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闵永龙.腹膜透析患者胃肠道因素相关性腹膜炎的病原学分析[J].内科急危重症杂志,2025,31(4):361-365
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| DOI：10.11768/nkjwzzzz20250415 |
| 中文关键词: 腹膜透析 腹膜炎 胃肠道因素 病原学 药敏 |
| 英文关键词: |
| 基金项目:武汉市卫健委项目（WX21B20） |
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| 摘要点击次数: 12 |
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| 中文摘要: |
| 摘要 目的：探讨腹膜透析患者胃肠道因素相关性腹膜炎的病原学特点及其药敏试验结果。方法：回顾性收集行腹膜透析过程中由胃肠道因素导致的腹膜炎患者45例，总结分析其病原菌培养、药敏试验结果及治疗转归。结果： 45例患者中累计发生腹膜炎事件54例次。腹透液培养阳性率为88.7%。共分离出致病菌57株，其中革兰阳性菌（G+）占52.6%，革兰阴性菌（G-）占38.6%，真菌占8.8%。其中大肠埃希菌和唾液链球菌占比最高，分别为24.6%和21.1%。大便常规阳性（白细胞增多或隐血阳性）患者腹透液培养阳性率更高（92.5% vs 77.8%，P<0.05），且致病菌以G-菌为主（40.3%）。药敏试验结果显示，万古霉素和利奈唑胺对G+菌敏感率为100%，而亚胺培南和美洛培南对G-菌的敏感率为90.5%。真菌对米卡芬净和卡泊芬净的敏感率均为100%。45例次患者治愈率为68.5%，技术失败率为14.8%，死亡率为3.7%，其中G+菌治愈率较高（87.0%），技术失败及死亡患者以真菌和混合感染为主。结论：腹膜透析患者胃肠道因素相关性腹膜炎的致病菌以G+菌为主，治愈率较高，真菌感染和混合感染为技术失败和死亡的主要原因。大便检查阳性患者腹透液培养阳性率高，且以G-菌为主。 |
| 英文摘要: |
| Abstract Objective: To investigate the etiological characteristics and antibiotic susceptibility profiles of peritonitis related to gastrointestinal factors in peritoneal dialysis (PD) patients. Methods: A total of 45 PD patients with gastrointestinal-associated peritonitis were retrospectively enrolled. Pathogen culture results, antimicrobial susceptibility data, and clinical outcomes were analyzed. Results: A total of 54 peritonitis episodes occurred in the cohort. The peritoneal fluid culture positive rate was 88.7%, with 57 pathogenic isolates identified. Gram-positive (G+), Gram-negative (G-), and fungal pathogens accounted for 52.6%, 38.6%, and 8.8% of isolates, respectively. Escherichia coli (24.6%) and Streptococcus salivarius (21.1%) were the most prevalent pathogens. Patients with abnormal stool tests (leukocytosis or occult blood positivity) exhibited higher peritoneal fluid culture positivity (92.5% vs 77.8%, P< 0.05) and predominance of G-pathogens (40.3%). Antimicrobial susceptibility testing revealed 100% sensitivity of G+ isolates to vancomycin and linezolid, while imipenem and meropenem demonstrated 90.5% sensitivity against G-pathogens. All fungal isolates were sensitive to micafungin and caspofungin. The overall cure rate was 68.5%, with a technique failure rate of 14.8% and mortality of 3.7%. Notably, G+ infections showed higher cure rates (87.0%), whereas technique failure and mortality primarily occurred in cases of fungal or polymicrobial infections. Conclusion: G+ bacteria constitute the predominant etiology of gastrointestinal-related peritonitis in PD patients and are associated with favorable treatment outcomes. Fungal and polymicrobial infections significantly contribute to technique failure and mortality. Positive stool tests correlate with increased peritoneal fluid culture positivity and G-pathogen predominance. |
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