| Objective:The characteristics of peritoneal dialysis-associated peritonitis(PDAP)caused by gram-negative bacteria were analyzed retrospectively.The main factors are bacterial spectrum,drug sensitivity,drug resistance and influencing factors.The objective is to provide reference for clinical diagnosis,treatment and prevention of gram-negative bacteria.Methods:PDAP in the Peritoneal dialysis Center of the Second Affiliated Hospital of Soochow University was selected.268 patients who met the inclusion criteria were included in the study.The date is 1 January 2009 solstice 31 December 2018.General information of patients,clinical manifestations,relevant laboratory results,bacterial spectrum and drug sensitivity,and outcome were recorded.The basic data of peritoneal dialysis-associated peritonitis caused by gram-negative bacteria and the change trend of bacterial spectrum were analyzed.The trend of sensitivity and drug resistance to commonly used drugs in clinic was analyzed.According to the results of PDE culture,the patients were divided into gram negative bacteria group(observation group)and gram positive bacteria group(control group),and the outcome was compared.Meanwhile,the influencing factors of different types of pathogenic bacteria peritonitis were compared by regression analysis.Results:(1).In the 268 patients with peritoneal dialysis-associated peritonitis included in this study,a total of 455 cases of peritonitis occurred,among which 4 patients had recurrent peritonitis,a total of 8 cases,and 1 patient had recurrence,a total of 2 cases.Among 163 patients,there were 1 occurrence,57 patients had 2 occurrence,and 48 patients had 3 or more peritonitis..(2).A total of 148 patients(53 males(48.62%)and 56 females(51.38%)developed peritoneal dialysis-associated peritonitis caused by gram-negative bacteria.The mean age was 60.98±14.11 years and the mean dialysis age was 29.62±25.26 months.The incidence rates of gram-negative bacteria causing PDAP from 2009 to 2018(unit:times/patient month)were 0,251.64,255.76,390.78,205.46,179.00,171.55,266.37,267.87 and 328.30,respectively.Peritonitis caused by gram-negative bacteria accounted for 0%,19.44%,25.00%,14.04%,21.69%,32.88%,31.03%,26.47%,24.66%and 26.15%of peritonitis in 2009 to 2018,respectively.The common pathogenic bacteria in peritoneal dialysis-associated peritonitis caused by gram-negative bacteria were escherichia coli(38.51%),klebsiella pneumoniae(19.59%)and enterobacter cloacae(10.14%).The gram-negative group was sensitive to meropenem,amikanamycin,imipenem,cefoperazone/sulbactam and piperacillin/sulbactam,with the sensitivity rates of 98.57%,97.84%,97.12%,90.91%and 86.86%,respectively.In 2014-2018 and 2009-2013,the sensitivity of peritoneal dialysis-associated peritonitis caused by gram-negative bacteria to cefoxime decreased and drug resistance increased(P<0.05),and there was no significant change in the resistance and sensitivity of other commonly used antimicrobial drugs.The outcome of peritonitis caused by gram-negative bacteria:134 cases improved,8 cases extubation,and 6 cases died,with a good recovery rate of 90.54%.(3).In this study,a total of 57 cases of peritoneal dialysis-associated peritonitis caused by escherichia coli occurred in 41 patients,among which 3 cases were ESBL positive,accounting for 5.26%of the cases of peritoneal dialysis-associated peritonitis caused by escherichia coli.There were 19 males(46.34%)and 22 females(53.66%).The mean age was 59.75±15.40 years and the mean dialysis age was 28.33±21.71 months.The incidence rates of escherichia coli induced PDAP from 2009 to 2018(unit:times/month of patients)were 0,880.74,937.79,0,924.57,429.60,308.79,799.11,535.74 and 697.64,respectively.The proportions of escherichia coli peritonitis in gram-negative bacterial peritonitis from 2009 to 2018 were 0%,28.57%,27.27%,0%,22.22%,41.67%,55.56%,33.33%,50.00%and 47.06%,respectively.Sensitivity to imipenem,meropenem,amikacin,cefoperazone/sulbactam and piperacillin/sulbactam were 100%,100%,100%,92.84%and 89.26%,respectively.Outcome of escherichia coli peritonitis:improvement in 51 cases,extubation in 4 cases,death in 2 cases,the recovery rate was 89.47%.(4).According to the results of culture of abdominal penetration fluid,it was divided into the gram negative bacteria group and the gram positive bacteria group.The age of the patients in the gram negative bacteria group was significantly higher than that in the gram positive bacteria group(P<0.05).There was no significant gender difference between the two groups(P>0.05).The patients in the gram-negative bacteria group had shorter penetration age than the gram-positive bacteria group,but the difference was not significant either(P>0.05).The gram-negative bacteria group showed higher rates of fever(P<0.001),abdominal pain(P=0.001),and turbidity of the fluid through the abdomen(P=0.001)than the gram-positive bacteria group.There was no statistically significant difference in blood routine,nutrition-related indicators and electrolyte indicators between the gram negative bacteria group and the gram positive bacteria group(P>0.05).The serum creatinine level of the patients in the gram-negative bacteria group was lower than that of the patients in the gram-positive bacteria group(P<0.05),but the number of white blood cells in the abdomen and in the normal range and the number of c-reactive protein(CRP)on the first day in the gram-negative bacteria group were all higher than those in the gram-positive bacteria group(P<0.05).Peritonitis in patients with bacterial pathogens for gram-negative bacterium and gram-positive bacterium as dependent variable,the difference of two types of peritonitis by Logistic regression analysis as independent variables,the results showed that serum creatinine levels,CRP,peritonitis,the first day to drain fluid cell count,to drain fluid leukocyte count down to the normal time needed for associated with peritoneal dialysis,peritonitis pathogenic bacteria types.Conclusions:(1)The incidence rate of peritoneal dialysis-related peritonitis caused by gram-negative bacteria in our peritoneal dialysis center did not decrease significantly,and the proportion of PDAP caused by gram-negative bacteria in the total PDAP was increasing in each year.The highly sensitive amikacin,cefoperazone/sulbactam,and piperacillin/sulbactam could be used for treatment.(2)Among the gram-negative bacteria causing PDAP,escherichia coli was the most common,and the proportion of escherichia coli causing PDAP in the negative bacteria was increasing in each year.Amikacin,cefoperazone/sulbactam,and piperacillin/sulbactam could be used for the treatment,and the effect of escherichia coli causing PDAP was relatively good.(3)Compared with patients with peritoneal dialysis-associated peritonitis caused by gram-negative bacteria,it took different time for the white blood cell count and the white blood cell count to fall to the normal range on the first day.Serum creatinine and CRP levels were correlated with the pathogen types of peritonitis.Before the results of liquid drug sensitivity were obtained,the antimicrobial agents with low drug resistance rate could be selected according to the patients’ white blood cell count,blood creatinine level and CRP level in the initial treatment plan.(4)In this center,the proportion of fever,abdominal pain and turbidity of fluid from abdominal penetration in the gram-negative bacteria group was higher than that in the positive bacteria group,and the clinical response was heavier.There was no significant difference in prognosis between the two groups. |
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