Risk factors for treatment failure of enterogenous PDAP, a multicenter retrospective study

doi:10.3877/cma.j.issn.2095-3216.2023.03.002

Abstract

Abstract:

Objective

To investigate the risk factors for treatment failure of enterogenous peritoneal dialysis-associated peritonitis (PDAP).

Methods

Retrospective collection of clinical data on PDAP patients from four hospitals in Jilin Province from 2013 to 2019. According to the type of pathogenic bacteria from PDAP, the study subjects were divided into the enterogenous PDAP group (284 cases) and the non-enterogenous PDAP group (519 cases). The generalized estimation equation (GEE) was used to compare the two groups in clinical data, initial therapeutic effect, and current therapeutic effect of PDAP, as well as risk factors for treatment failure of enterogenous PDAP.

Results

This study included a total of 803 cases of PDAP, including 284 cases in the enterogenous PDAP group, with E. coli being of the highest number of 100 cases and accounting for 35.21% of the enterogenous PDAP group. Compared with the non-enterogenous PDAP group, the enterogenous PDAP group showed higher proportion of female patients (55.99% versus 47.21%, P=0.043), and higher proportion of diabetic nephropathy as primary disease (16.96% versus 11.27%, P=0.029). There was no significant difference between the two groups in age, hemoglobin level, and serum albumin level (all P>0.05). Compared with the non-enterogenous PDAP group, the enterogenous PDAP group showed worse initial therapeutic effect and current therapeutic effect of PDAP (both P<0.001). Multivariate GEE analysis showed that long dialysis age, living in rural areas, low serum albumin, Klebsiella pneumoniae, Pseudomonas aeruginosa, fungi, and mixed bacteria were independent risk factors for the treatment failure of enterogenous PDAP (P<0.05).

Conclusion

The therapeutic effect of the enterogenous PDAP was worse than that of the non-enterogenous PDAP. The independent risk factors for treatment failure of the enterogenous PDAP included long dialysis age, living in rural areas, low serum albumin levels, and related types of enterogenous microorganisms.

Key words: Peritoneal dialysis, Peritoneal dialysis-associated peritonitis, Enterogenous microorganisms, Risk factors

Mengyuan Yu, Liming Yang, Xueyan Zhu, Xiaoxuan Zhang, Shengmao Liu, Shunyun Xie, Ce Ni, Xiaohua Zhuang, Wenpeng Cui. Risk factors for treatment failure of enterogenous PDAP, a multicenter retrospective study[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(03): 127-133.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhsbyjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3216.2023.03.002

