Analysis Of Pathogenic Bacteria And Drug Resistance Of Peritoneal Dialysis-associated Peritonitis Based On A 10-year Cohort In A Single Center

Objective To analyze the changes of pathogenic bacteria and drug resistance in Continuous ambulatory peritoneal dialysis associated peritonitis,and to provide evidence for the improvement of clinical experience in the treatment of peritoneal dialysis associated peritonitis.Methods This was a retrospective cohort study.Patients who were confirmed with PD associated peritonitis at Ningxia Medical University General Hospital between January 1,2010 and December 31,2019 with complete data and long-term follow-up were included as subjects 。(1)Demographic data,pathogenic bacteria in peritoneal dialysis fluid,antibiotic resistance and treatment outcomes of all patients were collected;(2)According to the year of peritonitis occurrence(the previous 5-year group and the latter 5-year group),the peritonitis incidence,positive rate of bacterial culture,changing trend of pathogenic bacteria,drug resistance of commonly used antibiotics and treatment outcomes of peritonitis in the two periods were compared and analyzed.Results(1)A total of 382 cases of peritonitis were included.A total of 564 cases of peritoneal dialysis associated peritonitis occurred,including 231 cases in the previous 5-year group and 333 cases in the latter 5-year group.The general situation of peritonitis incidence:Between 2010 and 2019,the average incidence of peritonitis was 0.134 cases per patient year(1/89.75 cases per patient month).The overall incidence of peritonitis decreased gradually over time,from 0.183 / patient year(1/65.7 patient month)in 2010 to 0.103 /patient year(1/116.7 patient month)in 2019,and tended to be stable at a low level.(2)Spectrum distribution of pathogenic bacteria : Bacterial culture was performed in100% of the 564 cases of peritonitis associated with peritonitis from 2010 to 2019,including283 cases of Gram-positive peritonitis(63.88%),145 cases of Gram-negative peritonitis(32.73%),8 cases of fungal peritonitis(1.81%),7 cases of mixed infection(1.58%),and 121 cases of culture-negative peritonitis(21.45%).the previous 5-year group and the latter5-year group culture negative rate were 24.24%,19.52%(P = 0.179),gram positive bacteria were 65.14% 63.06%(P = 0.655),gram-negative bacteria morbidity was 31.43% 33.58%,respectively(P = 0.637),which significantly increased the incidence of e.coli from 14.86% to21.27%(P = 0.030),other gram-positive bacteria(staphylococcus epidermis staphylococcus aureus,streptococcus,etc.)of gram-negative bacterium(klebsiella pneumoniae Pseudomonas,etc.)and mixed fungi had no significant difference.(3)Drug resistance rate analysis :From2010 to 2019,the resistance rate of Gram-positive bacteria to vancomycin,Linezolid,teicoplanin,tigecycline were the lowest,all of which were 0.Compared with the previous 5-year group,the drug resistance rate of gram-positive bacteria to penicillin increased significantly in the latter 5 years group(54.39%VS78.26%,P=0.001),and the drug resistance rate to levofloxacin,ciprofloxacin,genamicin and cefepime increased from 23.91%29.82% 15.52% 8.70% to 28.57% 33.64% 18.42% 13.33%,respectively,but had no statistical significance.From 2010 to 2019,Gram-negative bacteria showed low resistance to imipenem,amikacin,meropenem,piperacillin/tazobactam,which were 0%,0.76%,1.72%,3.28%,respectively.The drug resistance rate of ampicillin and ampicillin/sulbactam was higher than50%.Compared with the first 5 years group,the drug resistance rate of gram-negative bacteria to levofloxacin and ciprofloxacin increased significantly in the latter 5 years group(18.6%VS39.73%,P=0.018;21.62%VS41.02%,P=0.041),The resistance rates to ceftazidime,gentamicin,piperacillin and cefuroxime increased from 12%,29.03%,30.23%and 31.25% to 19.28%,34.88%,45.21% and 44.74%,respectively,but there was no significant difference.(4)Analysis of treatment outcomes:From 2010 to 2019,the total cure rate of peritonitis was 90.60%,the mortality rate of peritonitis was 4.26%,and The rate of technical failure was 5.14%.Compared with the previous 5-year group,the cure rate of peritonitis in the latter 5-year group was slightly increased(89.18%VS91.59%,P=0.334),the mortality rate was decreased(5.63%VS3.30%,P=0.205),and The failure rate was similar(5.19%VS5.11%,P=0.962).Conclusion(1)From 2010 to 2019,the incidence of peritonitis showed a decreasing trend and tended to be stable at a low level.The negative rate of culture decreased,but it did not reach the standard of ISPD guidelines.(2)In our center,Gram-positive bacteria are the most common,such as Staphylococcus epidermidis,followed by Gram-negative bacteria,such as Escherichia coli,and the proportion increased significantly.(3)Compared with the previous 5-year group,the drug sensitivity of antibiotics in the latter 5 years group decreased to a certain extent,and the drug resistance rate of Gram-positive bacteria to penicillin,cefotaxime and cefepime increased,while the drug resistance rate of Gram-negative bacteria to levofloxacin,ciprofloxacin and piperacillin increased.(4)From 2010 to 2019,most of the first-generation cephalosporin combined with third-generation cephalosporin in our center were used as the empirical treatment plan,making the overall cure rate of peritonitis in our center to be 90.60%.Compared with the previous 5 years group,the cure rate of peritonitis in the latter 5 years group was slightly increased and the withdrawal rate was slightly decreased,and the same results were also observed in the treatment outcomes of various strains.