Analysis of pathogens and predisposing factors in peritoneal dialysis-associated peritonitis

Abstract

Objective To analyze the predisposing factors, pathogen spectrum, antibiotic sensitivity, and prognosis in peritoneal dialysis-associated peritonitis (PDAP) patients of Xijing Hospital Affiliated to Fourth Military Medical University. Methods A retrospective analysis was made of clinical data including PD time ( 3 years groups), education level (under junior high school, junior high school and above groups), trainers seniority ( 10 years groups), serum albumin level, the spectrum of pathogens, antibiotic sensitivity, outcomes, and others, in continuous ambulatory peritoneal dialysis (CAPD) patients with or without PDAP of the Peritoneal Dialysis Centre in Xijing Hospital Affiliated to Fourth Military Medical University from July 2013 to June 2015. Results Among the 501 CAPD patients, 87 patients suffered from PDAP for 106 times, with an average PDAP incidence of once per 66.8 patient-month. In the PD time 3 years group, the incidence rates of PDAP were 18.8% (21/112), 24.0% (56/233), and 6.4% (10/156), respectively, with significant differences among the three groups (χ2=20.42, P<0.001); the incidence rate of PDAP in the group with education level under junior high school (29.1%, 59/203) was significantly higher than that of the group with education level of junior high school and above (12.4%, 37/298) (χ2=21.60, P<0.001); and in the trainer seniority low than 5 years group, 5-10 years group, and above 10 years group, the incidence rates of PDAP were 25.4% (51/201), 15.4% (23/148), and 8.6% (13/152), respectively, with significant differences among the three groups (χ2=17.55, P<0.001). The level of serum albumin in the group with PDAP (26.89±5.16 g/L) was significantly lower than that in the group without PDAP (34.58±6.27 g/L) (t=-8.8, P<0.001). Results of culture from peritoneal fluid indicated that the positive rates of pathogenic microorganisms and gram-positive bacteria were 58.3% (56/96) and 78.6% (44/56), respectively; and among gram-negative bacilli, the percentage of Eescherichia coli was 45.5% (5/11). The effective rate of empirical use of cefazolin sodium and ceftazidime was 65.9% (70/106). Staphylococcus epidermidis infection occurred in 21 cases, with relapse in 14 cases (66.7%) and extubation in 7 cases (33.3%). Conclusion The incidence of PDAP in this centre closely correlated with PD time, education level, trainer seniority, and serum albumin. Gram-positive bacteria played a dominant role in the pathogenic microorganisms of PDAP, in which Staphylococcus epidermidis was of the highest percentage with high rates of both relapse and extubation. Key words: Peritoneal dialysis; Peritonitis; Pathogenic bacteria; Predisposing factors