单中心14年腹膜透析相关性腹膜炎病原菌谱变化趋势分析

刘美婷; 戴欢子; 王玲

doi:10.16016/j.2097-0927.202206044

您当前的位置：

首页 >

文章列表页 >

单中心14年腹膜透析相关性腹膜炎病原菌谱变化趋势分析

临床医学 | 更新时间：2026-01-09

- 单中心14年腹膜透析相关性腹膜炎病原菌谱变化趋势分析
- Changing trends in pathogenic bacteria spectrum of peritoneal dialysis-related peritonitis in a single center in 14 years
- 陆军军医大学学报 2022年44卷第23期页码：2435-2439
- 作者机构：
  
  400012 重庆，陆军特色医学中心肾内科
- 作者简介：
  
  [王玲，E-mail: 592012858@qq.com WANG Ling, E-mail: 592012858@qq.com
- 基金信息：
- DOI：10.16016/j.2097-0927.202206044
  中图分类号： R372;R459.5;R572.2
- 收稿：2022-06-08，
  
  修回：2022-07-19，
  
  纸质出版：2022-12-15
- 稿件说明：
移动端阅览
刘美婷, 戴欢子, 王玲. 单中心14年腹膜透析相关性腹膜炎病原菌谱变化趋势分析[J]. 陆军军医大学学报, 2022,44(23):2435-2439.

Meiting LIU, Huanzi DAI, Ling WANG. Changing trends in pathogenic bacteria spectrum of peritoneal dialysis-related peritonitis in a single center in 14 years[J]. Journal of Army Medical University, 2022, 44(23): 2435-2439.
刘美婷, 戴欢子, 王玲. 单中心14年腹膜透析相关性腹膜炎病原菌谱变化趋势分析[J]. 陆军军医大学学报, 2022,44(23):2435-2439. DOI： 10.16016/j.2097-0927.202206044.

Meiting LIU, Huanzi DAI, Ling WANG. Changing trends in pathogenic bacteria spectrum of peritoneal dialysis-related peritonitis in a single center in 14 years[J]. Journal of Army Medical University, 2022, 44(23): 2435-2439. DOI： 10.16016/j.2097-0927.202206044.

摘要

目的

探讨单中心近14年腹膜透析相关性腹膜炎致病及初始治疗耐药的微生物变化趋势。

方法

选取2007年1月1日至2020年12月31日在陆军特色医学中心肾内科进行腹膜透析治疗的873位患者，其中352位患者发生过腹膜炎，根据腹膜炎发生时间分为时间段1(period 1，P1)：2007年01月01日至2012年12月31日、时间段2(period 2，P2)：2013年01月01日至2016年12月31日、时间段3(period 3，P3)：2017年01月01日至2020年12月31日三个组，分析不同时间段导致腹膜炎的致病菌的变化趋势、初始治疗耐药情况以及各个时间段腹膜炎治疗转归情况。

结果

各时间段导致腹膜炎的致病菌仍以革兰氏染色阳性细菌为主，其中表皮葡萄球菌占比最高(P1:15.8%

P2：15.4%

P3:14%)，对初始治疗耐药的比例也最大(P1 27.3%，P2 15.6%

P3 23.3%)。从P1到P3阶段，金黄色葡萄球菌出现频率呈增加趋势，P3阶段构成比例显著高于P1阶段(P3 6.7%

P1 1.3%

0.05)。革兰氏染色阴性菌中，大肠埃希氏菌出现频率逐渐减少，P3阶段构成比显著低于P1阶段(P3 5.7%

P1 13.2%

0.05)。木糖产气碱杆菌从P2阶段开始出现，P3阶段又呈减少趋势，P3阶段其构成比显著低于P2阶段(P3 0.3%

P2 2.8%

0.05)。嗜麦芽窄食单胞菌从P2阶段开始出现，呈增多趋势，P3阶段构成比显著高于P2阶段(P3 3.2%

P2 0.4%

0.05)，其耐药比例也明显增加(P2 1.6%

P3 11.1%)。各个时间对初始治疗耐药的患者拔管率明显高于不耐药患者(P1:31.8%

7.4%

P2：35.9%

17%

P3:45.5%

20.8%，

0.05)。

结论

各时间段导致腹膜炎的致病菌主要以革兰氏染色阳性细菌为主，其中表皮葡萄球菌占比最高。革兰氏染色阴性菌中大肠埃希氏菌占比最高，但呈减少趋势。嗜麦芽窄食单胞菌为P2阶段新出现的致病菌。

Abstract

Objective

To investigate the changing trends in pathogenic bacteria of peritoneal dialysis-related peritonitis and initial treatment resistance in a single center during the past 14 years.

