Analysis And Pathogenic Bacteria Research From 87 Episodes Of Peritoneal Dialysis Related Peritonitis

Objective (s):To investigate the microbial spectrum and antibiotic resistance of peritoneal dialysis related peritonitis (PDAP) and get a scientific basis for prevention and treatment PDAP.Methods:87 episodes of peritonitis in 58 peritoneal dialysis patients from January 2012 to December 2015 were analyzed. The episodes of peritoneal dialysis, the patients’ demography, clinical data, spectrum of pathogenic bacteria and their resistance to antibiotics were retrospectively analyzed.Results:In the time distribution of the first episode peritonitis, short-term and forward group have no statistical significant difference compared to demography and the blood biochemical before dialysis.40.00%,12.73%,21.82% and 9.09% of the patients, the first episode peritonitis occurred in the 6month,6～12month,12～ 18month and 18～24month after dialysis, respectively. There were 87 cases of peritonitis occurred in the 58 patients.77 episodes were pathogenic culture positive, in which gram-positive bacteria were found in 60 episodes (60/77,77.92%), gram-negative bacteria in 12 episode (12/77,15.58%), mixed bacteria in four episodes (4/77,5.19%), and fungi one episodes (1/77,1.30%). Staphylococcus epidermidis was the dominant bacteria in gram-positive bacteria (23/60,38.33%), and Escherichia coli was the most common gram-negative pathogen (5/12,41.67%). Most of the Gram-positive bacteria were resistant to penicillin-type drugs. The resistant rate in penicillin G, amoxicillin, and oxacillin was 95.24%,82.05%, and 85.71%, respectively. The gram-positive bacteria were also resistant to cefazolin (98.74%) and cefaclor (81.08%), but susceptible to linezolid, vancomycin, nitrofurantoin and moxifloxacin.88.00% of the Staphylococcus epidermidis were methicillin resistance coagulase staphylococcus (MRCoNS). Most of them were resistant to first, second generation cephalosporins, imipenem and meropenem, but were susceptible to linezolid, vancomycin. Gram-negative bacteria were resistant to cefazolin, cefradine, ceftriaxone, and cefotaxime (90%,100%,50%, and 41.15%) and susceptible to ceftazidime, aztreonam (80% to 66.67%). There were no gram-negative strains resistant to amikacin, nitrofurantoin, meropenem and imipenem.Conclusion(s):(1) The first episodes peritonitis often occurred in the first half year after dialysis, we should pain more attention to them.(2) The main pathogen of PDAP is Gram-positive bacteria (80.25%). Cefazolin is not suitable for the empiric initial treatment of PDAP in our dialysis center. The treatment of peritonitis recommended the use of vancomycin combine ceftazidime/amikacin.(3) Staphylococcus epidermidis was the main bacteria lead to PDAP in our dialysis center, in order to reduce the PDAD caused by contact contamination, we should strengthen the training of standardized peritoneal dialysis fluid replacement operation.