https://zhsbyjdzzz.cma-cmc.com.cn/EN/Y2023/V12/I03/127

Figures/Tables 6

References 31

[8]	官继超，龚淑文，汪艳艳，等. 肠源性腹膜透析相关性腹膜炎临床特点及危险因素分析[J]. 中国全科医学，2016(15): 1781-1785.
[9]	Li PK, Chow KM, Cho Y, et al. ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment [J]. Perit Dial Int, 2022, 42(2): 110-153.
[10]	中国腹膜透析相关感染防治专家组. 腹膜透析相关感染的防治指南[J]. 中华肾脏病杂志，2018(2): 139-148.
[11]	Buchanan RE, Gibbons NE. Bergey′s manual of determinative bacteriology [M]. 8th edition. Baltimore: Williams & Wilkins, 1984: 382-473.
[12]	Jorgensen JH, Pfaller MA. Manual of clinical microbiology [M]. 8th edition. Washington DC: Am Soc Microbiol, 2017: 497-519.
[13]	Yip T, Tse KC, Ng F, et al. Clinical course and outcomes of single-organism Enterococcus peritonitis in peritoneal dialysis patients [J]. Perit Dial Int, 2011, 31(5): 522-528.
[14]	Nash AK, Auchtung TA, Wong MC, et al. The gut mycobiome of the human microbiome project healthy cohort [J]. Microbiome, 2017, 5(1): 153.
[15]	Allert S, Foerster TM, Svensson CM, et al. Candida albicans-induced epithelial damage mediates translocation through intestinal barriers [J]. mBio, 2018, 9(3): e00915-e00918.
[16]	Hallen-Adams HE, Suhr MJ. Fungi in the healthy human gastrointestinal tract [J]. Virulence, 2017, 8(3): 352-358.
[17]	Valenza G, Tuschak C, Nickel S, et al. Prevalence, antimicrobial susceptibility, and genetic diversity of Pseudomonas aeruginosa as intestinal colonizer in the community [J]. Infect Dis (Lond), 2015, 47(9): 654-657.
[18]	Okuda J, Hayashi N, Okamoto M, et al. Translocation of Pseudomonas aeruginosa from the intestinal tract is mediated by the binding of ExoS to an Na，K-ATPase regulator, FXYD3 [J]. Infect Immun, 2010, 78(11): 4511-4522.
[19]	Deitch EA. Role of bacterial translocation in necrotizing enterocolitis [J]. Acta Paediatr Suppl, 1994, 396: 33-36.
[20]	Azam MW, Khan AU. Updates on the pathogenicity status of Pseudomonas aeruginosa [J]. Drug Discov Today, 2019, 24(1): 350-359.
[21]	Fiore E, Van Tyne D, Gilmore MS. Pathogenicity of enterococci [J]. Microbiol Spectr, 2019, 7(4): 10.
[22]	Krediet RT, Struijk DG. Peritoneal changes in patients on long-term peritoneal dialysis [J]. Nat Rev Nephrol, 2013, 9(7): 419-429.
[23]	赵晶，杨立明，朱学研，等. 长腹膜透析龄患者首次腹膜炎的临床特征及治疗转归：基于4家医院625例患者数据[J]. 南方医科大学学报，2020, 40(12): 1740-1746.
[24]	Wang X, Han Q, Wang T, et al. Serum albumin changes and mortality risk of peritoneal dialysis patients [J]. Int Urol Nephrol, 2020, 52(3): 565-571.
[1]	Tang SCW, Lai KN. Peritoneal dialysis: the ideal bridge from conservative therapy to kidney transplant [J]. J Nephrol, 2020, 33(6): 1189-1194.
[2]	Li PK, Chow KM, Van de Luijtgaarden MW, et al. Changes in the worldwide epidemiology of peritoneal dialysis [J]. Nat Rev Nephrol, 2017, 13(2): 90-103.
[3]	Scarpioni R, Manini A, Chiappini P. Remote patient monitoring in peritoneal dialysis helps reduce risk of hospitalization during Covid-19 pandemic [J]. J Nephrol, 2020, 33(6): 1123-1124.
[4]	Szeto CC, Li PK. Peritoneal dialysis-associated peritonitis [J]. Clin J Am Soc Nephrol, 2019, 14(7): 1100-1105.
[5]	Lin WH, Tseng CC, Wu AB, et al. Clinical and microbiological characteristics of peritoneal dialysis-related peritonitis caused by Escherichia coli in southern Taiwan [J]. Eur J Clin Microbiol Infect Dis, 2018, 37(9): 1699-1707.
[6]	Lin WH, Tseng CC, Wu AB, et al. Clinical and microbiological characteristics of peritoneal dialysis-related peritonitis caused by Klebsiella pneumoniae in southern Taiwan [J]. J Microbiol Immunol Infect, 2015, 48(3): 276-283.
[7]	许戎，胡宁，阿荣其其格，等. 肠源性与非肠源性腹膜透析相关性腹膜炎的临床特点及预后[J]. 中国血液净化，2012, 11(11): 621-625.
[25]	Uddin F, Imam SH, Khan S, et al. NDM production as a dominant feature in carbapenem-resistant Enterobacteriaceae isolates from a tertiary care hospital [J]. Antibiotics (Basel), 2021, 11(1): 48.
[26]	Szeto CC, Chow KM, Leung CB, et al. Clinical course of peritonitis due to Pseudomonas species complicating peritoneal dialysis: a review of 104 cases [J]. Kidney Int, 2001, 59(6): 2309-2315.
[27]	Siva B, Hawley CM, Mcdonald SP, et al. Pseudomonas peritonitis in Australia: predictors, treatment, and outcomes in 191 cases [J]. Clin J Am Soc Nephrol, 2009, 4(5): 957-964.
[28]	Olivares E, Badel-Berchoux S, Provot C, et al. Clinical impact of antibiotics for the treatment of Pseudomonas aeruginosa biofilm infections [J]. Front Microbiol, 2019, 10: 2894.
[29]	李忻阳，张禹，罗佩婷，等. 腹膜透析相关性真菌性腹膜炎的防治进展[J/CD]. 中华肾病研究电子杂志，2020, 9(6): 260-263.
[30]	Pereira R, Dos Santos Fontenelle RO, de Brito EHS, et al. Biofilm of Candida albicans: formation, regulation and resistance [J]. J Appl Microbiol, 2021, 131(1): 11-22.
[31]	刘美君，杨立明，朱学研，等. 腹膜透析相关的混合菌感染的发生和治疗失败的危险因素——814例多中心回顾性研究[J]. 南方医科大学学报，2021, 41(9): 1350-1357.

