222例次腹膜透析相关性腹膜炎的转归与预后分析

目的:分析腹膜透析相关性腹膜炎(CAPD)患者的病原菌特点及转归预后情况,为临床腹膜透析相关性腹膜炎的防治提供依据。方法:回顾性分析2009年1月~2013年12月在上海长海医院肾内科腹膜透析中心接受腹透治疗,且并发腹膜透析相关性腹膜炎患者的病原菌特点及转归情况。结果:共收治腹透相关性腹膜炎患者131例,发生腹膜透析相关性腹膜炎222例次,培养致病菌结果阳性143例次(64.4%),阴性79例次(35.6%)。185例次治愈;退出37例次,总治愈率为83.8%,病死率为4.1%,因感染导致腹膜透析退出率为16.3%,真菌感染的退出率为81.8%,显著高于G+球菌及G-杆菌感染(P0.001);多重感染退出率33%,4例均合并真菌感染。G-杆菌退出率明显高于培养阴性及G+球菌退出率(P0.001)。结论:腹透相关性腹膜炎是导致腹透患者退出的主要原因,其中多重感染比例增高,预后较差,且多与反复操作不当有关,故对腹透患者定期加强操作指导及监督尤为重要。     

持续性非卧床腹膜透析腹膜炎的致病菌及其耐药性

目的：探讨持续性非卧床腹膜透析（CAPD）腹膜炎的致病菌及其耐药性。方法：回顾性分析109例CAPD腹膜炎的临床表现、致病菌、耐药性和转归情况。结果：43例培养阳性,透出液培养阳性率为39．4％,其中11例为革兰阳性球菌,19例为革兰阴性杆菌,13例为真菌。主要的革兰阴性杆菌包括肺炎克雷白氏杆菌、大肠杆菌、不动杆菌和铜绿假单胞菌。革兰阴性杆菌对氨苄西林的耐药率最高,达85．7％;对阿米卡星的耐药率最低,为17．6％;庆大霉素的耐药率为44．4％;而头孢他啶的耐药率也高达42．9％。所有革兰阳性球菌对万古霉素敏感,大部分（71．4％）对头孢唑林敏感。腹腔内用抗真菌药对真菌性腹膜炎疗效不佳。腹膜炎CAPD的退出率为20．2％（22／109）。结论：革兰阴性杆菌腹膜炎比例有所增加,致病菌对庆大霉素和头孢他啶的耐药性较高,而对阿米卡星较敏感,宜作为经验用药。     

腹膜透析相关性腹膜炎经验用药分析

目的 研究华山医院及宝山分院腹膜透析（腹透）相关性腹膜炎的致病菌、耐药性及患者转归,为临床经验用药提供依据。 方法 回顾性分析2007年1月至2010年1月上述两医院腹透中心收治的93例腹透相关性腹膜炎的临床表现、致病菌、耐药性及转归。 结果 75例腹透液培养阳性,阳性率为80.2％,其中革兰阳性球菌45例,革兰阴性杆菌21例,真菌2例,革兰阳性杆菌1例,革兰阴性球菌1例,多种菌混合感染5例。革兰阳性球菌主要以凝固酶阴性的葡萄球菌为主,所有革兰阳性球菌对万古霉素均敏感,但对头孢唑林耐药率高达60.0%,而且耐药率有明显的逐年增加趋势。革兰阴性菌对头孢他啶的耐药率达到46.1％,所有革兰阴性杆菌对亚胺培南均敏感。因腹膜炎而退出腹膜透析有16例,退出率为17.2％（16/93）。腹腔使用万古霉素对残肾功能无显著影响。 结论 两院腹透中心腹透相关腹膜炎致病菌以革兰阳性球菌为多数。头孢唑啉耐药性逐年增高,目前不再适合作为初始治疗的经验用药。腹腔使用万古霉素可推荐作为革兰阳性菌致腹膜炎的初始经验用药。     

