| Objectives:This study take a retrospective analysis of peritoneal dialysis(PD)patients in our PD centre,aimed to describe the clinical characteristics and outcomes of Coagulase-negative staphylococcal(CoNS)caused peritoneal dialysis-associated peritonitis(PDAP).Materials:We collected all the episodes of peritonitis which were caused by CoNS in PD patients encountered in the Hospital from Jan 1,2009 to Dec 31,2018.According to the time when the peritonitis taken in place,we devided the episodes into two groups.The 2009-2013 group included 69 episodes,the 2013-2018 group included 83 episodes.The baseline data?biochemical laboratory data,etiology data were collected at the onset of peritonitis,in order to analysis the statistic differences of the biochemical laboratory data,etiology data and prognosis.Logistic regression was used to explore the risk factors associated with the prognosis of peritonitis in PD patients.Statistical analysis was performed using SPSS 22.0,and p<0.05 was considered statistical significance.Results:1.A total of 617 cases of peritonitis associated with peritonitis occurred in our center from 2009 to 2018,and the overall incidence of peritonitis decreased from 0.25 cases/year in 2009 to 0.16 cases/year in 2018.510 cases of positive peritonitis were cultured from 2009 to 2018.The proportion of culture-negative peritonitis in all peritonitis showed a decreasing trend,and the proportion of culture-negative peritonitis dropped to less than 10%in 2018.2.During January 1,2009(solstice),December 31,2018,there were 152 cases of CoNS associated peritonitis,and the distribution of pathogenic bacteria was that of staphylococcus epidermidis(86 cases(56.58%),followed by 30 cases of haemolytic staphylococcus(19.74%)and 16 cases of staphylococcus cephalus(10.53%).Among 152 cases of CoNS-associated peritonitis,106 cases(69.74%)were methicillin-resistant CoNS(MRCoNS).There were 86 cases of staphylococcus epidermidis associated peritonitis,including 67 cases of methicillin-resistant staphylococcus epidermidis(MRSE)(77.91%).3.2009-2018 cultured CoNS susceptibility analysis showed ampicillin,amoxicillin/clavulanic acid,benzene azole Westwood,cefazolin,cefoxitin,penicillin,erythromycin,ciprofloxacin and magnitude drug resistant rate were higher than 50%,the resistance to penicillin was 100%,ampicillin resistant rate of 99.31%,mupirocin resistant rate of 92.31%.However,the drug resistance rate of vancomycin,linezolid and furantoin was 0.Sixty-four cases(77.1%)of methicillin-resistant coagulase-negative staphylococcus(MRCoNS)were cultured in the 2014-2018 group,and the proportion of drug-resistant bacteria increased significantly compared with the 2009-2013 group(p=0.03).Compared with the 2009-2013 group,the drug resistance rate of the CoNS cultivated in the 2014-2018 group to amoxicillin/clavulinic acid,benzacillin,gentamicin,tobramycin,mupiroxacin HL was significantly increased(p<0.05).4.Among the 152 cases of secondary coagulase-negative staphylococcal infective peritonitis that occurred between 2009 and 2018,128 cases of secondary peritonitis were cured and 24 cases of treatment failure.Among the patients with treatment failure,6 cases were transferred to hemodialysis,8 died and 10 had recurrence.In the group from 2009 to 2013,53 cases were secondary cured(76.8%),16 cases were secondary treatment failure,and 8 cases were recurrent(11.6%).In the 2014-2018 group,75 patients were cured for the first time(90.4%),and 8 patients failed for the second time.The proportion of successful treatment(90.4%)in the group five years after recurrence(2.4%)was significantly higher than before(p<0.05),and the proportion of recurrence was lower than before(p<0.05).5.The results of logistic multivariate regression model showed that age,Alb were risk factors affecting the outcome of treatment(p<0.05).Conclusions:1.The incidence rate of peritonitis associated with peritonitis decreased year by year,and the proportion of coagulase negative staphylococcus decreased.2.In the past 10 years,the incidence of CoNS showed a downward trend,and the sensitivity to vancomycin and teicolanine was good,but the drug resistance rate of CoNS to methoxicillin was high,and the drug resistance rate had an upward trend.3.Although the drug resistance rate of group CoNS to methicillin significantly increased from 2014 to 2018,the proportion of successful treatment in the 2014-2018 group increased(p=0.026)and the proportion of recurrence decreased(p=0.044)4.Logistic multiple factors showed that age,Alb were risk factors affecting the outcome of treatment(p<0.05).Remove repetitive patients,Logistic multiple factors showed that gender(female),Alb were risk factors affecting the outcome of treatment(p<0.05). |
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