Pathogens and risk factors of peritoneal dialysis-related peritonitis / 中国感染控制杂志

ABSTRACT

Objective To investigate the bacterial spectrum and antimicrobial resistance of peritoneal dialysis (PD)-related peritonitis,and provide evidence for rational antimicrobial use.Methods Clinical data of 120 patients with PD-related peritonitis in a hospital from January 2013 to December 2014 were retrospectively analyzed. Results 91 cases (75.83%)showed positive result in bacterial culture,93 pathogenic strains were cultured,inclu-ding 73 (78.49%)gram-positive and 13 (13.98%)gram-negative bacterial strains,the most common gram-positive bacteria was Staphylococcus epidermidis (n=38,40.86%),and the main gram-negative bacteria was Escherichia coli (n =3,3.23%).Gram-positive strains had high resistance rates to penicillin,erythromycin,and oxacillin (93.65%,69.57%,and 64.41 % respectively),while resistance rates to vancomycin and linezolid were both low (2.90% and 1 .47% respectively),and were sensitive to teicoplanin,tigecycline,and nitrofurantoin.Gram-negative bacteria had high resistance rates to cefazolin,cefuroxime,and ampicillin(50.00%,37.50%,and 37.50% respec-tively),but were sensitive to imipenem,tobramycin,and piperacillin.Resistance rates of gram-positive and gram-negative bacteria to gentamicin and levofloxacin were both low.Non-standard operation during dialysate exchange was the most common cause of peritonitis (56.67%),most peritonitis were gram-positive bacterial infection (79.41 %);while gram-negative bacteria were the main pathogens of diarrhea-induced peritonitis (52.63%).The cure rates of gram-positive bacteria, gram-negative bacteria,and negative-cultured peritonitis were 92.96%, 76.92%,and 86.21% respectively,difference was not statistically significant(χ2 =3.39,P =0.18).Conclusion Gram-positive bacteria are major pathogens in PD-related peritonitis,and are usually caused by the bacteria through dialy-sis catheter due to non-standard operation during dialysate exchange.First-generation cephalosporins are not recom-mended as empirical therapy against gram-positive bacteria,while vancomycin is still the best choice.Third-genera-tion cephalosporins and aminoglycosides are recommended as empirical therapy against gram-negative bacteria. Gentamicin and levofloxacin can be used alone as empirical therapy in special circumstances.