摘要
目的分析腹透相关性腹膜炎(PDRP)病原菌特点与感染指标的相关性,为临床诊治PDRP提供参考依据.方法回顾性分析2016年1月-2021年6月邵阳学院附属第一医院收治的104例PDRP患者临床资料、病原菌分布及耐药情况.根据培养结果分为革兰阳性菌(G^(+))组和革兰阴性菌(G^(-))组,比较两组之间白细胞、中性粒细胞比率、C-反应蛋白(CRP)、血清降钙素原(PCT)等感染指标的差异,并分析其与病原菌的相关性.结果104例PDRP患者透出液培养阳性70例次,检出72株细菌,阳性率为67.31%,其中G^(+)菌48株(66.67%),G^(-)菌18株(25%),真菌6株(8.33%).其中G^(+)菌主要以表皮葡萄球菌和溶血葡萄球菌为主,其对万古霉素均敏感,对苯唑西林的耐药率分别为57.89%及92.31%;G^(-)菌主要以大肠埃希菌和肺炎克雷伯菌为主,对头孢他啶的耐药率较低;真菌以近平滑念珠菌及光滑念珠菌为主,对氟康唑等抗真菌药均敏感.G^(+)菌组患者的CRP及PCT都显著低于G^(-)菌组(P<0.05),CRP及PCT升高是影响G^(-)菌感染的独立危险因素.CRP、PCT及CRP+PCT联合指标鉴别诊断PDRP患者G^(+)菌及G^(-)菌感染的ROC曲线下面积(AUC)分别为0.768、0.800、0.882(均P<0.05),单一指标中PCT的鉴别诊断价值较高,但2项指标联合检测的AUC比单一指标高.结论PDRP患者透出液病原菌以G^(+)菌为主,CRP+PCT联合检测在鉴别诊断PDRP患者G^(+)菌及G^(-)菌感染中有一定的价值.
Objective To analyze the correlation between the characteristics of pathogenic bacteria and infection indicators of peritoneal dialysis related peritonitis(PDRP),and to provide a reference basis for clinical diagnosis and treatment of PDRP.Methods A total of 104 patients with PDRP who were admitted to the First Affiliated Hospital of Shaoyang College from January 2016 to June 2021 were retrospectively analyzed for clinical data,pathogen distribution and resistance.They were divided into gram positive(G^(+))and gram negative(G^(-))groups based on the culture results.The differences in leukocyte,neutrophil ratio,C-reactive protein(CRP),serum procalcitonin(PCT)and other infection indicators between the two groups were compared,and the correlation between infection indicators and pathogenic bacteria was analyzed.Results The dialysis fluid cultures from 104 patients with PDRP were positive in 70 patients,and 72 bacteria were detected,with a positive rate of 67.31%,including 48 strains of G+bacteria(66.67%),18 strains of G^(-)bacteria(25%)and 6 strains of fungi(8.33%).Among them,G+bacteria were mainly Staphylococcus epidermidis and Staphylococcus haemolyticus,which were sensitive to vancomyein.The resistance rates to oxacillin were 57.89%and 92.31%respectively.G^(-)bacteria were mainly Escherichia coli and Klebsiella pneumoniae,and the resistance rate to ceftazidime was low.The fungi were mainly Candida near smooth and Candida smooth,which were sensitive to fluconazole and other antifungal drugs.CRP and PCT in G^(+)bacteria group were significantly lower than those in G^(-)bacteria group(P<0.05).The increase of CRP and PCT was an independent risk factor for G^(+)bacteria infection.The area under the ROC curve(AUC)of CRP,PCT and CRP+PCT in the differential diagnosis of G+bacteria and G^(-)bacteria infection in PDRP patients were 0.768,0.800 and 0.882 respectively(all P<0.05).The differential diagnosis value of PCT in single indicators was higher,but the AUC of combined detection of two indicators was higher than those o
作者
曹新策
黄海花
阳巍
Cao Xince;Huang Haihua;Yang Wei(The First Affiliated Hospital of Shaoyang University,Hunan Shaoyang 422000,China)
出处
《首都食品与医药》
2022年第6期50-55,共6页
Capital Food Medicine
关键词
腹透相关性腹膜炎
病原菌
耐药性
感染指标
鉴别诊断
Peritoneal dialysis related peritonitis
Pathogen
Drug resistance
Infection indicators
Differential diagnosis
