Clinical Study Of Refractory Peritoneal Dialysis-associated Peritonitis In Single Center

Objective:Clinical data of patients with PDAP in the Second Hospital of Jilin University were retrospectively collected to analyze the clinical characteristics and prognosis of refractory PDAP,as well as the risk factors of its occurrence,extubation and treatment failure,so as to provide reference basis for clinical treatment and prevention.Method:This study retrospectively collected the clinical data of patients with PDAP registered in the PD Center of the Second Hospital of Jilin University from January 1,2013 to December 31,2019.According to the diagnostic criteria of refractory PDAP in ISPD guidelines,they were divided into two groups: refractory group and non-refractory group.Baseline data,pathogenic bacteria in the released fluid and treatment evaluation of patients in the two groups were analyzed.Risk factors for the occurrence of refractory PDAP,extubation and treatment failure were analyzed.The clinical features,the risk factors for its occurrence,extubation and treatment failure were summarized.Results:1.Research subjects: A total of 230 patients with PDAP were enrolled,including refractory group(n = 48)and non-refractory group(n = 182).2.Baseline data: The proportion of female patients in the refractory group was higher than that in the non-refractory group(P=0.021).There was no significant difference in age,dialysis age,primary disease,complicated disease(hypertension,diabetes),diarrhea or constipation,abdominal pain and fever between the two groups(P > 0.05).3.Exudate pathogenic bacteria: Patients with refractory PDAP have a higher proportion of fungal infections,while patients with non-refractory PDAP were more likely to have Gram-positive bacteria infection(P < 0.05).Compared with the non-refractory group,patients in the refractory group were more likely to be infected with enterobacteria and mixed bacteria,but there was no significant difference between the two groups(P>0.05).4.Treatment evaluation: In the initial treatment evaluation,the initial treatment effective rate of the refractory group was lower than that of the non-refractory group(P<0.05).In terms of overall treatment evaluation,the cure rate of the refractory group was lower than that of the non-refractory group,while the extubation rate was higher than that of the non-refractory group(P<0.05).There was no significant difference in recurrence and PDAP-related death between the two groups(P>0.05).5.Factors affecting the occurrence of refractory PDAP: Multivariate Logistic regression showed that the risk of refractory PDAP in female patients was 1.989 times higher than that in male patients(OR=1.989,95%CI:1.009-3.924,P=0.047);For every 1 month increase in dialysis age,the risk of refractory PDAP in PD patients increased by 2.2%(OR=1.022,95%CI:1.000-1.004,P=0.05).Serum albumin is an independent protective factor for refractory PDAP,Each 1g/L increase in albumin was associated with a 5.8% reduction in the risk of refractory PDAP in PD patients(OR=0.942,95%CI:0.889-0.999,P=0.045).6.Prognostic factors of refractory PDAP: Multivariate Logistic regression showed that fungal pathogens were independent risk factors for extubation(OR=20.954,95%CI:2.207-198.915;P=0.008)and treatment failure(OR=20.954,95%CI:2.207-198.915;P=0.008)of refractory PDAP.Conclusion:1.Female patients with PD are more likely to develop refractory PDAP.Refractory PDAP patients are prone to fungal infection,while non-refractory PDAP patients are more likely to develop Gram-positive bacteria infection.2.Female and long-dialysis age are the independent risk factors of refractory PDAP,and serum albumin is the independent protective factor.Fungi are the independent risk factors for extubation and treatment failure in patients with refractory PDAP.