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Evolution of Peritoneal Dialysis-Associated Peritonitis: Pathogen, Antibiotic Resistance, and the Impact of
YuJian He1,2, Guang Yang1, Pengpeng Wang1,3
1Renal Division, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China.
Purpose:
Antibiotic administration leads to alterations in pathogenic organisms and antibiotic resistance, posing a significant risk to peritoneal dialysis patients' health. This study aimed to investigate changes in the cause-specific peritonitis, pathogen profiles, antibiotic resistance, and the prognostic factors among patients with peritoneal dialysis-associated peritonitis (PDAP) at our center.
Patients And Methods:
We included 463 PDAP patients who attended Peking University Shenzhen Hospital between 2002 and 2023. We analyzed the effects of empirical treatment regimens with cefazolin and ceftazidime or gentamicin.
Results:
From 2002 to 2023, we observed that gram-positive staphylococci emerged as the primary causative agents, while the proportion of gram-negative bacillary, enteric peritonitis, and catheter-associated peritonitis decreased significantly. However, the overall cure rate for PDAP and gram-negative bacillary peritonitis declined significantly from 2014 to 2023. Notably, we observed no increase in antibiotic resistance associated with antibiotic drugs use. In addition, reduced lymphocyte counts due to the prevalence of 2019 coronavirus disease (COVID-19) emerged as an independent risk factor for treatment failure in cases of gram-negative bacillary peritonitis.
Conclusion:
We did not observe elevated antibiotic resistance in our center when employing empirical dosing strategies involving cefazolin, ceftazidime, or gentamicin. Additionally, we found that a decrease in lymphocyte count due to the COVID-19 epidemic was a significant risk factor for treatment failure in cases of gram-negative bacillary peritonitis at our center. This study provides a foundation for developing clinical treatment strategies for PDAP.
Insights
Peritoneal dialysis-associated peritonitis (PDAP) shows shifts in causative pathogens, with no increased antibiotic resistance observed. Reduced lymphocyte counts linked to COVID-19 are a risk factor for treatment failure in gram-negative peritonitis.
Area of Science:
- Nephrology
- Infectious Diseases
- Clinical Microbiology
Background:
- Antibiotic use alters pathogens and resistance, risking peritoneal dialysis (PD) patient health.
- Peritoneal dialysis-associated peritonitis (PDAP) requires ongoing monitoring of causative agents and treatment efficacy.
- Understanding evolving pathogen profiles and resistance patterns is crucial for effective PDAP management.
Purpose of the Study:
- To investigate changes in peritonitis causes, pathogen profiles, and antibiotic resistance in PDAP patients.
- To identify prognostic factors for treatment outcomes in PDAP.
- To evaluate empirical antibiotic regimens (cefazolin, ceftazidime, gentamicin) in PDAP.
Main Methods:
- Retrospective analysis of 463 PDAP patients from 2002-2023 at Peking University Shenzhen Hospital.
- Analysis of cause-specific peritonitis, pathogen distribution, and antibiotic resistance trends.
- Assessment of empirical treatment effects and identification of risk factors for treatment failure.
Main Results:
- Gram-positive staphylococci became the primary cause of PDAP; gram-negative and catheter-associated peritonitis decreased.
- Overall and gram-negative peritonitis cure rates declined from 2014-2023.
- No increase in antibiotic resistance was observed with cefazolin, ceftazidime, or gentamicin use.
- Reduced lymphocyte counts (COVID-19 related) emerged as an independent risk factor for gram-negative peritonitis treatment failure.
Conclusions:
- Empirical antibiotic strategies using cefazolin, ceftazidime, or gentamicin did not lead to increased resistance.
- Decreased lymphocyte counts due to COVID-19 significantly impact gram-negative peritonitis treatment outcomes.
- Findings support developing tailored clinical strategies for PDAP management.
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