Risk Factors And Clinical Outcomes Of Multidrug-resistant Bacterial Infection In Patients With Peritoneal Dialysis Associated Peritonitis

Objective To investigate the incidence of multidrug-resistant(MDR)bacterial infection in patients with peritoneal dialysis associated peritonitis(PDAP).Collect relevant basic and general clinical data and laboratory indicators,and explore the pathogenic characteristics,risk factors and clinical outcomes of multidrug-resistant bacterial infection in patients with PDAP,in order to provide reference for reducing multidrug-resistant bacterial infection in patients with PDAP.Methods 296 PDAP patients admitted to the Department of Nephrology,The First Affiliated Hospital of Anhui Medical University from July 1,2018 to November 1,2021 were enrolled,208 of whom were positive for peritoneal dialysis fluid culture.121 PDAP patients with monobacterial infection who met the inclusion and exclusion criteria were divided into MDR group and non-MDR group according to whether the pathogenic bacteria were multidrug-resistant bacteria,of which 71 were in MDR group and 50 were in non-MDR group.The basic and general clinical data and laboratory indicators of all enrolled patients were collected,a nd the pathogenic bacteria distribution and drug resistance of PDAP patients in our center were analyzed.The relevant data between the two groups were compared,and the statistically significant differences were included in the multivariate binary dependent variable logistic regression analysis to explore the risk factors of multidrug-resistant bacteria infection in PDAP patients.Results(1)Among 121 patients with monobacterial infection who met the inclusion and exclusion criteria,gram-positive bacteria were the main pathogen,accounting for 81.0%(98/121).The most common gram-positive pathogen was Staphylococcus,accounting for 47.1%(57/121).The most common gram-negative pathogen was Escherichia coli,accounting for 9.1%(11/121).(2)The infection rate of multidrug-resistant bacteria in culture-positive PDAP patients was 53.8%(112/208).Among 121 patients with PDAP who met the inclusion and exclusion criteria,70 cases were MDR infection and50 cases were non-MDR infection.In MDR group,most of the multidrug-resistant gram-positive bacteria were resistant to penicillin,erythromycin,clindamycin,ceftriaxone and levofloxacin,while no strains resistant to vancomycin and linezolid.Multidrug-resistant gram-negative bacteria have a high resistance rate to ampicillin/sulbactam,cefazolin,cefuroxime,gentamicin and ciprofloxacin,and no resistant strains to tegacyclin have been detected.(3)The proportion of male(P=0.035),the proportion of gram-positive bacterial infection(P=0.034),the proportio n of people who used wide-spectrum antibiotics for more than 5 days within 3 months before the onset of PDAP(P=0.022),the daily dialysate glucose exposure(P=0.028),the level of lipoprotein(a)(P=0.004),and the platelet-to-albumin ratio(P=0.003)in t he MDR group were higher than those in the non-MDR group.The multivariate binary dependent variable logistic regression analysis showed that the use of wide-spectrum antibiotics for more than 5 days within 3 months before the onset of PDAP(OR=3.634,95%CI=1.11-11.886,P=0.033),gram-positive bacterial infection(OR=3.741,95%CI=1.131-12.376,P=0.031),higher lipoprotein(a)level(OR=1.003,95%CI=1.001-1.004,P=0.003),and higher platelet-to-albumin ratio(OR=1.198,95%CI=1.010-1.420,P=0.038)were independent risk factors for multidrug-resistant infection in PDAP patients.(4)The incidence of refractory peritonitis in MDR group(29.6%)was higher than that in non-MDR group(12.0%)(X~2=5.229,P=0.022).The incidence of repeat peritonitis(16.9%)was also higher than that in the non-MDR group(4.0%)(X~2=4.773,P=0.029).Conclusion(1)The main pathogenic bacteria in PDAP patients were gram-positive bacteria,among which Staphylococcus was the most common.(2)The incidence of multidrug-resistant bacterial infection in PDAP patients is high,and the drug resistance spectrum is wide.According to the characteristics of drug resistance of pathogenic bacteria,vancomycin or linezolid combined with the third or fourth generation cephalosporins,aminoglycosides or carbapenems can be recommended as the initial empirical antibiotic treatment for PDAP patients.(3)The use of wide-spectrum antibiotics for more than 5 days within 3 months before the onset of PDAP,gram-positive bacterial infection,male,increased lipoprotein(a)level,increased platelet-to-albumin ratio,and higher daily dialysate glucose exposure may be related to the multidrug-resistant bacterial infection in PDAP patients.The use of wide-spectrum antibiotics for more than 5 days within 3 months before the onset of PDAP,gram-positive bacterial infection,high lipoprotein(a)level,and high platelet-to-albumin ratio were independent risk factors for the occurrence of multidrug resistant bacterial infection in PDAP patients.(4)The risk of refractory peritonitis and repeat peritonitis in PDAP patients with multidrug-resistant bacterial infection may be increased.