Methods

A total of 873 patients undergoing peritoneal dialysis in our department from January 1

2007 to December 31

2020 were recruited in this study. Among them

352 patients had peritonitis

and were divided into 3 groups according to the occurrence time of peritonitis

that is

Period 1 group (P1

January 1

2007 to December 31

2012)

Period 2 group (P2

January 1

2013 to December 31

2016) and Period 3 group (P3

January 1

2017 to December 31

2020). The change trends in pathogenic bacteria leading to peritonitis

drug resistance of initial treatment

and treatment outcome in above time periods were analyzed.

Results

The main pathogens causing peritonitis were Gram-positive bacteria in each time period

among which Staphylococcus epidermidis accounted for the highest proportion (P1: 15.8%

P1: 15.4%

P3: 14%)

and had the largest proportion of resistance to initial treatment (P1: 27.3%

P2: 15.6%

P3: 23.3%). From P1 to P3

the frequency of S. aureus was in a trend of increasing

which had significantly higher proportion of P3 than that of P1 (6.7%

1.3%

0.05). Among the isolated Gram-negative bacteria

the frequency of Escherichia coli was decreased gradually

and the composition ratio of P3 stage was obviously lower than that of P1 stage (5.7%

13.2%

0.05). Alcalibacterium xylogenes was firstly observed from the P2 stage

and then in a decreasing trend in the P3 stage

and its composition ratio was notably lower in the P3 stage than the P2 stage (0.3%

2.8%

0.05). Stenotrophomonas maltophilia was firstly observed in the P2 stage and showed an increasing trend

with its composition ratio of the P3 stage remarkably higher than that of the P2 stage (3.2%

0.4%

0.05)

and its drug resistance ratio was also increased significantly (P2: 1.6 %

P3: 11.1%). The extubation rate of patients who were resistant to initial treatment at each time was significantly higher than that of non-resistant patients (P1: 31.8%

7.4%

P2: 35.9%

17%

P3: 45.5%

20.8%

0.05).

Conclusion

The pathogenic bacteria that causing peritonitis are mainly Gram-positive bacteria in each time period

with Staphylococcus epidermidis most common

and having highest proportion of resistance to initial treatment. Escherichia coli accounts for the highest proportion in the Gram-negative bacteria

but shows a decreasing trend. Stenotrophomonas maltophilia is a newly emerged pathogen in the P2 stage

and the bacterial resistance ratio is high. At each stage

the extubation rate is significantly higher in the drug-resistant group than the non-resistant group.

关键词

Keywords

references

TEITELBAUM I. Peritoneal dialysis[J]. N Engl J Med, 2021, 385(19): 1786-1795. DOI: 10.1056/NEJMra2100152.

HTAY H, CHO Y, PASCOE E M, et al . Multicenter registry analysis of center characteristics associated with technique failure in patients on incident peritoneal dialysis[J ] . Clin J Am Soc Nephrol, 2017, 12(7): 1090-1099. DOI: 10.2215/CJN.12321216.

SZETO C C, LI P K. Peritoneal dialysis-associated peritonitis[J]. Clin J Am Soc Nephrol, 2019, 14(7): 1100-1105. DOI: 10.2215/CJN.14631218.

LI P K, SZETO C C, PIRAINO B, et al . ISPD peritonitis recommendations: 2016 update on prevention and treatment[J ] . Perit Dial Int, 2016, 36(5): 481-508. DOI: 10.3747/pdi.2016.00078.

KITTERER D, LATUS J, PÖHLMANN C, et al . Microbiological surveillance of peritoneal dialysis associated peritonitis: antimicrobial susceptibility profiles of a referral center in GERMANY over 32 years[J ] . PLoS One, 2015, 10(9): e0135969. DOI: 10.1371/journal.pone.0135969.