腹膜透析相关性腹膜炎的病原菌菌谱及耐药性分析

目的：分析本中心腹膜透析相关性腹膜炎（peritoneal dialysis-associated peritonitis,PDAP）的致病菌谱及其对常用抗生素的耐药性情况，为治疗提供依据。方法：回顾性总结分析本中心2010年01月—2019年12月的持续不卧床腹膜透析（CAPD）236例患者中发生PDAP的腹膜透析透出液病原学培养及药敏结果。结果：331例次PDAP腹膜透析透出液标本，病原菌培养阳性193例次，培养阴性138例次，阳性率58.51%，其中革兰氏阳性菌（G+菌）136株（70.47%），以表皮葡萄球菌、溶血葡萄球菌、金黄色葡萄球菌为主；革兰氏阴性菌（G-菌）42株（21.76%），以大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌为主；真菌15株（7.77%）。G+菌对青霉素、头孢唑林钠、左氧氟沙星的耐药率分别为70.16%、62.50%、38.28%，对万古霉素、利奈唑胺、替考拉宁敏感率分别为99.22%、99.15%、98.65%。G-菌对头孢曲松、哌拉西林、头孢噻肟的耐药率分别为28.57%、29.03%、25.00%；对莫西沙星、哌拉西林/他唑巴坦、美罗培南敏感率分别为1...     

单中心腹膜透析相关腹膜炎患者致病菌和耐药性及预后分析

目的:分析单中心腹膜透析相关腹膜炎患者致病菌和耐药性及预后情况。方法:收集我中心2009年1月1日～2017年12月31日收治的72例次腹膜透析相关腹膜炎患者致病菌分布和耐药情况及预后资料,采用统计学方法进行分析。结果:49例次培养阳性,共培养出58株致病菌,包括G+菌38株(65. 52%)、G-菌16株(27. 59%)和真菌4株(6. 9%)。G+菌中最常见的是表皮葡萄球菌,G-菌中最常见大肠埃希氏菌。G+菌对万古霉素、利奈唑胺、头孢曲松和呋喃妥因均耐药率为0。G-菌对哌拉西林/他唑巴坦、丁胺卡那、亚胺培南、美洛培南和头孢哌酮/舒巴坦均耐药率为0。培养阴性、单一G+菌、单一G-菌、单一真菌、混合感染腹膜炎的治愈率分别为78. 26%、88%、92. 86%、0%、57. 14%。真菌性腹膜炎的拔管率为100%。结论:G+菌仍是我中心腹膜透析相关性腹膜炎的主要致病菌,根据药敏选用抗生素治疗有助于提高治愈率。真菌性腹膜炎预后差,及时拔管并积极抗真菌治疗可减少死亡率。     

腹膜透析相关性腹膜炎致病菌特点与血清降钙素原的相关性分析

目的分析腹膜透析相关性腹膜炎致病菌特点与血清降钙素原的相关性。方法选取胜利油田中心医院腹膜透析中心2013年1月至2017年12月腹膜透析相关性腹膜炎138例次,其中腹膜透析液细菌培养阳性97例次,根据培养结果分为革兰阳性菌组和革兰阴性菌组。比较2组之间血红蛋白、血清白蛋白、C反应蛋白、血清降钙素原等的差异性及与致病菌的相关性。结果腹膜透析相关性腹膜炎腹透液培养阳性97例(70.29%),其中革兰阳性菌(G~+)51例(52.58%),以表皮葡萄球菌、沃氏葡萄球菌为主;革兰阴性菌(G~-)46例(47.42%),以大肠埃希菌、阴沟肠杆菌为主。2组间在年龄、透析时间、季节性等一般资料间无差异(P0.05);血清降钙素原有显著差异(P0.01)。结论腹膜透析相关性腹膜炎以G+菌感染为主;血清降钙素原检测对区分G~+菌与G~-菌感染有参考价值。     

