难治性腹膜透析相关腹膜炎的病原菌及预后的临床研究OA

Objective To analyze the clinical and microbiological characteristics of patients with refractory peritoneal dialysis-associated peritonitis(rPDAP)and to explore prognostic factors associated with treatment outcomes.Methods Clinical data from patients with rPDAP admitted to our hospital were retrospectively collected.Patients were divided into cured group and non-cured group according to clinical outcomes.Baseline clinical characteristics,laboratory parameters and microbiological findings were compared between the two groups.Baseline characteristics,pathogen culture results,antimicrobial resistance and clinical prognostic indicators were analyzed.Univariate and multivariate logistic regression analyses were performed to identify prognostic factors associated with treatment outcomes.Results A total of 75 patients with 83 episodes of rPDAP were included.Culture results were positive in 58 episodes,and 80 pathogenic strains were isolated.The counts of gram-positive bacteria gram-negative bacteria and fungi were 32 strains,32 strains and 16 strains,respectively.D-dimer levels in the cured and non-cured groups were 0.40(0.21,0.98)and 1.18(0.51,2.68)mg·L-1,respectively;fungal infection occurred in 0 cases(0％)and 16 cases(100.00％),respectively.The differences in these indicators between the two groups were statistically significant(all P＜0.05).Univariate logistic regression analysis showed that D-dimer and fungal infection were prognostic risk factors for treatment failure in rPDAP(both P＜0.05).When all risk factors identified in the univariate analysis were included in the multivariate logistic regression analysis,liver cirrhosis was found to be an independent protective factor for treatment in rPDAP[odds ratio(OR)=11.16,95％confidence interval(CI):1.07-116.96,P＜0.05].Further analysis indicated that D-dimer could serve as an independent biomarker for predicting treatment failure in rPDAP.The optimal cut-off value was 1.01 mg·L-1,with a sensitivity of 62.30％and a specificity of 80.00％.D-dimer levels above this cut-off suggested a significantly increased risk of treatment failure.Conclusion D-dimer,with an optimal cut-off value of 1.01 mg·L-1,may be used for early risk stratification of treatment failure in rPDAP and may provide evidence to guide clinical intervention strategies.