临床资料	总体(n＝803)	肠源性PDAP组(n＝284)	非肠源性PDAP组(n＝519)	Wald χ²值	P值
年龄(岁)	56.88(47，68)	57.79(48，69)	56.39(46，68)	1.239	0.266
女性[例(%)]	404(50.31)	159(55.99)	245(47.21)	4.099	0.043
当次PDAP透析龄(月)	23.45(7，33)	25.05(7，39.75)	22.57(7，31)	1.911	0.167
农村生活	249(31.01)	78(27.46)	171(32.95)	2.069	0.150
之前是否应用抗生素[例(%)]	80(9.96)	32(11.27)	48(9.25)	0.766	0.382
当次PDAP实验室指标
血白细胞(10⁹/L)	9.63(6.40，11.54)	9.60(6.32，11.92)	9.65(6.40，11.40)	0.018	0.893
血红蛋白(g/L)	99.43(85，113)	100.52(86，114.75)	98.83±20.04	1.152	0.283
血白蛋白(g/L)	28.81(24.70，33.19)	28.67±6.23	28.89(25，33.20)	0.183	0.669
血清钾(mmol/L)	3.83(3.29，4.26)	3.89(3.33，4.37)	3.79(3.29，4.22)	2.282	0.131
估算的肾小球滤过率[ml/(min·1.73 m²)]	6.46(4.44，7.65)	6.33(4.28，7.66)	6.52(4.48，7.62)	0.569	0.451
原发病[例(%)]
肾小球肾炎	362(45.08)	136(47.89)	226(43.55)	1.003	0.316
糖尿病肾病	205(25.53)	73(25.70)	132(25.43)	0.005	0.941
高血压肾病	120(14.94)	32(11.27)	88(16.96)	4.742	0.029
多囊肾病	42(5.23)	17(5.99)	25(4.82)	0.262	0.609
间质性肾病	32(3.99)	16(5.63)	16(3.08)	3.377	0.066
其他原发病	42(5.23)	10(3.52)	32(6.17)	1.708	0.191
疾病情况[例(%)]
合并糖尿病	282(35.12)	95(33.45)	187(36.03)	0.409	0.523
合并高血压	698(86.92)	244(85.92)	454(87.48)	0.282	0.596
合并腹泻或便秘	246(30.64)	94(33.10)	152(29.29)	1.124	0.289
当次PDAP性质[例(%)]
首发	465(57.91)	162(57.04)	303(58.38)	0.116	0.734
复发	47(5.85)	19(6.69)	28(5.39)	0.390	0.532
再发	46(5.73)	17(5.99)	29(5.59)	0.053	0.818
重现	42(5.23)	13(4.58)	29(5.59)	0.330	0.565
其他	203(25.28)	73(25.70)	130(25.05)	0.037	0.847