老年腹膜透析相关性腹膜炎的致病菌与预后特点分析

目的分析老年腹膜透析相关性腹膜炎致病菌的分布和预后特点,以指导临床采取有效预防措施。 方法回顾性分析2009年1月1日至2017年12月31日期间南京医科大学附属苏州医院肾内科收治的72例次腹膜透析相关性腹膜炎患者的临床资料;根据年龄分为老年组(≥65岁)和中青年组(<65岁),将老年组患者的基本临床特点、致病菌分布以及预后情况与中青年组相比较。采用Kaplan-Meier法计算患者生存率和技术生存率。 结果43例患者(老年组22例,中青年组21例)发生72例次腹膜透析相关性腹膜炎(老年组38例次,中青年组34例次),共培养出58株致病菌,老年组31株(包括G^＋菌19株,G^－菌11株,真菌1株);中青年组27株(包括G^＋菌19株,G^－菌5株,真菌3株)。老年组的主要致病菌为G^＋菌(61.29%)。老年组的表皮葡萄球菌的发生率显著高于中青年组(29.03%与3.70%,P＝0.028)。老年组G^－菌和真菌的发生率与中青年组相比,差异无统计学意义。老年组腹膜炎的治疗转归(治愈率、拔管率、死亡率)与中青年组差异无统计学意义(P＝0.265,P＝0.066,P＝0.279)。Kaplan-Meier分析显示老年组的总体生存率并不低于中青年组(P＝0.282),而老年组的技术生存率显著高于中青年组(P＝0.007)。 结论老年腹膜透析相关性腹膜炎患者的致病菌分布与中青年患者有所不同,与他们更容易出现接触污染有关。老年腹膜透析相关性腹膜炎患者的总体预后并不比中青年患者差。     

单中心腹膜透析相关性腹膜炎致病菌及原因分析

目的:分析腹膜透析相关性腹膜炎感染原因及致病菌菌谱、耐药性变化,为合理用药提供依据。方法:回顾深圳市第二人民医院近5年来腹膜透析相关性腹膜炎患者一般情况、细菌培养及药敏试验、疗效及转归。结果:96例次腹膜透析相关性腹膜炎中,常见的感染原因是不规范操作(28. 1%)及不洁饮食(41. 6%)。培养菌株65例次,其中G+菌31例次(47. 7%),G-菌25例次(38. 5%),真菌8例次(12. 3%),分支杆菌1例次(1. 5%)。本中心最主要的致病菌是G+球菌,以葡萄球菌及链球菌多见,而G-菌感染中以大肠杆菌最为常见。G+菌对万古霉素、利奈唑胺、替加环素无耐药,对青霉素G的耐药率为72. 7%。G-菌对亚胺培南、哌拉西林他唑巴坦、厄他培南无耐药,对阿米卡星(5%)、头孢他啶(5. 2%)及头孢替坦(5. 5%)低耐药,对氨苄西林耐药率为83. 33%。真菌对伊曲康唑、酮康唑、5-氟胞嘧啶无耐药。G+菌、G-菌、培养阴性腹膜炎患者治愈率分别为88%、86. 4%、92. 1%。结论:革兰阳性菌仍是腹膜透析相关性腹膜炎的主要致病菌;腹透液培养阴性的腹膜炎患者治愈率高、预后较好。革兰阳性球菌对青霉素耐药性较高,经验治疗宜首先万古霉素;革兰阴性菌腹膜炎经验治疗可选用氨基糖甙类、头孢他啶或哌拉西林/他唑巴坦。     

腹膜透析相关性腹膜炎的诊治进展

腹膜透析相关性腹膜炎受多种因素影响,操作不规范是引起腹膜透析相关性腹膜炎的重要原因,其发生与原发病有密切关系,另外营养状况、家居环境、文化程度都与持续性不卧床腹膜透析患者发生感染性腹膜炎有关.革兰氏阳性球菌是感染最常见致病菌,真菌性腹膜炎治疗效果仍差,应尽早拔管.     