DONG J, CHEN Y. Impact of the bag exchange procedure on risk of peritonitis[J]. Perit Dial Int, 2010, 30(4): 440-447. DOI: 10.3747/pdi.2009.00117.

RUSSO R, MANILI L, TIRABOSCHI G, et al . Patient re-training in peritoneal dialysis: why and when it is needed[J ] . Kidney Int Suppl, 2006(103): S127-S132. DOI: 10.1038/sj.ki.5001929.

ZENG Y, JIANG L S, LU Y, et al . Peritoneal dialysis-related peritonitis caused by gram-negative organisms: ten-years experience in a single center[J ] . Ren Fail, 2021, 43(1): 993-1003. DOI: 10.1080/0886022X.2021.1939050.

FENG X R, YANG X, YI C Y, et al . Escherichia coli Peritonitis in peritoneal dialysis: the prevalence, antibiotic resistance and clinical outcomes in a South China dialysis center[J ] . Perit Dial Int, 2014, 34(3): 308-316. DOI: 10.3747/pdi.2013.00012..

佟怡婧, 严豪, 李振元, 等. 711例次腹膜透析相关性腹膜炎的致病菌谱变化及药物敏感分析[J]. 中华肾脏病杂志, 2017, 33(8): 601-608. DOI: 10.3760/cma.j.issn.1001-7097.2017.08.007.

TONG Y J, YAN H, LI Z Y, et al . Analysis of microbiological trends and antibiotic susceptibility in 711 episodes of peritoneal dialysis-related peritonitis[J ] . Chin J Nephrology, 2017, 33(8): 601-608. DOI: 10.3760/cma.j.issn.1001-7097.2017.08.007.

KIM D K, YOO T H, RYU D R, et al . Changes in causative organisms and their antimicrobial susceptibilities in CAPD peritonitis: a single center & apos; s experience over one decade[J ] . Perit Dial Int, 2004, 24(5): 424-432.

KAVANAGH D, PRESCOTT G J, MACTIER R A. Peritonealdialysis-associated peritonitis in Scotland (1999-2002)[J]. Nephrol Dial Transplant, 2004, 19(10): 2584-2591. DOI: 10.1093/ndt/gfh386.

SZETO C C, LI P K, LEUNG C B, et al . Xanthomonas maltophilia peritonitis in urem ic patients receiving continuous ambulatory peritoneal dialysis[J ] . Am J Kidney Dis, 1997, 29(1): 91-95. DOI: 10.1016/s0272-6386(97)90013-5..

AZAK A, KOCAK G, HUDDAM B, et al . An unusual cause of continuous ambulatory peritoneal dialysis-associated outpatient peritonitis: Stenotrophomonas maltophilia [J ] . Am J Infect Control, 2011, 39(7): 618. DOI: 10.1016/j.ajic.2011.01.004..

DENTON M, KERR K G. Microbiological and clinical aspects of infection associated with Stenotrophomonas maltophilia [J ] . Clin Microbiol Rev, 1998, 11(1): 57-80. DOI: 10.1128/CMR.11.1.57.

BAEK J E, JUNG E Y, KIM H J, et al . Stenotrophomonas maltophilia infection in patients receiving continuous ambulatory peritoneal dialysis[J ] . Korean J Intern Med, 2004, 19(2): 104-108. DOI: 10.3904/kjim.2004.19.2.104..

LI P K, CHOW K M, VAN DE LUIJTGAARDEN M W, et al . Changes in the worldwide epidemiology of peritoneal dialysis[J ] . Nat Rev Nephrol, 2017, 13(2): 90-103. DOI: 10.1038/nrneph.2016.181.

BOUDVILLE N, KEMP A, CLAYTON P, et al . Recent peri tonitis associates with mortality among patients treated with peritoneal dialysis[J ] . J Am Soc Nephrol, 2012, 23(8): 1398-1405. DOI: 10.1681/ASN.2011121135.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

共享决策干预在终末期肾脏病患者透析治疗决策中的应用

骨髓间充质干细胞外泌体治疗改善高糖腹透液引起的小鼠腹膜纤维化

粪肠球菌基因hyl₁功能的实验研究