| Objective:To investigate the clinical character,pathogens and drug resistance,treatment and clinical outcome incontinuous ambulatory peritoneal dialysis(CAPD)related peritonitis from Dalian municipal central hospital peritoneal dialysis center between January,1,2010 and December,31,2015.To investigate the risk factors predicting the outcome of peritoneal dialysis-related peritonitis.Methods: In this restrospective study,all the episodes of peritoneal dialysis-related peritonitis undergoing CAPD at least one months were reviewed in our center from January,1,2010 to December,31,2015.The data,such as patient gender,age,duration of PD,dialy exchange number,laboratory data,treatment and clinical outcome were recorded.It analysed the general condition,pathogens and the change of treatment of PD-related peritonitis during the study period in our center,and it also investigated the risk factors predicting the outcome of PD-related peritonitis.Furthermore,subgroup analyses were performed by the differences of their pathogens,outcomes,ages and the frequency of the peritonitis.Results:There were 272 patients undergoing PD in our center,and 66 patients of the patients occured 91 episodes of peritonitis during the study period.The average peritonitis rate was 1 episode per every 70 patient-months.Forty-six patients suffered ongly one episode of PD-related peritonitis,20 of them who developed 45 episodes had more than or equal to two episodes.Among these 66 patients,35 males(53.03%)developed 52 episodes(57.14%)and 31 famales(46.97%)developed 39 episodes(42.86%).The mean age was(62.75 ± 11.97)years,and the mean duration of PD was(24.16 ± 21.52)months.The primary renal diseases were diabetic nephropathy(37.9%),and then hypertention bengin arteriolar nephrosclerosis(33.3%)and glomerulonephritis(21.2%).Among the 91 episodes of peritonitis,70 episodes(76.92%)had been cured,14 episodes(15.38%)had needed extubition or gave up treatment and 7 episodes(7.69%)had caused death.The dialysate culture of 66 cases was positive with a positive rate of 72.53%,including 40 cases(60.61%)of gram-positive bacteria,21 cases(31.82%)of gram-negative bacteria,5 cases(7.58%)of fungi.The most pathogenic of gram-positive peritonitis was Staphylococcus epidermids(16.67%),and then were Streptococcus salivarius and Streptococcus mitis(6.06%).The most pathogenic of gram-negative peritonitis was Escherichia coli(21.21%),and then was Klebsiella pneumoniae(4.55%).During the study,the ratio number of gram-negative peritonitis presented ascend trend,until 2014,the ratio of gram-negative peritonitis was 50%.The drug-resistant rate of gram-positive bacteria to vancomycin and linezolid were the lowest(0%),followed by quinupristin(8.00%),gentamicin(30.77%),levofloxacin(44.83%)and ampicillin(72.41%),and to cefazolin and imipenem,they were the highest(73.33%).The drug-resistant rate of gram-negative bacteria to cefperazone/sulbactam was the lowest(0%),followed by imipenem(4.76%),paperacillin/tazobactam(5.26%),amikacin(10.00%)and cefoxitin(16.67%),and to cefatriaxone,it was the highest(47.62%).The risistant rate of treatment to common antibiotics including cefuroxime,vancomycin and ceftazidime were 56.58%,28.57%,46.15% in our center,and cefuroxime had an increasing tendence year by year,the risistant rate was 80% in 2015.In the subgroup analyses:(1)Different pathogens had different outcomes: the cure rates of gram-positive peritonitis and microbial negative peritonitis patients(87.50%,88.00%)were significantly higher than gram-negative peritonitis and fungi peritonitis(57.14%,20.00%).The mortality rate of gram-negative peritonitis was significantly higher than gram-positive peritonitis(P < 0.05).The patients of the group gram-negative peritonitis had significantly higher level of numeration of leukocyte in the peritoneal dialysis solution than the group of gram-positive peritonitis,fungi peritonitis and microbial negative peritonitis.The percentage of neutrophils in group gram-negative peritonitis was higher than the group gram-positive peritonitis’ and microbial negative peritonitis’(P < 0.05).The patients of the group gram-negative peritonitis had significantly lower level of cholesterol,low density lipoprotein cholesterol and sodium than of the group gram-positive peritonitis,fungi peritonitis and microbial negative peritonitis(P < 0.05).(2)Different outcomes had different pathogens proportion: Compared to the complete cure group,less gram-positive bacterial infection and more gram-negative bacterial infection and fungi infection was prevalent in quiting group.The quit group had more male patients and mroe level of percentage of neutrophils the complete cure group(P < 0.05).Logistic analysis indicated fungi infection was independent predictor for peritonitis-related catheter removal or death(P = 0.031).(3)The younger patients had higher level of serum albumin,serum creatinine,potassium,sodium,chloride,magnesium,and lower blood glucose than the elderly patients(P < 0.05).(4)The multiple group had more staphylococcus epidermidis infection than the single group(P < 0.05).Conclution:Gram-positive bacteria is still the main pathogen in CAPD related peritonitis in our center,but there is an increasing proportion of peritonitis caused by gram-negative bacteria.The drug-resistant rates of gram-positive bacteria to cefazolin and imipenem were the highest,and the drug-resistant rate of gram-negative bacteria to cefatriaxone was the highest.The outcomes of gram-positive peritonitis were better than the gram-negative peritonitis and fungi peritonitis,and the mortality of gram-negative peritonitis was the highest.Fungi infection was independent predictor for peritonitis-related catheter removal or death. |
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