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Comparison of positive rate of peritoneal dialysis-associated peritonitis pathogens cultured by traditional method and modified method and analysis of drug resistance
Chen Chunmiao, Xu Zhihui, Wang Feifei, Yun Xiaoying, Li Bing
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Comparison of positive rate of peritoneal dialysis-associated peritonitis pathogens cultured by traditional method and modified method and analysis of drug resistance
It was a retrospective cohort study. Peritoneal dialysis exudate samples from patients diagnosed with peritoneal dialysis-associated peritonitis (PDAP) in the Nephrology Department of the Second Affiliated Hospital of Hainan Medical College from January 1, 2021 to December 31, 2022 were collected. Based on different time of peritonitis, the specimens were split into two groups: the traditional method group and the modified method group. Only the traditional method was used for pathogen culture in the traditional method group. Both the traditional method and modified method were used for pathogen culture in the modified method group. The rates of positive culture of pathogenic bacteria, duration required to obtain positive culture results, spectrum of pathogenic bacteria, and drug resistance were analyzed. The results showed that a total of 223 patients (324 cases) with PDAP were included in the study, including 115 patients (168 cases) in the traditional method group and 108 patients (156 cases) in the modified method group. The modified method group displayed a significantly higher rate of pathogenic bacteria than the traditional method group [84.62% (132/156) vs. 69.23% (108/156), χ2 =18.903, P<0.001]. Additionally, the modified method group required less time to achieve a positive culture result of pathogenic bacteria than the traditional method group [69.0 (58.0, 90.9) h vs. 79.5 (65.6, 90.2) h, Z=2.061, P=0.039]. In this study, 120 culture-positive pathogens were identified in the traditional method group, of which, 69 (57.50%) were Gram-positive, 46 (38.33%) were Gram-negative, and 5 (4.17%) were fungi; The common strains of Gram-positive bacteria were staphylococcus epidermidis (17 strains, 14.17%) and streptococcus salivarius (10 strains, 8.33%). There were 134 culture-positive pathogens identified in the modified method group, of which 106 (79.10%) were Gram⁃positive, 24 (17.91%) were Gram⁃negative, and 4 (2.99%) were fungi; The common strains of Gram-positive bacteria were streptococcus salivarius (20 strains, 14.93%) and staphylococcus epidermidis (15 strains, 11.19%). Gram-positive bacteria had the highest resistance rate to oxacillin (50/85, 58.82%), Gram-negative bacteria had the highest resistance rate to ampicillin (21/35, 60.00%), and fungi was only resistant to fluconazole (1/9, 11.11%). The study suggests that the modified method can increase the positive rate of pathogen culture and shorten the culture time in peritoneal dialysate effluent. Gram⁃positive cocci are the main pathogenic bacteria of PDAP in this center. Oxacillin and ampicillin should not be the first choice for the treatment of PDAP in this center.
Peritoneal dialysis / Peritonitis / Drug resistance, bacterial / Pathogenic bacteria / Culture method {{custom_keyword}} /
表1 改良法组传统法和改良法病原菌培养阳性率及培养阳性时间比较 |
| 组别 | 培养阳性 ［例次（%）］ | 培养阴性 ［例次（%）］ | 培养阳性时间 ［h，M（P 25，P 75）］ |
|---|---|---|---|
| 改良法组（n=156） | 132（84.62） | 24（15.38） | 69.0（58.0，90.9） |
| 传统法组（n=156） | 108（69.23） | 48（30.77） | 79.5（65.6，90.2） |
| 统计量（χ 2/Z） | 18.903 | 2.061 | |
| P值 | <0.001 | 0.039 |
表2 腹膜透析透出液样本病原菌药敏试验结果 |
| 抗生素 | 敏感（株） | 中介（株） | 耐药（株） | 耐药率 ［%（构成比）］ |
|---|---|---|---|---|
| 革兰阳性菌（n=175） | ||||
| 苯唑西林 | 34 | 1 | 50 | 58.82（50/85） |
| 红霉素 | 69 | 3 | 81 | 52.94（81/153） |
| 青霉素G | 50 | 21 | 77 | 52.03（77/148） |
| 头孢唑林 | 69 | 4 | 78 | 51.66（78/151） |
| 克拉霉素 | 50 | 0 | 45 | 47.37（45/95） |
| 革兰阴性菌（n=70） | ||||
| 氨苄西林 | 14 | 0 | 21 | 60.00（21/35） |
| 头孢唑啉 | 23 | 2 | 19 | 43.18（19/44） |
| 莫西沙星 | 29 | 0 | 18 | 38.30（18/47） |
| 复方新诺明 | 36 | 0 | 22 | 37.93（22/58） |
| 氯霉素 | 35 | 3 | 19 | 33.33（19/57） |
| 真菌（n=9） | ||||
| 氟康唑 | 7 | 1 | 1 | 11.11（1/9） |
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http://journal.yiigle.com/LinkIn.do?linkin_type=cma&DOI=10.3760/cma.j.cn441217-20230809-00809
陈春苗：数据收集、分析及论文撰写；许志辉：数据分析指导和文章修订；王菲菲、云晓滢：数据收集；李冰：研究指导、文章修订
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