Clinical Study On The Efficacy And Safety Of Different Initial Treatment Regimenson Of Peritoneal Dialysis Associated Peritonitis

Objective:To review the data of patients with Peritoneal Dialysis Associated Peritonitis(PDAP)in our center,and analyze the two initial treatment options of PDAP and the two modes of administration of first generation cephalosporin to provide an appropriate treatment strategy of PDAP.Method:This study retrospectively collected 118 cases with peritonitis who received regular peritoneal dialysis at the Peritoneal Center of the Second Hospital of Jilin University from January 2012 to December 2017.According to the different treatment plan,it is divided into VC program group(vancomycin combined with third generation cephalosporin)and CC program group(first generation cephalosporin combined with third generation cephalosporin).Group CC was divided into observation group(intraperitoneal intermittent administration)and control group(intraperitoneal continuous administration)according to different administrations of first generation cephalosporin.General information(gender,age,duration of dialysis,duration of hospitalization,duration of antimicrobial treatment,diabetes mellitus and hypertension)and renal function(serum creatinine,urea nitrogen,uric acid,serum cystatin C,glomerular filtration rate)and peritonitis index(ascites ascites protein,white blood cells,bacterial culture and drug sensitivity)and other indicators(white blood cell,blood neutrophil,serum albumin,serum total cholesterol,low density lipoprotein)were recorded.The above data were analyzed statistically to explore the efficacy and safety of two initial treatment regimens and two modes of administrations of first generation cephalosporin in peritoneal dialysis associated peritonitis.Results:1.There was no significant difference(p > 0.05)in gender,age,duration of dialysis and primary kidney disease,white blood cells,blood neutrophil,hemoglobin,serum albumin,triglyceride,total cholesterol,HDL,LDL,urea nitrogen,uric acid,creatinine,Cystatin C,ascites WBC,ascites protein,total CCR and total K/tv between VC group(n=68)and CC group(n=50).There was no significant difference(p > 0.05)in above baseline clinical data between observation group(n=12)and control group(n=38).2.In group VC(n=68),31 cases of bacterial culture were positive,including 16 cases(51.6%)of gram positive bacteria,14 cases(45.2%)of gram negative bacteria and 1 cases(3.2%)of fungi.In group CC(n=50),31 cases of bacterial culture were positive,including24 cases(77.4%)of gram positive bacteria;5 cases(16.1%)of gram negative bacteria and 2 cases(6.5%)of fungi.There was no significant difference in the total distribution of pathogenic bacteria between the two groups(p > 0.05).In observation group(n=12),7 cases of bacterial culture were positive,including 7 cases(100%)of gram positive bacteria,0 cases(0%)of gram negative bacteria and 0 cases(0%)of fungi.In control group(n=38),24 cases of bacterial culture were positive,including17 cases(70.8%)of gram positive bacteria;5 cases(20.8%)of gram negative bacteria and 2 cases(8.3%)of fungi.There was no significant difference in the total distribution of pathogenic bacteria between the two groups(p > 0.05)3.There was no significant difference(p > 0.05)in the effective rate of initial treatment,total cure rate,persistent infection rate,the duration of hospitalization and duration of antimicrobial treatment,the change rate and withdrawal rate of the initial treatment program betweent VC(n=68)group and CC group(n=50)(p>0.05).There was no significant difference(p > 0.05)in above date between observation group(n=12)and control group(n=38).4.There was no significant difference in eGFR,urine volume,urea nitrogen and creatinine in group VC(n=68)before and after treatment.There was no significant difference in eGFR,urine volume,urea nitrogen and creatinine in group CC(n=50)before and after treatment.There was no obvious deterioration in above safety indicators before and after treatment in observation group and control group(p>0.05)Conclusion:1.Vancomycin combined with third generation cephalosporin and first generation cephalosporin combined with third generation cephalosporin have similar efficacy and safety in the initial treatment of peritoneal dialysis related peritonitis.2.Intermittent administration and continuous administration of first generation cephalosporin have similar efficacy and safety in the initial treatment of peritoneal dialysis related peritonitis.The intermittent administration of first generational cephalosporin has advantages over continuous administration in the outpatient treatment and economical saving.