| Background:With the increase of uremia patients and the unique advantages of peritoneal dialysis,more and more people choose peritoneal dialysis.Peritonitis is a common and serious complication of peritoneal dialysis,and it is also the main factor for patients to withdraw from peritoneal dialysis.The application of broad-spectrum antibiotics leads to the continuous changes of bacterial spectrum and drug-resistant strains.Therefore,it is important to understand the clinical characteristics,pathogenic bacteria and drug resistance rate changes of patients with peritoneal dialysis related peritonitis after extubation for prolonging the service life of peritoneal dialysis.In this paper,the relevant factors were analyzed to provide theoretical reference for guiding clinical practice,prolonging the life span of peritoneal dialysis and improving the quality of the patient's life.Objective:To retrospectively analyze the clinical data,pathogenic bacteria and drug resistance rate changes of extubation patients with peritoneal dialysis related peritonitis in peritoneal dialysis center of our hospital,and to provide clinical reference for reducing withdrawal from peritoneal dialysis due to peritonitis.Materials and Methods:From January 2013 to January 2019,50 patients with peritonitis who had been extubated from the second Department of the First Hospital of Jilin University were selected as the study subjects and classified as extubation group.Meanwhile,50 patients who had peritonitis and were cured in the same period and were currently undergoing peritoneal dialysis were selected as control group.The clinical data of the two groups were analyzed and discussed.The clinical characteristics,bacterial flora distribution and drug resistance of patients with peritoneal dialysis-related peritonitis after extubation were analyzed.In addition,15 patients with extubation from 2013 to 2016 and 35 patients from 2017 to 2019 were compared longitudinally to explore the characteristics of bacterial flora in extubation group in recent years.Results:(1)The erythrocyte count,hematocrit(HCT)and hemoglobin concentration in extubation group were lower than those in cure group(P<0.01).Serum albumin and prealbumin level in extubation gro-up was significantly lower than that in cure group(P<0.05).The level of ferritin in extubation group was significantly higher than that in cure group(P<0.05),and MAMC in extubation group was lowe-r than that in cure group(P<0.01).The incidence of peritonitis in extubation group was higher than that in cure group(P<0.01),the proportion of neutrophils in extubation group was higher than that in cure group(P<0.05),and the routine white blood cell count(WBC)in peritoneal dialysis solution in extubation group was lower than that in cure group(P<0.05).Stepwise logistic regression was used to analyze the possible factors of extubation.The results showed that the number of peritonitis was the risk factor of extubation,and the difference was statistically significant(P=0.011).In other words,the risk of extubation increased by 1.443 times with each increase of peritonitis.HCT(P=0.010),albumin(P=0.001)and MA-MC(P=0.001)were protective factors for extubation,and the differences were statistically significant.(2)For the distribution of patients in the two groups among different strains,only the distribution of Gram-positive bacteria(P=0.001)and fungi(P<0.001)was different between the two groups,and the difference was statistically significant.There was no difference in the distribution of Gram-positive bacteria and Gram-negative bacteria between the two groups.There was no difference in the distribution of drug resistance of Gram-positive bacteria between the two groups,but there was difference in the distribution of drug resistance of compound sulfonamide(P=0.048)and chloramphenicol(P=0.011)in Gram-negative bacteria between the two groups,and there was no significant difference in the drug resistance of other Gram-negative bacteria.(3)There was no statistical difference in the distribution of Gram-positive bacteria and Gram-negative bacteria from 2013 to 2016 and from 2017 to 2019 in extubation group.Staphylococcus accounted for the highest proportion of Gram-positive bacteria;Pseudomonas,Escherichia coli and Klebsiella pneumoniae accounted for the highest proportion of Gram-negative bacteria.(4)There were statistically significant differences in the number and distribution of fungal infections(P=0.016)in extubation group from 2013 to 2016 and from 2017 to 2019.Candida parapsilokis was the main pathogen in the two periods.(5)For the distribution of relapsing,recurrent,repeated and multiple infection peritonitis in the two groups,only the distribution of relapsing peritonitis(P=0.022)and recurrent peritonitis(P=0.022)was different between the two groups,and the difference was statistically significant.Conclusion:1.Extubation of peritoneal dialysis is related to nutritional status(erythrocyte count,hematocrit(HCT)and hemoglobin concentration,serum albumin,prealbumin level,MAMC),number of peritonitis,inflammatory status(percentage of neutrophils,ferritin,routine white blood cell count peritoneal dialysis solution).The number of peritonitis is a risk factor for extubation,while HCT,albumin and MAMC are protective factors for extubation.2.Gram-positive peritonitis is more easily cured.Fungal infection is the main cause of extubation which is mainly caused by Candida parapsilokis.Relapsing,recurrent peritonitis increase the risk of extubation.3.Eliminating susceptible factors,strengthening education and preventing double infection are still the most important tasks in the future. |
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