维持性腹膜透析患者腹膜透析相关性葡萄球菌腹膜炎的发生率及危险因素分析

目的 探讨维持性腹膜透析患者腹膜透析相关性葡萄球菌腹膜炎的发生率及相关危险因素.方法 以中山大学附属东华医院腹膜透析中心192例患者为研究对象.根据腹膜透析液培养结果分成腹膜炎组与正常组.采用多因素logistic回归分析腹膜透析相关性葡萄球菌腹膜炎的危险因素.结果 共16例（8.3％）患者发生腹膜透析相关性葡萄球菌腹膜炎.致病菌以表皮葡萄球菌为主,占50.0％（8/16）.治愈12例（75.0％）,死亡1例.高龄（OR=1.35,95％ CI 1.16～7.68,P=0.026）、糖尿病（OR =3.34,95％ CI 1.90～6.54,P＜0.001）、低血红蛋白（OR=1.68,95％ CI 1.21～6.48,P=0.022）及低白蛋白血症（OR=1.04,95％ CI1.02～1.07,P=0.036）是腹膜透析相关性葡萄球菌腹膜炎的相关危险因素.结论 腹膜透析相关性葡萄球菌腹膜炎发生率较高;高龄、低血红蛋白、糖尿病及低白蛋白血症是其相关危险因素.     

Analysis of microbiological trends and antibiotic susceptibility in 711 episodes of peritoneal dialysis-related peritonitis

Objective To investigate the microbiological trends and antibiotic susceptibility of peritoneal dialysis(PD)-related peritonitis (PDAP). Methods All patients who developed PDAP between 2004 and 2015 in Renji Hospital, Shanghai Jiao Tong University School of Medicine were enrolled. Demographic data, results of dialysate pathogen culture and drug susceptibility test were recorded. The trend of peritonitis incidence was measured by Poisson regression and the chi-square test or Fisher exact test method was used to compare the composition of causative organisms and their antimicrobial susceptibilities over time. Results During the study period, a total of 711 episodes of PDAP were occurred in 386 patients. The culture positive rate of pathogens rose from 52.0% in 2004 to 77.0% in 2015 (P＜0.001). The distribution of causative organisms of the culture positive peritonitis was gram-positive bacteria (270, 59.5%), followed by gram-negative bacteria (129, 28.4%), polymicrobial(39, 8.6%), fungi (15, 3.3%) and mycobacteria (1, 0.2%). From 2004 to 2015, the incidence of peritonitis decreased from 0.214 to 0.160 episodes/patient?year (P=0.034). The incidence of coagulase-negative staphylococcus peritonitis decreased from 0.049 to 0.027 episodes/patient?year (P=0.025), while others had no significant change; A significant decline was observed in the sensitivity of Gram-positive strains to the first generation cephalosporin and ampicillin/sulbactam in 2010-2015 group compared with those in 2001-2009 group (61.3% vs 88.2%, P＜0.001; 61.7% vs 85.5%, P=0.001), whereas the sensitivity to vancomycin remained the same. The sensitivity of Gram-negative strains to ceftazidime and amikacin showed no significant change. As for the gram-positive peritonitis treated with cefradine as empirical treatment, compared with those in 2004-2009 group, in 2010-2015 group the proportion of patients requiring to change their treatment regime was significantly higher, and the treatment course was longer. Conclusions A gradual decline is observed in the incidence of PDAP and the culture positive rate of pathogens improves. Peritonitis caused by coagulase-negative staphylococcus decreases overtime. The present empirical treatment protocols may need re-evaluation considering the decreased rate of the first generation cephalosporin sensitivity in recent years.     

An analysis of ten-year trends in infections in adults on continuous ambulatory peritoneal dialysis (CAPD)

Infectious complications are the Achilles heel of CAPD. To determine trends in these events, we analyzed the CAPD related infections of 303 adults on CAPD at a single university center between 1979 and 1989. During this decade the percentage of insulin-dependent diabetics increased from 14% to 39% (p less than 0.005). Peritonitis rates fell from 2.4 episodes/y in 1979 to 0.8 episodes/y in 1989. The proportion of patients with multiple episodes of peritonitis decreased (40% of the patients in 1979-1982 vs 15% in 1983-1989, p = 0.0001) while the proportion of patients with no episodes of peritonitis increased during the same periods (29% vs 49%, p = 0.005). The proportion of peritonitis episodes due to S. aureus rose over the 10-year period (p = 0.005), while those due to S. epidermidis decreased (p less than 0.10). The overall incidence of S. aureus peritonitis remained unchanged. Catheter infection rates initially increased and then fell during the decade; S. aureus remained the predominant cause. The proportion of peritonitis episodes associated with catheter infection rose (13% in 1982 vs 24% in 1989, p = 0.025), and in 1989, 80% of these episodes were caused by S. aureus. Catheter loss was also primarily due to S. aureus infections in 1989 (80%). Infections due to P. aeruginosa were a persistent problem. The proportion of patients transferring to hemodialysis each year paralleled catheter loss rates, which in turn appeared to be more related to catheter infection rates than to peritonitis rates. We conclude that control of S. aureus and P. aeruginosa will be the key to future reductions in the infectious complications of CAPD patients.     

