Evolution of Peritoneal Dialysis-Associated Peritonitis: Pathogen, Antibiotic Resistance, and the Impact of Lymphocyte Count on Treatment Outcomes

Abstract

YuJian He,1,2,* Guang Yang,1,* Pengpeng Wang,1,3 Xu Wang,1,3 Zuying Xiong,1 Yan He,1,* Zibo Xiong1,* 1Renal Division, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China; 2Renal Division, PKU-Shenzhen Clinical Institute of Shantou University Medical College, Shenzhen, People’s Republic of China; 3Renal Division, PKU-Shenzhen Clinical Institute of Shenzhen University Medical College, Shenzhen, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zibo Xiong, Renal Division, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China, Tel [phone], Email [email protected]: 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.Keywords: antibiotic resistance, COVID-19, lymphocyte count, peritoneal dialysis, peritonitis, pathogen spectrum

Keywords

• antibiotic resistance
• covid-19
• lymphocyte count
• peritoneal dialysis
• peritonitis
• pathogen spectrum