The clinical course of culture-negative peritonitis complicating peritoneal dialysis.
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).


CONCLUSIONS
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.
Szeto
Cheuk-Chun
CC
Department 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
Wong
Teresa Yuk-Hwa
TY
Chow
Kai-Ming
KM
Leung
Chi-Bon
CB
Li
Philip Kam-Tao
PK
D000368:Aged; D000900:Anti-Bacterial Agents; D001202:Ascitic Fluid / Q000382:microbiology; D001419:Bacteria / Q000254:growth & development / Q000302:isolation & purification; D001431:Bacteriological Techniques; D015897:Comorbidity; D018450:Disease Progression; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D012189:Retrospective Studies; D015163:Superinfection; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents