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中华肾病研究电子杂志

中华肾病研究电子杂志 ›› 2018, Vol. 07 ›› Issue (05) : 211 -216. doi: 10.3877/cma.j.issn.2095-3216.2018.05.005

所属专题： 文献；

论著

老年腹膜透析相关性腹膜炎的致病菌与预后特点分析
汤立1,†(), 沈平1, 胡钦凤1, 柴华旗1   
  1. 1. 215002　南京医科大学附属苏州医院　苏州市立医院　肾内科
  • 收稿日期:2018-05-21 出版日期:2018-10-28
  • 通信作者: 汤立

Analysis of pathogens and prognosis in the elderly patients with peritoneal dialysis-related peritonitis

Li Tang1,†(), Ping Shen1, Qinfeng Hu1, Huaqi Chai1   

  1. 1. Department of Nephrology, Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital), Suzhou 215002, Jiangsu Province, China
  • Received:2018-05-21 Published:2018-10-28
  • Corresponding author: Li Tang
  • About author:
    Corresponding author: Tang Li, Email:
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引用本文：

汤立, 沈平, 胡钦凤, 柴华旗. 老年腹膜透析相关性腹膜炎的致病菌与预后特点分析[J/OL]. 中华肾病研究电子杂志, 2018, 07(05): 211-216.

Li Tang, Ping Shen, Qinfeng Hu, Huaqi Chai. Analysis of pathogens and prognosis in the elderly patients with peritoneal dialysis-related peritonitis[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2018, 07(05): 211-216.

目的

分析老年腹膜透析相关性腹膜炎致病菌的分布和预后特点，以指导临床采取有效预防措施。

方法

回顾性分析2009年1月1日至2017年12月31日期间南京医科大学附属苏州医院肾内科收治的72例次腹膜透析相关性腹膜炎患者的临床资料；根据年龄分为老年组(≥65岁)和中青年组(<65岁)，将老年组患者的基本临床特点、致病菌分布以及预后情况与中青年组相比较。采用Kaplan-Meier法计算患者生存率和技术生存率。

结果

43例患者(老年组22例，中青年组21例)发生72例次腹膜透析相关性腹膜炎(老年组38例次，中青年组34例次)，共培养出58株致病菌，老年组31株(包括G＋菌19株，G－菌11株，真菌1株)；中青年组27株(包括G＋菌19株，G－菌5株，真菌3株)。老年组的主要致病菌为G＋菌(61.29%)。老年组的表皮葡萄球菌的发生率显著高于中青年组(29.03%与3.70%，P＝0.028)。老年组G－菌和真菌的发生率与中青年组相比，差异无统计学意义。老年组腹膜炎的治疗转归(治愈率、拔管率、死亡率)与中青年组差异无统计学意义(P＝0.265，P＝0.066，P＝0.279)。Kaplan-Meier分析显示老年组的总体生存率并不低于中青年组(P＝0.282)，而老年组的技术生存率显著高于中青年组(P＝0.007)。

结论

老年腹膜透析相关性腹膜炎患者的致病菌分布与中青年患者有所不同，与他们更容易出现接触污染有关。老年腹膜透析相关性腹膜炎患者的总体预后并不比中青年患者差。

关键词: 腹膜透析相关性腹膜炎, 老年患者, 致病菌, 预后
Objective

To analyze the distribution of pathogens and prognosis in elderly patients with peritoneal dialysis-related peritonitis in our hospital so as to guide clinical preventive measures.

Methods

A retrospective analysis was made with clinical data of 72 patients with peritoneal dialysis-related peritonitis admitted to the Department of Nephrology, Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital) from January 1, 2009 to December 31, 2017. According to the age, the patients were divided into the elderly group (≥65 years old) and the young-middle-aged group (<65 years old), which were compared in the basic clinical characteristics, pathogen distribution, and prognosis. Patient survival and technical survival were calculated with the Kaplan-Meier method.

