| Objective:We want to explore the clinical data,pathogenic bacteria,drug susceptibility,and outcome of patients with peritoneal dialysis-associated peritonitis(PDRP)at this peritoneal dialysis center,and we want to find changes in the pathogenic bacteria spectrum,drug resistance of pathogenic bacteria,and prognostic risk factors,in order to provide more basis for PDRP prevention and prognosis judgment.Methods:A retrospective analysis was performed on 170 patients with peritoneal dialysis-associated peritonitis treated at the Southern Peritoneal Dialysis Center of Shanghai General Hospital from January 1,2010 to January 1,2020.The history and clinical data,Peritonitis pathogen composition,bacterial spectrum changes,drug sensitivity test results,outcomes and risk factors affecting their outcomes,and subgroup analysis is performed according to the following groups:(1)grouped according to the time of admission(2)grouped by patient’s primary disease(3)grouped by the bacteria of the culture results.Results:(1)The incidence of PDRP in our PD center decreased from 0.19 times/(patient per year)to 0.11times/(patient per year)in 2019.The positive rate of peritoneal fluid culture was 65.30%(111 cases),of which G~+bacteria accounted for57.66%(64 cases),G~-bacteria accounted for 32.43%(36 cases),and fungi accounted for 9.91%(11 cases).The most strains of G~+bacteria were Staphylococcus aureus,but coagulase-negative staphylococci accounted for 39.06%of the total G~+strains.Most of the G-bacteria are E.coli(7.21%),second is Acinetobacter baumannii(5.41%).(2)Drug susceptibility test results suggest that penicillin and ampicillin have the highest resistance to G~+bacteria,and vancomycin,daptomycin,teicoplanin,and cefotaxime(0%)have the lowest drug resistance.G~-bacteria have the highest resistance rates to cefuroxime,ampicillin,and cefazolin,and resistance rates to piperacillin/tazobactam,cefoperazone/sulbactam,panipenem,and minocycline The lowest is 0%.(3)Bacterial spectrum change showed that there was no significant change in the proportion of G~+and G~-bacteria infections,which fluctuated in individual years,and the proportion of fungal infections was the lowest.(4)Grouping by time:The composition of G~+bacteria infection in the first 5 years increased compared with the second 5 years,P<0.05,and there was no significant difference between the other strain groups;the patient’s age and dialysis time in the first 5 years were both higher than the previous 5 years.Increased,there was a statistical difference(P<0.05),blood glucose and CRP levels had differences between groups(P<0.05),and the other clinical indicators were not different between groups(P>0.05);the cure rate,transfusion rate,There were no significant differences between the mortality groups(P>0.05).(5)Grouping according to primary disease:The proportion of coagulase negative staphylococci strains in the chronic glomerulonephritis group is the highest.The proportion of G~-bacteria infection in the diabetic nephropathy group was higher than that in other groups,and the G~-bacteria infection in the hypertensive nephropathy group was lower than that of other groups,but there was no significant difference between the groups(χ~2=8.154,P=0.519,P>0.05).The age of PDRP patients was hypertension group>diabetes group>other secondary kidney disease group>chronic glomerulonephropathy group(P=0.000,P<0.05),and compared by dialysis time was as follows,other secondary kidney disease group>hypertension kidney disease Group>Chronic glomerulonephropathy group>Diabetic nephropathy group(P=0.02,P<0.05).The blood glucose and glycated hemoglobin levels in patients with diabetic nephropathy were higher than those other groups(P=0.002,P=0.001,P<0.05);the levels of procalcitonin in the diabetic nephropathy group were higher than those in other groups(P=0.026,P<0.05);there was no significant difference between the other index groups.The lowest cure rate was in the diabetic nephropathy group(75.9%),and the highest was in the other secondary nephropathy groups(94.1%).The highest transfusion rate was also in the diabetic nephropathy group,which reached20.7%.The highest mortality was in the hypertensive nephropathy group(11.1%),and there was no statistical difference between the groups(χ2=7.344,P=0.435,P>0.05).(6)Grouping according to culture results:The time from infection to admission in the fungal group was longer than that in the other three groups(P=0.045,P<0.05).The highest peritoneal peritoneal leukocytes in each group were G-bacteria group>fungi group>G+bacteria group>culture negative group;the procalcitonin(PCT)in the G-bacterial group was significantly higher than that in the G+bacteria group and culture negative group(P=0.000,P<0.05);the left ventricular ejection fraction(EF%)was lower in the G-bacteria group and the fungal group than in the G+bacteria group and the culture-negative group(P=0.002,P<0.05).The other indicators were between the groups.No significant difference.The cure rate of the G+bacteria group and the culture-negative group was significantly higher than that of the G-bacteria group and the fungal group;the transfusion rate of the fungal group was significantly higher than the other groups(P=0.000,P<0.05).(7)Analysis of prognostic risk factors:A single factor Logistic regression analysis was performed for each clinical index of PDRP patients,suggesting dialysis age,white blood cell neutrality ratio,serum albumin level,procalcitonin level,low Kt/V level,high procalcitonin level,time from infection symptoms to admission,G-bacterial infection and fungal infection are risk factors for hemodialysis or death in PDRP patients.By multivariate logistic regression analysis,dialysis age,hypoproteinemia,high procalcitonin levels,and fungal infections were independent risk factors for hemodialysis or death in PDRP patients.Conclusions:(1)The peritoneal fluid culture positive rate was 65.3%in our PD center.The pathogenic bacteria spectrum has not changed significantly in the past 10years,and G+bacteria are the main,followed by G-bacteria,and the proportion of fungi is the lowest.CNS is the main G+bacteria,MRCNS are more common,and patients need to be educated about the concept of sterility.(2)According to the results of drug susceptibility test for pathogenic bacteria,the intraperitoneal antibiotic regimen(vancomycin with third-generation cephalosporin/amikacin)used by our center is still feasible.(3)The G-bacteria ratio of PDRP is high in patients with diabetes,and the cure rate is lower than that in other patients with primary disease.(4)Dialysis age,blood neutrophil ratio,low serum albumin level,low Kt/V level,high procalcitonin level,time from infection to admission,G-bacterial infection,and fungal infection are risk factors for poor prognosis in PDRP patients.Among them,dialysis age,hypoproteinemia,high procalcitonin,and fungal infection were independent risk factors. |
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