Clinic diagnosis and treatment of culture-negative peritonitis in peritoneal dialysis patients

Abstract

Objective To investigate the treatment experiences and clinic features of culture-negative peritonitis(CNP) in peritoneal dialysis(PD) patients. Methods CNP episodes were reviewed retrospectively in our medical center from January 2008 to December 2012.The clinical manifestations, laboratory indicators, pathogenic bacteria, treatment, recovery rate, extubation rate, and relapse rate were analyzed and compared with those of gram positive and gram negative bacterial peritonitis.Comparing of curative effect, history of previous antibiotics treatment and the incidence of complications were analyzed by chi-squart test. Results Fifty-six patients with peritoneal dialysis-associateel peritonitis (PDAP) were reviewed.There were 21 cases with CNP, 24 episodes with gram positive and 11 episodes with gram negative bacterial peritonitis in the 56 cases.CNP group had a much higher history of previous antibiotic treatment (23.8%). There were no significant differences in the white blood cell (WBC) count of dialysate (2486.9±2576.4×106/L, 3017.5±1979.4×106/L, 2526.7±509.7×106/L, F=0.185, P>0.05), history of previous antibiotic treatment (23.5%, 4.2%, 9.0%, χ2=4.48, P>0.05), the combined infection of export/subcutaneous tunnel (4.8%, 4.2%, 0.0%, χ2=0.5, P>0.05) of the three groups.CNP group had lower hemoglobin(78.2±11.9)g/L, compared with gram positive group(89.5±16.5)g/L(LSD-t=11.26, P 0.05), the complete cure rate(66.7%, 75%, 81.8%, χ2=1.12, P>0.05), the catheter removal rate(9.5%, 4.2%, 0.0%, χ2=1.4, P>0.05) and relapse rate (23.8%, 8.3%, 0%, χ2=4.42, P>0.05)among the three groups. Conclusions The appearance of CNP may not be associated with history of previous antibiotic treatment.CNP has severe malnutrition, lower complete cure rate, higher catheter removal rate and catheter removal rate, suggesting a bad prognosis. Key words: Peritoneal dialysis; Peritonitis; Diagnosis; Prognosis