Pathogens and risk factors of peritoneal dialysis-associated peritonitis in patients with end-stage renal disease

doi:10.3877/cma.j.issn.1674-0785.2025.03.004

Abstract

Abstract:

Objective

To analyze the pathogen distribution and risk factors for peritoneal dialysis（PD）-associated peritonitis （PDAP） in patients with end-stage renal disease （ESRD）.

Methods

Clinical data of 231 ESRD patients undergoing PD at Ansteel Group General Hospital from January 2019 to January 2024 were retrospectively collected.Biochemical indicators and comorbidities were compared between the PDAP group and the control group，with risk factors identified using logistic regression.

Results

Among the 231 PD patients included，128 episodes of PDAP occurred.Gram-positive bacteria，predominantly Staphylococcus epidermidis，accounted for 75 cases （58.59%）.Gram-negative bacteria，primarily Escherichia coli，caused 32 cases （25.0%）.Other pathogens included Stenotrophomonas maltophilia （2 cases，1.56%） and fungi （3 cases，2.34%）.Risk factors identified for PDAP included hypoalbuminemia，anemia，comorbid diabetes，and hypokalemia （P＜0.05）.

Conclusion

The primary pathogens of PDAP are Staphylococcus epidermidis and Escherichia coli.Key risk factors for PDAP include comorbid diabetes，hypoalbuminemia，anemia，and hypokalemia.

Key words: End-stage renal disease, Peritoneal dialysis, Peritoneal dialysis-associated peritonitis, Pathogenic bacteria, Risk factors

Li Ma, Wenhua Liu, Dan Liu, Xiaotong Wang, Weiwan Kang, Yi Zhang, Xuejiao Wang. Pathogens and risk factors of peritoneal dialysis-associated peritonitis in patients with end-stage renal disease[J]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(03): 194-198.

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URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2025.03.004

https://zhlcyszz.cma-cmc.com.cn/EN/Y2025/V19/I03/194

Figures/Tables 3

病原菌	株数	构成比（%）
G⁺ 菌	75	58.59
金黄色葡萄球菌	6	8.0
链球菌	8	10.67
粪肠球菌	4	5.33
其他葡萄球菌	12	16.0
其他球菌	7	9.33
G- 菌	32	25.0
大肠埃希菌	20	62.5
肺炎克雷白杆菌	4	12.5
鲍曼不动杆菌	4	12.5
嗜麦芽窄食单胞菌	2	1.56
其他杆菌	4	12.5
真菌属	3	2.34

影响因素	PDAP 组（n=128）	对照组（n=103）	t/χ²/Z值	P值
性别［例（%）］			2.539	0.111
男性	84（65.63）	57（55.34）
女性	44（34.38）	46（44.66）
年龄（岁， $\overset{ˉ}{x}$ ± s ）	58.61±12.41	55.23±12.67	0.843	0.015
合并糖尿病［例（%）］	52（40.62）	41（39.81）	2.813	＜0.001
合并高血压［例（%）］	113（88.28）	96（93.2）	0.349	0.712
透析龄（月， $\overset{ˉ}{x}$ ± s ）	61.58±27.31	42.61±22.62	8.639	0.036
BMI（kg/m²， $\overset{ˉ}{x}$ ± s ）	22.83±2.15	22.46±2.23	0.463	0.668
白细胞计数［M ( Q₁,　 Q₃ )］	8.9（5.4，10.8）	8.2（5.9，11.2）	-0.436	0.675
血红蛋白（g/L， $\overset{ˉ}{x}$ ± s ）	92.67±21.24	103.21±20.38	5.573	＜0.001
血白蛋白（g/L， $\overset{ˉ}{x}$ ± s ）	25.65±4.26	31.72±2.39	9.763	＜0.001
血肌酐（μmol/L， $\overset{ˉ}{x}$ ± s ）	836.2±236.5	795.7±218.4	-1.237	-0.203
胆固醇（mmol/L， $\overset{ˉ}{x}$ ± s ）	3.08±1.24	4.62±1.36	8.538	0.663
HDL-C（mmol/L， $\overset{ˉ}{x}$ ± s ）	1.09±0.28	1.21±0.34	3.271	0.863
iPTH ［ng/L，M ( Q₁,　 Q₃ )］	342.6（102.5，415.7）	189.3（86.2，291.5）	-0.899	0.631
血磷（mmol/L， $\overset{ˉ}{x}$ ± s ）	1.73±0.46	1.61±0.38	1.365	0.089
血钾（mmol/L， $\overset{ˉ}{x}$ ± s ）	2.89±0.92	3.57±0.79	3.302	＜0.001

