南方医科大学学报

南方医科大学学报 ›› 2021, Vol. 41 ›› Issue (9): 1350-1357.doi: 10.12122/j.issn.1673-4254.2021.09.09

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腹膜透析相关的混合菌感染的发生和治疗失败的危险因素——814例多中心回顾性研究

刘美君，杨立明，朱学研，张晓暄，张 禹，庄小花，白晓莹，周文华，罗 萍，崔文鹏   

  1. 吉林大学第二医院肾病内科，吉林 长春 130041；吉林大学第一医院二部肾病内科，吉林 长春 130031；吉林市中心医院肾病内科，吉林 吉林 132011；吉林省一汽总医院肾病内科，吉林 长春 130011
  • 出版日期:2021-09-20 发布日期:2021-09-30

Risk factors of occurrence and treatment failure of peritoneal dialysis-associated polymicrobial peritonitis: a multicenter retrospective study

LIU Meijun, YANG Liming, ZHU Xueyan, ZHANG Xiaoxuan, ZHANG Yu, ZHUANG Xiaohua, BAI Xiaoying, ZHOU Wenhua, LUO Ping, CUI Wenpeng   

  1. Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China; Department of Nephrology, Second Division of First Hospital of Jilin University, Changchun 130031, China; Department of Nephrology, Jilin Central Hospital, Jilin 132011, China; Department of Nephrology, Jilin FAW General Hospital, Changchun 130011, China
  • Online:2021-09-20 Published:2021-09-30

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摘要： 目的 明确混合菌腹膜透析相关性腹膜炎（PDAP）发生和治疗失败的危险因素。方法 回顾性收集2013~2019年期间，在吉林省4家三甲医院腹膜透析（PD）中心随访的PDAP患者临床资料，将其分为混合菌PDAP组和对照组。比较两组患者的临床资料与治疗结果，应用多因素回归分析探讨影响混合菌PDAP发生和当次治疗失败的独立危险因素。结果 共纳入814例次PDAP，分为混合菌PDAP组（79例次PDAP）和对照组（735例次PDAP）。与对照组相比，混合菌PDAP组老年人（>65岁）和难治性PDAP占比更高，第1天透出液白细胞计数更多，抗生素治疗天数更长（P<0.05）。混合菌PDAP组拔管和发生治疗失败（拔 管+PDAP相关性死亡）的风险分别是对照组的2.972倍（OR=2.972，95% CI 1.634~5.407，P<0.001）和2.692倍（OR=2.692, 95%CI1.578~4.591，P<0.001）。老年人（>65岁）发生混合菌PDAP的风险是中青年人的1.937倍（OR=1.937，1.207~3.109，P=0.006）；合并糖尿病（OR=5.554，95% CI 1.021~30.201，P=0.047）、致病菌类型为混合真菌（OR=343.687，95%CI 21.554~5480.144，P< 0.001）或铜绿假单胞菌感染（OR=11.518，95% CI 1.632~81.310，P=0.014）分别可使混合菌PDAP患者治疗失败（拔管+PDAP相关性死亡）的风险增加4.554倍、342.687倍、10.518倍。结论 本地区近3年混合菌PDAP在整体PDAP中的占比较以往升高，混合菌感染是当次PDAP治疗失败的独立危险因素。老年人是发生混合菌PDAP的独立危险因素，合并糖尿病与致病菌混合真菌感染或混合铜绿假单胞菌感染是混合菌PDAP当次治疗失败的独立危险因素。

关键词: 腹膜透析相关腹膜炎；腹膜透析；混合菌

Abstract: Objective To determine the risk factors of occurrence and treatment failure of peritoneal dialysis associated-peritonitis (PDAP) due to polymicrobial infections. Methods We retrospectively collected the clinical data of patients with PDAP from the peritoneal dialysis (PD) centers in 4 general hospitals in Jilin Province from 2013 to 2019. The patients were divided, according to the results of peritoneal dialysate culture, into polymicrobial PDAP group and control group for comparison of the clinical data, treatment outcomes, and long-term prognosis. The independent risk factors of the occurrence and treatment failure of polymicrobial PDAP were explored using multivariate regression analysis. Results We recruited a total of 625 patients from the 4 PD centers, among whom 1085 episodes of PDAP were recorded. Polymicrobial PDAP accounted for 7.6% of the total PDAP episodes, and this proportion increased from 5.3% in 2013-2016 to 9.4% in 2017-2019 (P= 0.012). Compared with the control group, polymicrobial PDAP group had higher proportions of elderly patients and patients with refractory PDAP, with greater white blood cell counts in the first-day dialysate and longer course of antibiotic treatment (P<0.05). The risk of catheter removal and treatment failure (catheter removal or PDAP-related death) in polymicrobial PDAP group was 2.972 times (OR=2.972, 95% CI: 1.634-5.407, P<0.001) and 2.692 times (OR=2.692, 95% CI: 1.578-4.591, P<0.001) that in the control group, respectively. The risk of withdrawal from PD (technical failure + all-cause death) was 1.5- fold higher in polymicrobial PDAP group than that in the control group (OR=1.500, 95% CI: 1.085-2.074, P=0.014). Elderly patients (>65 years) had a 1.937- fold higher risk of experiencing polymicrobial PDAP than younger patients (OR=1.937, 95% CI: 1.207-3.109, P= 0.006). Diabetes mellitus (OR=5.554, 95% CI: 1.021-30.201, P=0.047), mixed fungal infeciton (OR=343.687, 95% CI: 21.554-5480.144, P<0.001), and Pseudomonas aeruginosa infection (OR=11.518, 95% CI: 1.632 to 81.310, P=0.014) were associated with increased risks of treatment failure by 4.554, 342.687 and 10.518 times, respectively. Conclusion The proportion of polymicrobial PDAP in the total PDAP cases tends to increase in recent years. Polymicrobial infection is an independent risk factor of both treatment failure and poor prognosis in patients with PDAP. An old age is an independent risk factor for polymicrobial PDAP, while diabetes mellitus and infections with mixed fungi or Pseudomonas aeruginosa are independent risk factors for treatment failure.

Key words: peritoneal dialysis associated peritonitis; peritoneal dialysis; mixed pathogens