Results

Forty-three patients (22 from the elderly group, and 21 from the young-middle-aged group) had 72 occurrences of peritoneal dialysis-related peritonitis (38 occurrences in the elderly group, and 34 occurrences in the young-middle-aged group). A total of 58 strains of pathogenic bacteria were found from culture, with 31 strains from the elderly group (including 19 strains of G+ , 11 strains of G- bacteria, and 1 strain of fungus), and 27 strains from the young-middle-aged group (including 19 strains of G+ , 5 strains of G- bacteria, and 3 strains of fungi). The main pathogens in the elderly group were G+ bacteria (61.29%). The incidence of Staphylococcus epidermidis in the elderly group was significantly higher than that in the young-middle-aged group (29.03% vs 3.70%, P=0.028). The incidences of G- bacteria and fungi in the elderly group were not significantly different from those in the young-middle-aged group. There were no significant differences in the treatment outcomes (cure rate, extubation rate, and mortality) between the elderly group and the young-middle-aged group (P=0.265, P=0.066, P=0.279). Kaplan-Meier analysis showed that the overall survival rate of the elderly group was not lower than that of the young-middle-aged group (P=0.282), while the technical survival rate of the elderly group was significantly higher than that of the young-middle-aged group (P=0.007).

Conclusion

The distribution of pathogens in the elderly patients with peritoneal dialysis-related peritonitis was different from that of the young and middle-aged patients, which was more likely to be associated with the contact contamination. It is necessary to strengthen the concept of active prevention, and take active and targeted preventive measures. The overall prognosis in the elderly patients with peritoneal dialysis-related peritonitis was not worse than that of the young and middle-aged patients.

