Multicentre registry data analysis comparing outcomes of culture-negative peritonitis and different subtypes of culture-positive peritonitis in peritoneal dialysis patients

Htay, Htay; Cho, Yeoungjee; Pascoe, Elaine M.; Hawley, Carmel; Clayton, Philip; Borlace, Monique; Badve, Sunil V.; Sud, Kamal; Boudville, Neil; Chen, Jenny H. C.; Sypek, Matthew P.; Johnson, David W.

doi:10.1177/0896860819879891

Cited by 29 publications

(23 citation statements)

References 22 publications

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“…More importantly, our results were further confirmed by using a multivariable logistic regression model. Our observation had both similarities and differences with previous data from ANZDATA registry study, which included 11122 episodes of peritonitis in 5367 patients in Australia during the period of 2004-2014[ 29 ]. Our study demonstrated that the complete cure rates were comparable between DM group and non-DM group, which was similar to the study by Htay et al[ 29 ].…”

Section: Discussionsupporting

confidence: 76%

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Comparison of clinical features and outcomes in peritoneal dialysis-associated peritonitis patients with and without diabetes: A multicenter retrospective cohort study

Meng

Yang

Zhu

et al. 2020

WJD

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BACKGROUND The number of end-stage renal disease patients with diabetes mellitus (DM) who are undergoing peritoneal dialysis is increasing. Peritoneal dialysis-associated peritonitis (PDAP) is a serious complication of peritoneal dialysis leading to technical failure and increased mortality in patients undergoing peritoneal dialysis. The profile of clinical symptoms, distribution of pathogenic organisms, and response of PDAP to medical management in the subset of end-stage renal disease patients with DM have not been reported previously. Discrepant results have been found in long-term prognostic outcomes of PDAP in patients with DM. We inferred that DM is associated with bad outcomes in PDAP patients. AIM To compare the clinical features and outcomes of PDAP between patients with DM and those without. METHODS In this multicenter retrospective cohort study, we enrolled patients who had at least one episode of PDAP during the study period. The patients were followed for a median of 31.1 mo. They were divided into a DM group and a non-DM group. Clinical features, therapeutic outcomes, and long-term prognostic outcomes were compared between the two groups. Risk factors associated with therapeutic outcomes of PDAP were analyzed using multivariable logistic regression. A Cox proportional hazards model was constructed to examine the influence of DM on patient survival and incidence of technical failure. RESULTS Overall, 373 episodes occurred in the DM group ( n = 214) and 692 episodes occurred in the non-DM group ( n = 395). The rates of abdominal pain and fever were similar in the two groups ( P > 0.05). The DM group had more infections with coagulase-negative Staphylococcus and less infections with Escherichia coli ( E. coli ) as compared to the non-DM group ( P < 0.05). Multivariate logistic regression analysis revealed no association between the presence of diabetes and rates of complete cure, catheter removal, PDAP-related death, or relapse of PDAP ( P > 0.05). Patients in the DM group were older and had a higher burden of cardiovascular disease, with lower level of serum albumin, but a higher estimated glomerular filtration rate ( P < 0.05). Cox proportional hazards model confirmed that the presence of diabetes was a significant predictor of all-cause mortality (hazard ratio = 1.531, 95% confidence interval: 1.091-2.148, P < 0.05), but did not predict the occurrence of technical failure ( P > 0.05). CONCLUSION PDAP patients with diabetes have similar symptomology and are predisposed to coagulase-negative Staphylococcus but not E. coli infection compared those without. Diabetes is associated w...

