Culture-negative peritonitis: a fifteen-year review

Area of Science:

• Nephrology
• Infectious Diseases

Background:

• Peritonitis is a significant complication for patients undergoing peritoneal dialysis (PD).
• The clinical outcomes of culture-negative peritonitis (CNP) remain controversial, necessitating further investigation.

Purpose of the Study:

• To evaluate the clinical outcomes of culture-negative peritonitis (CNP) in peritoneal dialysis (PD) patients.
• To compare the efficacy of different effluent culture methods in diagnosing CNP.
• To identify risk factors associated with relapse and treatment failure in CNP.

Main Methods:

• A retrospective study reviewed 813 episodes of peritonitis, focusing on 202 CNP cases in 152 PD patients.
• Two effluent culture methods were compared: 10 ml direct inoculation and 50 ml centrifugation.
• Clinical outcomes, including cure rates, relapse, and treatment failure, were analyzed in relation to patient demographics and clinical factors.

Main Results:

• The 50 ml centrifugation culture method significantly reduced the incidence of CNP compared to the 10 ml direct inoculation method (20.7% vs. 35.7%).
• The overall cure rate for CNP exceeded 80% with initial cefamezine and gentamicin therapy.
• Older age (62.0 vs. 54.3 years), higher incidence of abdominal pain (91.4% vs. 69.3%), and increased need for salvage therapy (54.3% vs. 11.0%) were associated with relapse or treatment failure.

Conclusions:

• Culture-negative peritonitis in PD patients typically has a benign clinical outcome.
• The 50 ml centrifugation method is superior for reducing CNP incidence.
• Older age, abdominal pain, and the need for salvage therapy are risk factors for adverse outcomes in CNP.