临床资料	总体(n＝803)	肠源性PDAP组(n＝284)	非肠源性PDAP组(n＝519)	Wald χ²值	P值
年龄(岁)	56.88(47，68)	57.79(48，69)	56.39(46，68)	1.239	0.266
女性[例(%)]	404(50.31)	159(55.99)	245(47.21)	4.099	0.043
当次PDAP透析龄(月)	23.45(7，33)	25.05(7，39.75)	22.57(7，31)	1.911	0.167
农村生活	249(31.01)	78(27.46)	171(32.95)	2.069	0.150
之前是否应用抗生素[例(%)]	80(9.96)	32(11.27)	48(9.25)	0.766	0.382
当次PDAP实验室指标
血白细胞(10⁹/L)	9.63(6.40，11.54)	9.60(6.32，11.92)	9.65(6.40，11.40)	0.018	0.893
血红蛋白(g/L)	99.43(85，113)	100.52(86，114.75)	98.83±20.04	1.152	0.283
血白蛋白(g/L)	28.81(24.70，33.19)	28.67±6.23	28.89(25，33.20)	0.183	0.669
血清钾(mmol/L)	3.83(3.29，4.26)	3.89(3.33，4.37)	3.79(3.29，4.22)	2.282	0.131
估算的肾小球滤过率[ml/(min·1.73 m²)]	6.46(4.44，7.65)	6.33(4.28，7.66)	6.52(4.48，7.62)	0.569	0.451
原发病[例(%)]
肾小球肾炎	362(45.08)	136(47.89)	226(43.55)	1.003	0.316
糖尿病肾病	205(25.53)	73(25.70)	132(25.43)	0.005	0.941
高血压肾病	120(14.94)	32(11.27)	88(16.96)	4.742	0.029
多囊肾病	42(5.23)	17(5.99)	25(4.82)	0.262	0.609
间质性肾病	32(3.99)	16(5.63)	16(3.08)	3.377	0.066
其他原发病	42(5.23)	10(3.52)	32(6.17)	1.708	0.191
疾病情况[例(%)]
合并糖尿病	282(35.12)	95(33.45)	187(36.03)	0.409	0.523
合并高血压	698(86.92)	244(85.92)	454(87.48)	0.282	0.596
合并腹泻或便秘	246(30.64)	94(33.10)	152(29.29)	1.124	0.289
当次PDAP性质[例(%)]
首发	465(57.91)	162(57.04)	303(58.38)	0.116	0.734
复发	47(5.85)	19(6.69)	28(5.39)	0.390	0.532
再发	46(5.73)	17(5.99)	29(5.59)	0.053	0.818
重现	42(5.23)	13(4.58)	29(5.59)	0.330	0.565
其他	203(25.28)	73(25.70)	130(25.05)	0.037	0.847

病原菌	株数(株)	构成比(%)
革兰氏阴性菌	187	65.85
大肠埃希菌	100	35.21
肺炎克雷伯杆菌	21	7.40
肠杆菌	30	10.56
铜绿假单胞菌	13	4.58
其他	23	8.10
革兰氏阳性菌	19	6.69
肠球菌	19	6.69
真菌	28	9.86
厌氧菌	1	0.35
混合菌	49	17.25

病原菌	株数(株)	构成比(%)
革兰氏阴性菌	187	65.85
大肠埃希菌	100	35.21
肺炎克雷伯杆菌	21	7.40
肠杆菌	30	10.56
铜绿假单胞菌	13	4.58
其他	23	8.10
革兰氏阳性菌	19	6.69
肠球菌	19	6.69
真菌	28	9.86
厌氧菌	1	0.35
混合菌	49	17.25

病原菌	株数(株)	构成比(%)
革兰氏阳性菌
凝固酶阴性葡萄球菌	232	44.70
金黄色葡萄球菌	48	9.25
链球菌	92	17.72
其他	33	6.36
革兰氏阴性菌
不动杆菌	25	4.82
假单胞菌	11	2.12
其他	24	4.62
真菌	14	2.70
抗酸杆菌	10	1.93
混合菌	30	5.78

Please choose a citation manager

Content to export