Analysis Of Bacterial Spectrum And Drug Sensitivity Of Peritoneal Dialysis-associated Peritonitis

Objective: A retrospective study was conducted on 45 patients with peritoneal dialysis-associated peritonitis treated in my hospital from January 2015 to December 2017.To detect and analyze the distribution and resistance of pathogenic bacteria in peritoneal dialysis-associated peritonitis in our hospital,and to explore the changes before and after the occurrence of peritonitis to provide reference for clinical treatment.Methods: Data of all patients with peritoneal dialysis-associated peritonitis(PDAP)from 2010 to 2017 were collected,including sex,age,pathogen culture and drug sensitivity.The selected patients were divided into two groups before and after pdap,including urea,creatinine,hemoglobin,parathyroid hormone(PTH)and other laboratory results were compared.Retrospective analysis of culture-positive PDAP pathogenic bacteria spectrum and its resistance characteristics and changes in laboratory indicators before and after illness.Results: 1.forty-five patients were selected.among them,23 cases(51.11 %)were mainly gram-positive bacteria(7 cases),enterococcus faecalis(6 cases),staphylococcus aureus(4 cases),17 cases(37.78 %)were single gram-negative bacteria(mainly Escherichia coli(5 cases),Enterobacter cloacae(5 cases)),3 cases(6.67 %)were single fungal infection,and the other 2 cases were multiple bacterial infection2.According to the results of drug sensitivity test,gram-positive cocci were highly resistant to ampicillin(100 %),penicillin(72.22),oxacillin(58.33),cefazolin(50.00),gentamicin(23.53 %),vancomycin,imipenem,linezolid,teicoplanin and tigecycline.no drug-resistant strains were found.the drug resistance rates of moxifloxacin(10.00 %)and nitrofurantoin(6.25 %)were low.Gram-negative bacilli were highly resistant to cefazolin(90.91 %),ampicillin(85.71 %)and ceftriaxone(62.50 %).they were sensitive to ertapenem,piperacillin / tazobactam,but not to amikacin(10.00 %)and imipenem(10.00 %).Simple fungal infections were sensitive to 5-FC,fluconazole,voriconazole,amphotericin B,and itraconazole.No drug-resistant strains were found.One case of mixed infection of fungi was resistant to fluconazole3.On the treatment outcome,45 patients had an average hospitalization day of 13.4 ±6.32 days,33 cases were cured(cure rate was 73.3%),2 cases were repeated,and extubation was switched to hemodialysis in 9 cases(including catheter-associated infection in 1 case,fungal infection).All 3 cases were extubated and another 1 was mixed with fungal infection.One died(enterococcus faecalis infection).4.Plasma protein,blood phosphorus and parathyroid hormone,three indicators of the two groups have statistical differences,p values were 0.000,0.029 and 0.000,p < 0.05.the rest of the indicators were not statistically different,p > 0.05.Multivariate logistic regression showed that plasma albumin was statistically significant(p = 0.002,p < 0.05).the other two indexes were not significant(p > 0.05).Conclusion: According to the culture and drug sensitivity of peritoneal dialysis-related peritonitis,gram-positive bacteria were the main pathogenic bacteria.Vancomycin,linezolid,teicoplanin,tigecycline and nitrofurantoin can be selected as treatment schemes for gram-positive bacteria,and cyclopropcillin,piperacillin / tazobactam,amikacin and imipenem can be selected as treatment schemes for gram-negative bacteria;Vancomycin combined with amikacin can still be used as the initial treatment of peritonitis in our hospital.After comparing the clinical data of the group with peritonitis after the onset of peritonitis,it was found that there was a significant change in serum albumin,serum phosphorus,and PTH before and after the illness.The sample size was small in this study and a larger sample size needed to be further verified.