Gram-negative And Gram-positive Caused By Peritoneal Dialysis Associated Peritonitis:the Drug Resistance And The Risk Factors

Background:Peritoneal dialysis(PD)is one of the main alternative treatment methods for patients with end-stage renal disease.when peritonealysis-related peritonitis(PDAP)occurs,it not only affects the effect of PD treatment,but also recurrent PDAP can cause peritoneal function.Obstacles,Ultimately,it is impossible to continue to take PD treatment,and severe cases can endanger lives.The occurrence of PDAP can be caused by gram-positive(G+)bacteria,gram-negative(G-)bacteria and fungi.G+bacteria and G-bacteria infection are the main clinical infectionsObjective:To investigate the risk factors of G-bacteria and G+bacteria caused by PDAP,so as to provide for the diagnosis and treatment.And analysis the resistance of peritoneal dialysis associated peritonitis to provide a reference for clinical use.Methods:In this retrospective study,from 1 January 2012 to 31 December 2016,A total of 236 PDPA patients in Kunshan First People’s Hospital were taken as case groups,of which 56(23.7%)were G-bacteria group and 180(76.3%)were G+bacteria group.To record the clinical data of 236 patients as the control group,not occurred PDAP as the observation group.Setting the following as conditions,we were selected with the G-bacteria and G+bacteria such as hospital stay and PD at the same time.Data are analyzed using SPSS 19.0.In the measurement data,T test is used for the normal distribution,and Wilcoxon symbol rank test is used for the normal distribution.The counting data is analyzed by means of χ2 test:Risk factors Logitic regression analysis.Results:Research findings based on single factors:The single factor affecting the incidence of PDAP in G+bacteria:diabetes(P=0.007),human operation(P<0.001),dialysate karyocyte(P<0.001),dialysate leucocytes(P<0.001),WBC(P=0.005),K(P=0.002),Ca(P=0.021),PCT(P=0.000).The single factor affecting the incidence of PDAP in G-bacteria:diabetes(P=0.005),intestinal infection(P<0.001),average dialysis time(P<0.001),dialysate kary ocyte(P<0.001),dialysate leucocytes(P<0.001),WBC(P=0.030),hs-CRP(P<0.001),K(P<0.001),PCT(P<0.001).The clinically-relevant variables and statistically significant variables in single-factor analysis are included in the multi-factor analysis.After adjusting diabetes,human operation,intestinal infection,average dialysis time,WBC,K,Ca,hs-CRP and PCT,a multi-factor analysis found that:Independent risk factors of PDAP induced by G+bacteria,diabetes OR(95%CI)is 1.640(1.010,2.664),human operation OR(95%CI)is 3.969(2.226,6.137),K OR(95%CI)is 0.718(0.532,0.970);The independent risk factor for PDAP due to G-bacteria,the average dialysis time OR(95%CI)is 2.379(1.261,4.488),K OR(95%CI)is 0.115(0.022,0.602)and Hs-CRP OR(95%CI)is 1.127(1.011,1.257);compared with G+bacteria,the independent risk factor of PDAP caused by G-bacteria was the average dialysis time OR(95%CI)is 1.245(1.157,1.339),human operation OR(95%Cl)is 0.329(0.142,0.758),K OR(95%CI)is 0.484(0.264,0.887),and PCT OR(95%CI)is 1.014(1.002,1.025).The results of PDAP resistance induced by G-bacteria and G+ bacteria showed that the drug resistance rate of G-bacteria to epefpime and imamipenem was low.ESBLs in G-bacterial staining have increased year by year.G+bacteria strain had the lowest resistance to vancomycin and linezolid.MRSA is on the rise year by year.Conclusions:1.The independent risk factors for PDAP caused by G+bacteria are diabetes,human operation error,and the protective factor is K elevated.The independent risk factors for PDAP caused by G-bacteria are average dialysis time extended and Hs-CRP elevated.2.Compared with PDAP caused by G+bacteria,the independent risk factors for G-infection are average dialysis time extended,PCT elevated,and the protective factor is no human operation error,K elevated.3.MRSA and ESBLs increased year by year.Cefferpime,imamipenem,and linezolamine can be used as clinical experience in the treatment of PDAP.