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

Abstract

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.

Keywords:

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

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author, Zibo Xiong, upon reasonable request.

Ethical Disclosure

This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of the Ethics Committee of Peking University Shenzhen Hospital approved this study.

Patient Consent Statement

Informed consent was waived because it was a retrospective study.

Acknowledgments

We are grateful to all our colleagues in the clinical departments and laboratories.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by Shenzhen San-Ming Project of Medicine (SZSM201812097), Shenzhen Postdoctoral Research Grant (50820191286), Shenzhen Science and Technology Innovation Commission (JCYJ20220530150412026), and the General Program for Clinical Research at Peking University Shenzhen Hospital (LCYJ2021004).