Key words: Peritoneal dialysis-related peritonitis, Elderly patients, Pathogens, Prognosis
表1 两组患者的基线资料
? 老年组[n＝22，(38例次)] 中青年组[n＝21，(34例次)] χ2/Z值 P值
男(例) 13 12 0.017a 0.897
透析龄(月) 28.58±22.40 22.79±19.73 －0.948b 0.343
原发病及伴随疾病 ? ? ? ?
? 慢性肾炎[例(%)] 10(45.45) 15(71.43) 2.978a 0.084
? 糖尿病肾病[例(%)] 5(22.73) 3(14.29) 0.102a 0.750
? 伴糖尿病[例(%)] 11(50.00) 6(25.87) 2.064a 0.151
实验室检查 ? ? ? ?
? 血红蛋白(g/L) 100.66±17.34 93.09±21.88 1.622 0.109
? 血白蛋白(g/L) 27.73±6.17 26.80±7.40 0.581 0.563
? 钾(mmol/L) 3.45±0.73 3.75±0.60 －1.904 0.061
? 钙(mmol/L) 2.14±0.24 2.02±0.22 1.953 0.057
? 磷(mmol/L) 1.53±0.45 1.77±0.47 －1.981 0.055
? iPTH(ng/L) 242.26±151.66 311.73±236.49 －1.499 0.138
表2 两组患者腹膜透析相关性腹膜炎的致病菌分布及构成比
菌株 老年组(n＝31株) 中青年组(n＝27株) χ 2值 P值
例次 占比% 例次 占比%
G＋菌 19 61.29 19 70.37 0.527 0.468
? G＋球菌 19 61.29 17 62.97 0.017 0.896
? ? 葡萄球菌 13 41.94 7 25.93 2.840 0.092
? ? ? 凝固酶阴性葡萄球菌 12 38.71 5 18.52 3.697 0.055
? ? ? ? 表皮葡萄球菌 9 29.03 1 3.70 4.835 0.028
? ? ? ? 溶血葡萄球菌 1 3.23 1 3.70 － －
? ? ? ? 人葡萄球菌 1 3.23 1 3.70 － －
? ? ? ? 巴氏葡萄球菌 0 0.00 1 3.70 － －
? ? ? ? 头部葡萄球菌 0 0.00 ? ? ? ?
? ? ? ? 华纳氏葡萄球菌 1 3.23 0 0.00 － －
? ? ? 金黄色葡萄球菌 1 3.23 2 7.41 0.015 0.902
? 链球菌 4 12.90 9 33.33 3.464 0.063
? ? 唾液链球菌 2 6.45 1 3.70 － －
? ? 口腔链球菌 0 0.00 2 7.41 － －
? ? 草绿色链球菌 0 0.00 2 7.41 － －
? ? 无乳链球菌 1 3.23 1 3.70 － －
? ? 化脓链球菌 0 0.00 1 3.70 － －
? ? 停乳链球菌 0 0.00 1 3.70 － －
? ? 乳房链球菌 0 0.00 1 3.70 － －
? ? 戈登链球菌 1 3.23 0 0.00 － －
? 肠球菌 2 6.45 0 0.00 － －
? ? 鸟肠球菌 1 3.23 0 0.00 － －
? ? 屎肠球菌 1 3.23 0 0.00 － －
? G＋杆菌 0 0.00 2 7.41 － －
G－菌 11 35.48 5 18.52 2.079 0.149
? 大肠埃希氏菌 3 9.68 4 14.81 0.038 0.845
? 肺炎克雷伯菌 3 9.68 0 0.00 1.136 0.287
? 产酸克雷伯菌 1 3.23 0 0.00 － －
? 恶臭假单胞菌 1 3.23 0 0.00 － －
? 脑膜炎奈瑟菌 1 3.23 0 0.00 － －
? 浅黄奈瑟菌 0 0.00 1 3.70 － －
? 嗜水气单胞菌 1 3.23 0 0.00 － －
? 阴沟肠杆菌 1 3.23 0 0.00 － －
真菌 1 3.23 3 11.11 0.439 0.508
表3 两组患者不同类型致病菌感染所致腹膜炎的构成比
腹膜炎 老年组(n＝38) 中青年组(n＝34) χ 2值 P值
例次 发生率(%) 例次 发生率(%)
单一G＋菌 14 36.84 11 32.35 0.160 0.690
单一G－菌 9 23.68 5 14.71 0.923 0.337
单一真菌 1 2.63 2 5.88 0.010 0.922
混合感染 3 7.89 4 11.76 0.024 0.877
培养阴性 11 28.95 12 35.29 0.332 0.564
表4 两组腹膜透析相关性腹膜炎的治疗转归
预后 老年组(n＝38) 中青年组(n＝34) χ 2值 P值
例次 发生率(%) 例次 发生率(%)
治愈 32 84.21 25 73.53 1.241 0.265
拔管 3 7.89 8 23.53 3.389 0.066
死亡a 3 7.89 0 0 1.173 0.279
其他b 0 0 1 2.94 － 0.472
图1 两组腹膜炎患者的生存曲线(Kaplan－Meier生存分析)
图2 两组腹膜炎患者的技术生存曲线(Kaplan-Meier生存分析)
[1]
Collins AJ, Foley RN, Herzog C, et al. United States National Kidney Foundation United States Renal Data System 2012 annual data report: atlas of chronic kidney disease & end-stage renal disease in the United States [J]. Am J Kidney Dis, 2013, 59(1 Suppl 1): A7 e1-e480.
[2]
Perl J, Wald R, Bargman JM, et al. Changes in patient and technique survival over time among incident peritoneal dialysis patients in Canada [J]. Clin J Am Soc Nephrol, 2012, 7(7): 1145-1154.
[3]
Lobo JV, Villar KR, de Andrade MR, et al. Predictor factors of peritoneal dialysis-related peritonitis [J]. J Bras Nephrol, 2010, 32(2): 156-164.
[4]
Couchoud C, Moranne O, Frimat L, et al. Associations between comorbidities, treatment choice and outcome in the elderly with end-stage renal disease [J]. Nephrol Dial Transplant, 2007, 22(11): 3246-3254.
[5]
李阳，王海云，王颖，等．老年腹膜透析患者长期生存分析[J]. 中华肾脏病杂志，2017，31(1)：1-7.
[6]
De Vecchi AF, Maccario M, Braga M, et al. Peritoneal dialysis in non-diabetic patients older than 70 years: comparison with patients aged 40 to 60 years [J]. Am J Kidney Dis, 1998, 31(3): 479-490.