The changing trends of peritoneal dialysis related peritonitis and novel risk factors

Abstract

Aim: Continuous ambulatory peritoneal dialysis (PD) has become a treatment modality for end stage renal disease with a peak of its use in 1990s. The aim of this study was to examine the peritonitis rates, causative organisms and the risk factors of peritonitis in a large group of patients in our center. Methods: The study was conducted in the Nephrology Department of a University Hospital in Turkey. Patients in the PD programme between January 2000 and January 2006 were included. Cohort-specific and subject specific peritonitis incidence, and peritonitis-free survival were calculated. Causative organisms and risk factors were evaluated. Results: Totally 620 episodes of peritonitis occurred in 440 patients over the six years period. Peritonitis rates showed a decreasing trend through the years (0.79 episodes/patient-year 2000–2003 and 0.46 episodes/patient-year 2003–2006). Cohort-specific peritonitis incidence was 0.62 episodes/patient-years and median subject-specific peritonitis incidence was 0.44 episodes/patient-years. The median peritonitis-free survival was 15.25 months (%95 CI, 9.45–21.06 months). The proportion of gram-negative organisms has increased from 9.8% to 17.3%. There was a significant difference in the percentage of culture negative peritonitis between the first three and the last three years (53.1% vs. 43.2%, respectively). Peritonitis incidence was higher in patients who had been transferred from HD, who had catheter related infection and who had HCV infection without cirrhosis. Conclusions: Our study showed significant trends in the peritonitis rates, causative organisms and antibiotic resistance. Prior HD therapy, catheter related infections and HCV infection were found to be risk factors for peritonitis.     

Increased risk of Staphylococcus epidermidis peritonitis in patients on dialysate containing 1.25 mmol/L calcium.

Peritoneal macrophage function is decreased in vitro in the presence of dialysate with 1.25 mmol/L calcium compared with that containing 1.75 mmol/L calcium. Theoretically, patients using this dialysate may have a higher risk of peritonitis. Nineteen patients on continuous ambulatory peritoneal dialysis (CAPD) or continuous cycling peritoneal dialysis (CCPD) were converted from dialysate with 1.75 mmol/L calcium (mean time, 33 +/- 26 months) to that with 1.25 mmol/L calcium, for some or all exchanges (mean time, 10 +/- 4.7 months). Peritonitis rates were compared with 19 control patients who remained on dialysate with 1.75 mmol/L calcium. The two groups were matched for the proportion of diabetics, sex, age, use of the Y-set, and dialysis modality (CAPD, CCPD). Peritonitis rates were similar in the study patients before conversion to 1.25 mmol/L calcium dialysate and in the control patients (0.49 v 0.58 episodes/patient-year, respectively). After conversion to dialysate with 1.25 mmol/L calcium, the peritonitis rate was 0.82 episodes/patient-year contrasted to 0.58 episodes/patient-year in the control patients (P = 0.09). The peritonitis rate due to Staphylococcus epidermidis was 0.51 episodes/patient-year when 1.25 mmol/L calcium dialysate was used, and 0.19 episodes/patient-year for the comparable period in the control patients on 1.75 mmol/L calcium dialysate (P = 0.005). The proportion of peritonitis episodes due to S epidermidis increased from 20% to 61% after conversion to 1.25 mmol/L calcium (P = 0.01). The increased risk of peritonitis due to S epidermidis in patients using dialysate with 1.25 mmol/L calcium is consistent with a previous study demonstrating that clearance of S epidermidis by peritoneal macrophages is less effective with a decrease in the dialysate calcium content.(ABSTRACT TRUNCATED AT 250 WORDS)     

Peritoneal dialysis-associated peritonitis in Scotland (1999-2002).

