐药率分别为20.00%、36.11%、5%、0%、0%。革兰阴性杆菌对头孢哌酮/舒巴坦、庆大霉素、头孢唑林和头孢他啶的耐药率分别为6.25%、10.53%、64.29%、15.38%。未发现对亚胺培南、阿米卡星、哌拉西林/他唑巴坦耐药的菌株。结论:引起CAPD相关腹膜炎最常见的病原体是革兰阳性菌。早期进行抗感染治疗对CAPD相关腹膜炎至关重要。需通过改进方法提高细菌培养阳性率。同时,医生可根据药敏结果调整用药,提高CAPD相关腹膜炎的治疗效果。

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