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The clinical course of culture-negative peritonitis complicating peritoneal dialysis
Cheuk-Chun Szeto1, Teresa Yuk-Hwa Wong, Kai-Ming Chow
1Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China People's Republic of China. ccszeto@cuhk.edu.hk
Background:
Culture-negative peritonitis is a serious complication in peritoneal dialysis patients.
Methods:
We studied all consecutive episodes of culture-negative peritonitis in our unit from 1995 to 2001. We identified 1,182 episodes of peritonitis recorded; 212 episodes in 149 patients had negative culture results.
Results:
The overall primary response rate was 67.5%, and the complete cure rate was 37.7%. In 95 episodes (44.8%), technical problems during the collection of dialysis effluent were suspected. There was a history of antibiotic therapy within 30 days before the onset in 56 episodes (26.4%). Recent antibiotic therapy was associated with a lower primary response rate (31 of 56 versus 113 of 156 episodes; P = 0.019) and lower complete cure rate (12 of 56 versus 68 of 156 episodes; P = 0.003). Furthermore, a history of peritonitis from 31 to 120 days before the onset also was associated with a lower complete cure rate (P = 0.001). Multivariate analysis showed that recent peritonitis was the only independent predictor of treatment failure (odds ratio, 2.87; 95% confidence interval, 1.56 to 5.29).
Conclusion:
Most of the culture-negative peritonitis could be explained by recent antibiotic therapy or technical problems during dialysate culture. Recent peritonitis and antibiotic therapy are associated with a poor treatment response. Early Tenckhoff catheter removal is recommended in this group of patients.
Insights
Culture-negative peritonitis in peritoneal dialysis patients often results from recent antibiotic use or technical issues. This condition is linked to poorer treatment outcomes, suggesting early catheter removal may be beneficial.
Area of Science:
- Nephrology
- Infectious Diseases
- Dialysis Medicine
Background:
- Culture-negative peritonitis is a significant complication for patients undergoing peritoneal dialysis.
- Identifying causes and predictors of treatment failure is crucial for patient management.
Purpose of the Study:
- To investigate the causes and outcomes of culture-negative peritonitis in peritoneal dialysis patients.
- To identify factors associated with treatment failure in these cases.
Main Methods:
- Retrospective analysis of 212 culture-negative peritonitis episodes from 149 patients between 1995 and 2001.
- Evaluation of primary response rates, complete cure rates, and potential contributing factors like antibiotic history and technical issues.
- Multivariate analysis to determine independent predictors of treatment failure.
Main Results:
- The primary response rate was 67.5% and complete cure rate was 37.7%.
- Technical collection problems (44.8%) and recent antibiotic therapy (26.4%) were common suspected causes.
- Recent antibiotic therapy and a history of peritonitis within 31-120 days were associated with significantly lower cure rates (P=0.019, P=0.003, P=0.001).
- Recent peritonitis was the sole independent predictor of treatment failure (OR 2.87).
Conclusions:
- Most culture-negative peritonitis cases are attributable to recent antibiotic use or technical dialysis effluent collection issues.
- Recent peritonitis and prior antibiotic exposure negatively impact treatment response.
- Early removal of the Tenckhoff catheter is recommended for patients with culture-negative peritonitis, especially those with risk factors.