Analysis Of Pathogenic Bacteria Of PDRP And The Risk Factors Of Repeated Attack

ObjectiveTo analyze the distribution and drug resistance of pathogenic bacteria of peritoneal dialysis related peritonitis(PDRP)in the present hospital,and to investigate the risk factors of repeated attack of PDRP.Methods43 patients with PDRP and integral clinical data,who received continuous ambulatory peritoneal dialysis(CAPD)in the peritoneal dialysis center from March1,2014 to March 1,2020,were selected,and their clinical data of 83 times of PDRP was analyzed retrospectively.All the 83 times of PDRP were performed abdominal dropsy cultivation and drug sensitivity test,and 43 positive culture results and 46 strains of pathogenic bacteria were obtained.The distribution and drug resistance of all the pathogenic bacteria were analyzed.According to the PDRP clinical data and the frequency of peritonitis within one year,the 43 patients included were divided into two groups,with 24 patients in single attack group(PDRP occurred once a year in the observation period)and 19 patients in the frequent attack group(PDRP occurred more than twice a year in the observation period).The risk factors of PDRP in the frequent attack group were analyzed by binary logistic regression.Results1 According to the culture results,46 strains were cultured with the 83 times of peritonitis,including 30 strains of Gram-positive bacteria(65.22%),14 strains of Gram-negative bacteria(30.43%)and 2 strains of fungi(4.35%).In gram positive bacteria,there were 23 Staphylococcus(76.67%),5 streptococci(16.67%)and 2enterococci(6.66%).Gram negative bacteria are mainly Klebsiella pneumoniae.2 According to the drug sensitivity results,the Gram-positive bacteria had high resistance to erythromycin(83.33%),penicillin(82.14%),oxacillin(60.87%)and clindamycin(51.85%);the Gram-negative bacteria were highly resistant to tetracycline(100.00%),ampicillin(83.33%),polymyxin B(66.67%),cefazolin(57.14%),amoxicillin/clavulanic acid(50.00%)and macrodantin(50.00%)3 The results of binary logistic regression analysis showed that hypokalemia(P=0.024)and hypoproteinemia(P=0.003)were independent risk factors of frequent attack of PDRP.Conclusion1 The main pathogenic bacteria of PDRP in the present peritoneal dialysis center are Gram-positive bacteria and mostly staphylococcus epidermidis.In clinical practices,it is necessary to enhance the aseptic concept of patients,strengthen the training guidance of patients’ medium change operation,improve the quality of trainees,modify the training methods and reduce the incidence of peritonitis caused by contact infection.Among the Gram-negative bacteria,klebsiella pneumoniae has high incidence rate.In most cases,once fungal peritonitis occurs,the illness condition could be serious and the rate of extubation would be high.2 It is appropriate for the present peritoneal dialysis center to adopt vancomycin combined with cefoperazone or sulbactam as the preferred regimen for initial treatment.However,the practicability of cefazolin combined with cefoperazone or sulbactam remains to be further studied.In this research,Gram-negative bacteria are highly sensitive to aminoglycosides.Therefore the local application of aminoglycosides can be used as the initial treatment of PDRP.3 Hypokalemia and hypoproteinemia are independent risk factors of frequent attack of PDRP.