影响因素	PDAP 组（n=128）	对照组（n=103）	t/χ²/Z值	P值
性别［例（%）］			2.539	0.111
男性	84（65.63）	57（55.34）
女性	44（34.38）	46（44.66）
年龄（岁， $\overset{ˉ}{x}$ ± s ）	58.61±12.41	55.23±12.67	0.843	0.015
合并糖尿病［例（%）］	52（40.62）	41（39.81）	2.813	＜0.001
合并高血压［例（%）］	113（88.28）	96（93.2）	0.349	0.712
透析龄（月， $\overset{ˉ}{x}$ ± s ）	61.58±27.31	42.61±22.62	8.639	0.036
BMI（kg/m²， $\overset{ˉ}{x}$ ± s ）	22.83±2.15	22.46±2.23	0.463	0.668
白细胞计数［M ( Q₁,　 Q₃ )］	8.9（5.4，10.8）	8.2（5.9，11.2）	-0.436	0.675
血红蛋白（g/L， $\overset{ˉ}{x}$ ± s ）	92.67±21.24	103.21±20.38	5.573	＜0.001
血白蛋白（g/L， $\overset{ˉ}{x}$ ± s ）	25.65±4.26	31.72±2.39	9.763	＜0.001
血肌酐（μmol/L， $\overset{ˉ}{x}$ ± s ）	836.2±236.5	795.7±218.4	-1.237	-0.203
胆固醇（mmol/L， $\overset{ˉ}{x}$ ± s ）	3.08±1.24	4.62±1.36	8.538	0.663
HDL-C（mmol/L， $\overset{ˉ}{x}$ ± s ）	1.09±0.28	1.21±0.34	3.271	0.863
iPTH ［ng/L，M ( Q₁,　 Q₃ )］	342.6（102.5，415.7）	189.3（86.2，291.5）	-0.899	0.631
血磷（mmol/L， $\overset{ˉ}{x}$ ± s ）	1.73±0.46	1.61±0.38	1.365	0.089
血钾（mmol/L， $\overset{ˉ}{x}$ ± s ）	2.89±0.92	3.57±0.79	3.302	＜0.001

影响因素	OR 值	95%CI		P值
影响因素	OR 值	上限	下限	P值
血红蛋白	0.975	0.958	0.995	0.006
年龄	1.05	0.98	1.132	0.197
血钾	0.722	0.682	0.843	0.026
透析龄	1.231	0.836	1.428	0.942
血清白蛋白	0.822	0.701	0.932	0.003
合并糖尿病	3.628	1.126	11.357	0.031

References 18

1	Al Sahlawi M，Bargman JM，Perl J.Peritoneal dialysis-associated peritonitis： suggestions for management and mistakes to avoid ［J］.Kidney Med，2020，2（4）： 467-475.
2	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.
3	Hwang TY，Kim MG，Oh SW，et al.Pathogens of peritoneal dialysis peritonitis： trends from a single-center experience over 15 years ［J］.Kidney Res Clin Pract，2020，39（2）： 221-227.
4	Hu S，Ming P，Qureshi AR，et al.Peritonitis： episode sequence，microbiological variation，risk factors and clinical outcomes in a North China peritoneal dialysis center ［J］.Kidney Blood Press Res，2018，43（5）： 1573-1584.
5	Harmanjeet H，Jani H，Zaidi STR，et al.Stability of ceftolozane and tazobactam in different peritoneal dialysis solutions ［J］.Perit Dial Int，2020，40（5）： 470-476.
6	Zhou J，Yang C，Lei W，et al.Exploration of the correlation between intestinal flora and Escherichia coli peritoneal dialysis-related peritonitis ［J］.BMC Nephrol，2022，23（1）： 76.
7	Prasad KN，Singh K，Rizwan A，et al.Microbiology and outcomes of peritonitis in northern India ［J］.Perit Dial Int，2014，34（2）： 188-194.
8	Wu H，Ye H，Huang R，et al.Incidence and risk factors of peritoneal dialysis-related peritonitis in elderly patients： A retrospective clinical study ［J］.Perit Dial Int，2020，40（1）： 26-33.
9	Besarab A，Chernyavskaya E，Motylev I，et al.Roxadustat （FG-4592）： correction of anemia in incident dialysis patients ［J］.J Am Soc Nephrol，2016，27（4）： 1225-1233.
10	Tsai CC，Lee JJ，Liu TP，et al.Effects of age and diabetes mellitus on clinical outcomes in patients with peritoneal dialysis-related peritonitis［J］.Surg Infect （Larchmt），2013，14（6）： 540-546.
11	Santamaría B，Sanz A，Justo P，et al.Peritoneal defence-lessons learned which apply to diabetes complications ［J］.Nephrol Dial Transplantat，2006，21（suppl_2）： ii12-ii15.
12	Wu J，Yang X，Zhang YF，et al.Glucose-based peritoneal dialysis fluids downregulate toll-like receptors and trigger hyporesponsiveness to pathogen-associated molecular patterns in human peritoneal mesothelial cells ［J］.Clin Vaccine Immunol，2010，17（5）： 757-763.
13	Kwan BC，Kronenberg F，Beddhu S，et al.Lipoprotein metabolism and lipid management in chronic kidney disease ［J］.J Am Soc Nephrol，2007，18（4）： 1246-1261.
14	Tanaka S，Couret D，Tran-Dinh A，et al.High-density lipoproteins during sepsis： from bench to bedside ［J］.Critical Care，2020，24： 1-11.
15	Cirstea M，Walley KR，Russell JA，et al.Decreased high-density lipoprotein cholesterol level is an early prognostic marker for organ dysfunction and death in patients with suspected sepsis ［J］.J Crit Care，2017，38： 289-294.
16	Bermudes ACG，de Carvalho WB，Zamberlan P，et al.Changes in lipid metabolism in pediatric patients with severe sepsis and septic shock ［J］.Nutrition，2018，47： 104-109.
17	Zhang R，Zhang X，Tang X，et al.The association between diabetes coexisting with low levels of high-density lipoprotein cholesterol and peritoneal dialysis-related peritonitis ［J］.Diabetol Metab Syndr，2022，14（1）： 60.
18	Liu D，Lin Y，Gong N，et al.Degree and duration of hypokalemia associated with peritonitis in patients undergoing peritoneal dialysis ［J］.Int J Clin Pract，2021，75（8）： e14188.

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