BACKGROUND: Peritonitis is a major complication of peritoneal dialysis (PD). We have performed a national study of all patients on PD in Scotland over a 3.5 year period examining the causes of technique failure, rates of peritonitis, causative organisms, clinical outcomes and differences between automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). METHODS: All 10 adult renal units in Scotland participated in the study and the data include all 1205 patients who were on PD in Scotland from January 1999 to June 2002. The data were collected prospectively by the PD nurses and reported to the Scottish Renal Registry every 6 months. RESULTS: Refractory or recurrent peritonitis was the cause of technique failure in 167 patients (42.6% of all cases of technique failure). There were 928 cases of peritonitis in 1487 patient-years, which equates to an overall peritonitis rate of one episode every 19.2 months. The peritonitis rates for APD and CAPD were similar at one episode every 20.3 months and one episode every 18.6 months, respectively. These results include 88 cases of peritonitis due to relapse or re-infection. There was a statistically significant difference (P = 0.012) in peritonitis rates between units using nasal mupiricin (one episode every 21.9 months) and those that did not (one episode every 18.3 months). Coagulase-negative Staphylococcus was the most common cause of peritonitis (29%), although this rate is lower than in historic studies. The overall initial cure rate was 75%. The initial cure rate for APD was 77.2% and for CAPD was 73.7%. No causative organism was isolated in 17% of cases. CONCLUSION: PD-associated peritonitis is the leading cause of technique failure in Scotland. We validate previous studies showing a decrease in the proportion of peritonitis episodes that are caused by coagulase-negative staphylococci. APD peritonitis rates are not significantly better than CAPD peritonitis rates in Scotland, and the initial cure rates for APD and CAPD are similar.     

Evaluation of the lysis-centrifugation system for culturing dialysates from continuous ambulatory peritoneal dialysis patients with peritonitis

Recovery of organisms from continuous ambulatory peritoneal dialysis (CAPD) patients with peritonitis presents special problems to the laboratory. The Isolator (Dupont Co, Wilmington, DE), based on lysis and centrifugation, is generally used for the recovery of blood isolates. This study determined the efficacy of the Isolator relative to the Bactec System (Johnston Laboratories, Inc, Towson, MD) for the culture of dialysates from CAPD patients with peritonitis. On the basis of clinical criteria, 31 episodes of peritonitis were included for our study. Dialysate was inoculated into an Isolator and Bactec 6B and 7D bottles. A causative agent was isolated by the Isolator in 29 of 31 episodes, by the Bactec in 29 of 31, and by one or both techniques in 30 of 31 episodes (overall sensitivity 97%). The Isolator failed to detect a Pseudomonas luteola and the Bactec failed to detect a coagulase-negative staphylococcus. Coagulase-positive and negative staphylococci represented 58.1% of the isolates. The Isolator detected 21.4% (six of 28) of the isolates 24 to 72 hours earlier than the Bactec; the Bactec was faster in this regard in 3.6% (one of 28). Time to positivity for the remaining 21 cultures was the same in both systems. Isolate identification and antimicrobial sensitivity was available 24 hours earlier using the Isolator in 96.4% (27 of 28). The Isolator was more rapid and as sensitive as the Bactec system in detecting causative organisms of peritonitis in CAPD patients.     

Risk factors and outcomes of multiple episodes of peritoneal dialysis related bacterial peritonitis

