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Culture-negative CAPD peritonitis: the Network 9 Study
M Bunke1, M E Brier, T A Golper
1Academic Committee of Network 9, University of Louisville, Kentucky.
Abstract:
A portion of peritonitis episodes are reported as culture-negative or as initial no growth peritonitis (INGP). To determine if demographics, symptoms, signs, treatment, and outcome were different in INGP when compared to culture-positive peritonitis (Pos), we examined data from the Network 9 Peritonitis and Catheter Survival Study. Only peritonitis episodes occurring in adults with peritoneal dialysis (PD) fluid WBC counts greater than 100 were included in the analysis. INGP accounted for 14% of the episodes of peritonitis. Organisms grew out of 13 of the 37 patients in INGP that were recultured: 3 fungal, 5 gram-negative, and 5 gram-positive isolates. A difference in culture methodology for the two groups could not be detected. There was no difference in gender, race, incidence of diabetes, previous peritonitis, or exit-site infections between the two groups. INGP had a greater percentage of patients over age 70 (23.3% vs 14.7%, p < 0.05), and a larger percentage of INGP patients placed additives in their dialysate (55% vs 43.6%, p < 0.05). There was no difference in symptoms or signs between the two groups. The INGP group had half the catheter removal rate (9/103 vs 110/630 for Pos, p < 0.05), otherwise, there was no difference in the rate of hospitalization, death, or switch to hemodialysis. There was no difference in types of drugs used or method of drug administration between the two groups. A lower percentage of INGP patients were treated for 6 days or less and a higher percentage received 7-10 days of intraperitoneal (IP) therapy when compared to Pos.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Initial no growth peritonitis (INGP) in peritoneal dialysis (PD) patients is more common in older adults and may require longer intraperitoneal (IP) therapy. INGP outcomes are similar to culture-positive peritonitis, with less catheter removal.
Area of Science:
- Nephrology
- Infectious Diseases
- Peritoneal Dialysis
Background:
- Peritonitis is a common complication of peritoneal dialysis (PD).
- Some peritonitis episodes are culture-negative, termed initial no growth peritonitis (INGP).
- Understanding INGP characteristics is crucial for PD patient management.
Purpose of the Study:
- To compare demographics, symptoms, signs, treatment, and outcomes of INGP versus culture-positive (Pos) peritonitis.
- To identify factors associated with INGP in PD patients.
Main Methods:
- Analysis of data from the Network 9 Peritonitis and Catheter Survival Study.
- Inclusion criteria: PD patients with fluid WBC counts > 100.
- Comparison of INGP (14% of episodes) with Pos peritonitis.
Main Results:
- INGP patients were older (≥70 years) and more likely to use dialysate additives.
- No significant differences in gender, race, diabetes, previous peritonitis, or exit-site infections.
- INGP group had a lower catheter removal rate but similar hospitalization, death, and hemodialysis switch rates.
- INGP patients received longer intraperitoneal (IP) therapy (7-10 days vs. ≤6 days).
Conclusions:
- INGP is a distinct subgroup of peritonitis in PD patients, often affecting older individuals.
- While INGP shows a lower rate of catheter removal, outcomes are otherwise comparable to culture-positive peritonitis.
- Longer duration of intraperitoneal therapy may be indicated for INGP cases.