The Comparison Of Clinical Characteristics Between Gram-negative And Gram-positive Peritoneal Dialysis Related Peritonitis

Objective:To investigate the clinical characteristics of gram-negative peritonitis compared with gram-positive peritonitis in order to guide the peritoneal dialysis, prevent gram-negative peritonitis,and to provide evidence for clinical diagnosis and treatment. Methods:Investigate retrospectively peritoneal dialysis related peritonitis 83 episodes in our hospital during 1/2011 to 4/2014.The general information of patients,clinical symptoms, laboratory tests and treatment effect were analysised.There were 57 episodes of peritoneal dialysis related peritonitis caused by bacteria, and the general information of patients,clinical symptoms, laboratory tests and treatment effect of gram-negative peritonitis( G- group) were compared with those of gram-positive peritonitis( G+ group).Results There were 57 episodes of peritoneal dialysis related peritonitis caused by bacteria during the observation time among the 83 peritonitis,Among them,20(35.1%) episodes were gram-negative cases, 37(64.9%) were gram-positive peritonitis. gram-negative peritonitis group :peritoneal dialysis time 20.89(10.26,41.16)months,white blood cells in dialysis effluent 4780(2387,7867)106L-1, polymorphonuclear cells rate in dialysis effluent 90( 85,91.5) %, C-reactive protein,serum 97.5(43.9,135.6)mg·L-1, polymorphonuclear cells rate in blood 84(69.5,97.5)%,serum potassium 3.21(2.76,3.6)mmol·L-1,gram-positive peritonitis::peritoneal dialysis time 9( 4.29,29.72) month, white blood cells in dialysis effluent 1060(400,2362)106L-1,polymorphonuclear cells rate in dialysis effluent 75(64.5,855)%,C-reactive protein 68(27.4,95.6)mg·L-1, polymorphonuclear cells rate in blood 79.7(69.3,84.2)%, serum potassium 3.8(3.3,4.3)mmol·L-1,Those data were significantly different between the two groups(P<0.05).The cure rate of gram-negative peritonitis and serum potassium was lower than gram-positive peritonitis, the difference was statistically significant(65% vs.89%,P<0.05). There was no difference in age,sex,proportion of diabetes,albumin,blood urea nitrogen, serum natrium,serum chlorine,serum phosphate and serum calcium between them(P>0.05).The pathogenic bacterium of gram-negative peritonitis were 8 Escherichia coli(40%),4 Klebsiellapneumoniae(20%),3Enterobactercloacae(15%),and 3 Citrobacter freudii(15%). The drug resistance rate of gram-negative bacteria to Imipenem and Amikacin was 0 and 5%. Common pathogenic bacterium of gram-positive peritonitis were Staphylococcus epidermidis, Staphylococcus aureus and Staphylococcus haemolyticus,None of them was resistant to Vancomycin.Conclusions: The inflammation of gram-negative peritonitis is more severe than gram-positive peritonitis, hypokalemia is more obvious,and it’s cure rate is lower. The drug resistance to Amikacin is low in our center,so it can be an effective medicine on initial treatment of gram-negative peritonitis.