[7]
Holley JL, Bernardini J, Perlmutter JA, et al. A comparison of infection rates among older and younger patients on continuous peritoneal dialysis [J]. Perit Dial Int, 1994, 14(1): 66-69.
[8]
Szeto CC, Leung CB, Chow KM, et al. Change in bacterial aetiology of peritoneal-dialysis-related peritonitis over ten years: experience from a center in South-East Asia [J]. Clin Microbiol Infect, 2005, 11(10): 837-839.
[9]
Li PKT, Szeto CC, Piraino B, et al. Peritoneal dialysis-related infections recommendations [J]. Perit Dial Int, 2010, 30(4): 393-423.
[10]
Oygar DD, Yalin AS, Altiparmak MR, et al. Obligatory referral among other factors associated with peritoneal dialysis patients [J]. Nefrologia, 2011, 31(4): 435-440.
[11]
Piraino B, Bernardini J, Brown E, et al. ISPD: reducing the risks of PD-related infections [J]. Perit Dial Int, 2011, 31(6): 614-630.
[12]
Li PKT, Szeto CC, Piraino B, et al. ISPD peritonitis recommendations: 2016 update on prevention and treatment [J]. Perit Dial Int, 2016, 36(5): 481-508.
[13]
Brown EA, Johansson L. Epidemiology and management of end-stage renal disease in the elderly [J]. Nat Rev Nephrol, 2011, 7(10): 591-598.
[14]
Moon SJ, Han SH, Kim DK, et al. Risk factors for adverse outcomes after peritonitis-related technique failure [J]. Perit Dial Int, 2008, 28(4): 352-360.
[15]
Perez Fontan M, Rodriguez-Carmona A, Garcia-Naveiro R, et al. Peritonitis-related mortality in patients undergoing chronic peritoneal dialysis [J]. Perit Dial Int, 2005, 25(3): 274-284.
[16]
Choi P, Nemati E, Banerjee A, et al. Peritoneal dialysis catheter removal for acute peritonitis: a retrospective analysis of factors associated with catheter removal and prolonged postoperative hospitalization [J]. Am J Kidney Dis, 2004, 43(1): 103-111.
[17]
de Lourdes Ribeiro de Souza da Cunha M, Montelli AC, Fioravante AM, et al. Predictive factors of outcome following staphylococcal peritonitis in continuous ambulatory peritoneal dialysis [J]. Clin Nephrol, 2005, 64(5): 378-382.
[18]
Szeto CC, Kwan BC, Chow KM. Peritonitis risk for older patients on peritoneal dialysis [J]. Perit Dial Int, 2008, 28(5): 457-460.
[19]
Piccoli G, Quarello F, Salomone M, et al. Dialysis in the elderly: comparison of different dialysis modalities [J]. Adv Perit Dial, 1990, 6(Suppl): 72-81.
[20]
Jarvis EM, Hawley CM, McDonald SP, et al. Predictors, treatment, and outcomes of non-Pseudomonas Gram-negative peritonitis [J]. Kidney Int, 2010, 78(4): 408-414.
[21]
Barretti P, Montelli AC, Batalha JE, et al. The role of virulence factors in the outcome of staphylococcal peritonitis in CAPD patients [J]. BMC Infect Dis, 2009, 9: 212.
[22]
Yang CY, Chen TW, Lin YP, et al. Determinants of catheter loss following continuous ambulatory peritoneal dialysis peritonitis [J]. Perit Dial Int, 2008, 28(4): 361-370.
[23]
Chao CT, Lee SY, Yang WS, et al. Viridans streptococci in peritoneal dialysis peritonitis: clinical courses and long-term outcomes [J]. Perit Dial Int, 2015, 35(3): 333-341.
[24]
Miles R, Hawley CM, McDonald SP, et al. Predictors and outcomes of fungal peritonitis in peritoneal dialysis patients [J]. Kidney Int, 2009, 76(6): 622-628.
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