Objective To investigate the risk factors and prognosis of peritoneal dialysis (PD) related bacterial peritonitis. Methods The clinical data of patients with PD related bacterial peritonitis from January 2006 to September 2016 in our hospital were retrospectively analyzed and followed up until December 2016. Patients were divided into two groups according to the frequency of peritonitis, single episode group and multiple episodes group (no less than two episodes of peritonitis). According to efficacy of therapy, the episodes of peritonitis were divided into two groups, cured group (no relapse, recurrence or repeat episodes) and failure group (relapse, recurrent or repeat infection after the therapy of initial episode). Logistic regression and Cox regression were used to analyze the risk factors for outcomes. Results Five hundred and fifty-nine patients had PD related bacterial peritonitis, including 339 patients in the single episode group and 220 patients in the multiple episodes group. Logistic analysis showed low serum albumin level (OR=787, P＜0.001) and malnutrition (OR=0.422, P＜0.001) at baseline were independent risk factors for multiple episodes (P＜0.001). The technical survival was better in the single episode group than that in the multiple episodes group (75.2% vs 36.2%, P=0.001) while the difference of survival rate was not significant between the two groups (48.2% vs 24.1%, P=0.592). Five hundred and thirteen episodes of peritonitis were analyzed, including 147 episodes in failure group (88 relapse episodes, 16 recurrent episodes and 43 repeat episodes) and 366 episodes in cured group. There were 78 patients in failure group and 253 patients in cured group. Logistic analysis showed prolonged response time (OR=1.200, P＜0.001), Gram-positive bacteria infection (OR=1.736, P=0.022), higher hs-CRP level (OR=1.004, P=0.013), lower serum albumin level (OR=0.936, P=0.008) were independent risk factors for failure of therapy. Multivariate Cox regression showed prolonged response time (HR=1.120, P=0.032), Gram-positive bacteria infection (HR=2.462, P=0.002), higher hs-CRP level (HR=1.007, P=0.009) were independent risk factors for failure of therapy and higher serum albumin level (HR=0.942, P=0.048) was an independent protection factor. Conclusions Low serum albumin level and malnutrition at baseline are independent risk factors for patients with multiple peritonitis episodes. Prolonged response time, Gram-positive bacteria infection, the high hs-CRP level are independent risk factors for relapse or recurrent or repeat episodes while high serum albumin level was an independent protection factor.     

The characteristic of causative organisms and outcomes of peritonitis in younger and elderly peritoneal dialysis patients

Objective To provide guide for prevention and cure of peritonitis in peritoneal dialysis(PD) by comparing the causative organisms and clinical outcome of PD related peritonitis in younger and elderly patients in our center. Methods All patients who developed PD related peritonitis between January 2006 and December 2013 in Wuhan NO.1 hospital were included. According to their age, episodes were divided into younger patients group (＜65 years) and elderly patients group (≥65 years). The microbiology and clinical outcome of PD related peritonitis were compared, and the related risk factors of the treatment failure were analyzed. Results Three hundred and sixty - six episodes of peritonitis occurred in 258 patients during the study period. The overall rate of peritonitis was 1 episode in 76.8 patient-months. Elderly patients had higher incidence of peritonitis (1 episode every 56.4 months vs 1 episode every 88.7 months, P=0.001), higher incidence of fungus infection (9.6% vs 3.9%, P=0.026) and higher mortality ( 46.2% vs 14.0%, P=0.001) than that in younger patients. Cox regression analysis showed that longer duration of PD treatment and fungal peritonitis were both risk factors of the treatment failure. Conclusion Elderly patients had higher incidence of peritonitis, higher incidence of fungus infection and higher PD - related mortality than younger patients.     

Clinical outcome of 371 episodes of peritoneal dialysis related peritonitis

Objective To analyze the clinical outcome of PD related peritonitis in our center. Methods All patients who developed PD related peritonitis between January 2004 and December 2010 in Renji Hospital of Shanghai Jiao Tong University School of Medicine were included. Outcomes of PD related peritonitis were analyzed. Results A total of 220 patients developed 371 episodes of PD related peritonitis during the study period in our center, and the average peritonitis rate was one episode per every 54.4 patient-months. Among the 371 episodes of peritonitis, 285 (76.8%) episodes had been cured, 17 (4.6%) episodes had needed temporary hemodialysis (HD), 46 (12.4%) episodes had led to switch to permanent HD and 21 (5.7%) episodes had caused death. After refractory peritonitis, there was a significant reduction of 4 h ultrafiltration (330 vs 270 ml, P＝0.036) and an increase tendency of 4h D/Pcr (0.55±0.08 vs 0.58±0.10, P＝0.086). Conclusions Peritoneal dialysis related peritonitis is an important contributor to technique failure and death in Chinese PD patients. Refractory peritonitis might injure peritoneal membrane function.