| Objective:To investigate the pathogenic bacteria spectrum,antimicrobial resistance and the risk factors of peritoneal dialysis(PD)-related peritonitis.Methods:In this retrospective study,peritonitis and non-peritonitis dialysis patients were analyzed for their General information and blood test results(Hemoglobin,albumin,blood urea nitrogen,creatinine,blood potassium,blood calcium,blood phosphorusAnd so on),from January 2014 to December 2017 in Department of Nephrology of Minda Hospital Affiliated to Hubei Minzu University in Enshi.To investigate the pathogenic bacteria spectrum,antimicrobial resistance and the risk factors of peritonitis.Results:There were 148 case dialysis patients(including 86 males and 62 females)from January 2014 to December2017,the average age at the beginning of PD was57.88±17.31 years.Followed until 30 December 2018,the average duration of dialysis was(23.76 ±13.48)months,there are 49 patients withdrew from peritoneal dialysis,died in 14 cases(28%),changed to hemodialysis in 26 cases(52%),treated with kidney transplant in 9 cases(18%);A total of 128 episodes of peritonitis corresponding to a rate of 0.43 episodes per year;There were 54 patients with single episodes of peritonitis and 27 patients with two or more episodes of peritonitis.Among128 cases with peritonitis,68 cases showed positive resulte in bacterial culture,67 cases cultured positive(53.13%),In total,69 pathogenic strains were cultured,including 67 cases with single pathogen infection and 1 case with mixed infection;there were Gram-positive 48(73.8%),Gram-negative 13(20%)and fungal infection 4(6.2%)pathogenic strains,The most common gram-positive bacteria was Staphylococcus epidermidis[27 strains(55.1%)],the second was Staphylococcus aureus [7 strains(16.29%)].The most common gram-negative bacteria was Escherichia coli [7 strains(43.75%)],next were Acinetobacter baumannii [2 strains(12.5%)] and Klebsiella pneumoniae [2 strains(12.5%)].The strains of mixed infection is staphylococcus aureus and Candida glabrata smooth The antibiotic resistance test of the Gram-positive bacteria showed that antibiotics with less than 5%resistance rates were Teicoplanin(4.55%),amikacin(2.44%),vancomycin(2.17%),ceftriaxone(0%)and ampicillin(0%),and the highest resistance were penicillin(68.75%),azithromycin(63.41%),erythromycin(66.67%),clarithromycin(58.54%),meropenem(50%)and linezolid(50%).The antibiotic resistance test of theGram-negativebacteria appeared that it was sensitive to levofloxacin(6.25%),cefoperazone sulbactam(6.25%),ceftazidime(6.25%),polymyxin B(0%),minocycline(0%),ticarcillin/clavulanic acid(0%),ciprofloxacin(0%),piperacillin(0%),tobramycin(0%),aztreonam(0%),imipenem(0%),piperacillin/tazobactam(0%),amikacin(0%)and meropenem(0%).and the highest resistance were Ampicillin(66.67%),cefazolin(54.55%)and compound trimethoprim(50%).Binary logistic regression analysis suggested that hypoalbuminemia,hypokalemia and low education level was the risk factor of PD-related peritonitis.Conclusion: Gram-positive cocci were the most common pathogenic bacteria followed by Gram-negative bacteria,the least common were fungal leading to peritoneal dialysisrelated peritonitis.Staphylococcus epidermidis was the most common in Gram-positive cocci.Escherichia coli was the most common in gram-negative bacteria.The antibiotic resistance test of the bacteria showed that:We can first choose teicoplanin,amikacin,vancomycin,ceftriaxone and ampicillin to treat Gram-positive bacteria.We can first choose levofloxacin,cefoperazone sulbactam,ceftazidime,polymyxin B,minocycline,Tekacillin clavulanic acid,ciprofloxacin,piperacillin,tobramycin,aztreonam,imipenem,piperacillin/tazobactam,amikacin and meropenem to treat Gram-negative bacteria.The results of drug susceptibility support the initial treatment of vancomycin + third generation cephalosporins.We found that hypoalbuminemia,hypokalemia and low education level was the risk factor of PDrelated peritonitis. |
PDF Full Text Request