Differing outcomes of gram-positive and gram-negative peritonitis

Area of Science:

• Nephrology
• Infectious Diseases
• Clinical Medicine

Background:

• Peritonitis is a major cause of treatment withdrawal in continuous peritoneal dialysis (CPD).
• Limited comparative data exists on patient morbidity and mortality between gram-positive and gram-negative peritonitis in CPD patients.

Purpose of the Study:

• To compare the clinical outcomes, including morbidity, mortality, and treatment continuation, for patients experiencing gram-positive versus gram-negative peritonitis during CPD therapy.

Main Methods:

• Retrospective chart review of 375 CPD patients with 415 episodes of gram-positive or gram-negative peritonitis from 1993 to 1995.
• Analysis of patient demographics, causative organisms, treatment continuation, hospitalization, mortality, catheter removal, and recurrence rates.

Main Results:

• Gram-negative peritonitis occurred more frequently in diabetic patients (53% vs. 40%).
• Patients with gram-negative peritonitis had significantly higher rates of hospitalization (74% vs. 24%), catheter removal (18% vs. 4%), and mortality within 6 months (21% vs. 9%) compared to gram-positive peritonitis.
• CPD continuation rates were lower for gram-negative peritonitis at 2 weeks (73% vs. 97%) and 6 months (58% vs. 81%).
• Recurrence of peritonitis with the same organism was more common in gram-positive cases (32% vs. 9%), particularly with Staphylococcus aureus (60% vs. 24% for other gram-positive organisms).

Conclusions:

• Gram-positive and gram-negative peritonitis have distinct clinical outcomes in CPD patients.
• Separate analysis of gram-positive and gram-negative peritonitis rates is necessary for accurate outcome prediction in CPD therapy.