The Change Trend Of Peritoneal Dialysis-associated Peritonitis In A Single Center: Research Of The Pathogens And Their Antimicrobial Resistance Over Eight Years

Objective: To investigate the changes of the pathogens and their antimicrobialresistance in a single center over eight years.Materials and methods: Retrospectively analyze252peritonitis episodes in the FirstAffiliated Hospital peritoneal dialysis center of AnHui Medical University from January2009to Dcember2013,and compared with pathogens and their antimicrobialsusceptibilities from January2006to June2008.Results:1.The pathogenic bacteria culture result: In252cases of PDAP patients,158cases hadpositive cultured, the positive rate was62.7%.Among of them,146cases were the singleorganism peritonitis,12cases were the polymicrobial peritonitis (including onemultiple Gram-positive cocci infection, one multiple Gram-negative bacilli, four mixedinfections of Gram-positive and Gram-negative organisms,6mixed infections ofbacteria and fungi.),the total pathogens were178strains.Copmared with the date fromJanuary2006to June2008, the positive rate increased (62.7%vs.50.8%, P=0.076);theproportion of Gram-positive cocci decreased (70.6%vs.54.5%, P=0.082), theproportion of Gram-negative bacilli and Fungi increased over eight years(20.6%vs.23.0%, P=0.755;2.9%vs.10.7%, P=0.274,respectively),but the differences had nosignificance.It was worth noting that the proportion of Coagulase negativestaphylococcus epidermidis decreased significantly (35.3%vs.17.4%, P=0.018). 2.The drug susceptibilties: there was no report of Vancomycin resistant bacteria fromJanuary2006to June2008,in recent five years,there were two Enterococcis of Vanco-mycin resistance and one Streptococcus bovis of Vancomycin medium resistance.Thesensitive rate of Ciprofloxacin and Cefazolin to Gram-positive cocci decreased overeight years(70.0%vs.50.0%,P=0.110;34.8%vs.17.6%,P=0.140, respectively);exceptLinezolid, the sensitive rate of other antimicrobials all decreased,but the differences hadno significance.The sensitive rate of Amikacin, Imipenem and Ceftazidime had nosignificant change(90.0%vs.85.7%，P=0.745；87.5%vs.85.7%，P=0.629；51.6%vs.57.1%，P=0.705, respectively). There were no drug sensitivity results because ofGram positive bacteria, Neisseria without corresponding susceptibility breakpoint.Fungi was sensitive to Amphotericin B,Fluconazole, Flukytosine, Voricona-zole,Itraconazole in vitro drug sensitivity test.3.The outcome: from January2009to Dcember2013,193cases were recovery,35caseswere transferred to hemodialysis,3cases died,21cases lost. In recent five years, culturepositive patients and culture negative patients exit rate both were23.4%;the exit rate ofthe polymicrobial peritonitis was higher than the single pathogen infection(50.0%vs.18.4%,P=0.027);the exit rate of the fungal peritonitis was higher than the bacterialperitonitis(83.3%vs.12.4%,P<0.001). Among of Gram-positive cocci,Gram-negativebacilli, Gram-positive bacilli and Neisseria gonorrhoeae, The exit rate had nosignificant differences.Conclusion:1.The culture positive rate improved in this center,but there is a big gap compared withthe ISPD standard, need to take further measures to enhance the positive culture rate; 2.The proportion of Gram-positive coccus fell,the proportion of Gram-negative bacilliand Fungi increased in this center, Coagulase negative staphylococcus epidermidisdecreased significantly;3.The drug sensitivity of the Gram-positive cocci decreased,we should pay attention toVancomycin-resistant Enterococcus;the drug sensitivity of Gram-negative bacilli had nosignificant change;4. Empiric antibiotics selection:Gram-positive organisms may be covered by Vanco-mycin, and gram-negative organisms by Amikacin or Carbapenems.