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Section: Discussionsupporting

confidence: 76%

“…DM was not associated with PDAP-related death in our study. In contrast, Htay et al[ 29 ] showed that DM correlated with PDAP-related death. Regional differences may account for this discrepancy.…”

Section: Discussionmentioning

confidence: 95%

Comparison of clinical features and outcomes in peritoneal dialysis-associated peritonitis patients with and without diabetes: A multicenter retrospective cohort study

Meng

Yang

Zhu

et al. 2020

WJD

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“…Therefore, patients in the EOP group might be suffered from PDAP due to unskilled operation, and Staphylococcus epidermidis was the main pathogenic agents caused by touch contamination [29, 30]. Meanwhile, as Htay et al [31] reported, most patients with the culture‐negative peritonitis respond well to treatment, which was similar as non‐Staphylococcal aureus gram‐positive organisms. Therefore, we speculated that non‐Staphylococcal aureus gram‐positive organisms, especially Staphylococcus epidermidis with good therapeutic effect, may be one of the main culprits of culture‐negative PDAP.…”

Section: Discussionmentioning

confidence: 99%

Poorer clinical outcomes of early‐onset peritonitis in elderly peritoneal dialysis patients: A longitudinal and multicenter study

Guo

Chen

Wu³

et al. 2021

Ther Apher Dial

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Introduction: Early-onset peritonitis (EOP) is a risk factor for mortality in peritoneal dialysis (PD) patients. This study investigates the clinical features and outcomes of EOP in elderly patients. Methods: This multicenter retrospective study evaluated 433 elderly PD patients with end-stage renal disease. The cohort was divided into nonperitonitis group (n = 239), EOP group (≤12 months, n = 109) and late-onset peritonitis (LOP) group (>12 months, n = 85). Clinical data, treatment results, and outcomes were compared between the groups.Results: Compared with LOP group, there were no significant intergroup differences in the rate of primary recovery, complete cure, relapse, catheter removal, or death from PDAP (p >0.05) in the most recent PDAP episode. However, Kaplan-Meier analysis showed that patients in the EOP group were likely to have multiple episodes of PD-associated peritonitis (PDAP), technique failure, all-cause death, and composite endpoint in the long-term prognostic outcomes (p <0.001).Conclusions: EOP is significantly associated with poorer clinical outcomes in older PD patients. K E Y W O R D Searly-onset peritonitis, elderly peritoneal dialysis patients, outcomes, peritoneal dialysisassociated peritonitis

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“…These results, as well as those of previous studies, indicate favorable outcomes, a high cure rate (77–80%), and a low catheter removal rate (8–12%) in patients with culture-negative peritonitis. 4 , 8 , 9 Although median time to primary response was shorter and the probability of primary response was higher in the combination therapy group, the final clinical outcomes, primary response at day 5, and incidence of relapse peritonitis did not differ significantly between the two groups. The fact that the short-term outcomes are quite similar in the two groups suggests that the benefits combination of cefazolin and ceftazidime may not be clinically meaningful in terms of primary response at day 5 and in relapse peritonitis.…”

Section: Discussionmentioning

confidence: 89%

Cefazolin Plus Ceftazidime versus Cefazolin Monotherapy in the Treatment of Culture-Negative Peritonitis: A Retrospective Cohort Study

Kovitangkoon¹,

Lukkanalikitkul²,

Wiangnon³

et al. 2022

IJNRD

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Background Based on current ISPD guidelines, it is unclear as to whether ceftazidime should be discontinued in subsequent management of culture-negative peritonitis if it is used as empirical gram-negative coverage. Herein, we aim to compare the clinical outcomes of cefazolin plus ceftazidime versus cefazolin alone. Methods This was a retrospective cohort study. Adult peritoneal dialysis (PD) patients who were diagnosed with culture-negative peritonitis between 2014 and 2020 were included. Patients were categorized into two groups according to treatment regimen. Primary response rate, peritonitis relapse rate, and time to primary response were compared. Factors that predicted primary response were determined using Cox regression analysis. Results A total of 58 patients were included in the study. Of these, 42 received cefazolin plus ceftazidime and 16 received cefazolin monotherapy. Overall, the mean age was 65.7±10.4 years. Most of the patients (81.3%) were prescribed continuous ambulatory peritoneal dialysis. Initial effluent WBC was 4211±10357 in the combination group and 3833±6931 cell/mm 3 in the monotherapy group (p=0.89). There was no significant difference in primary response at day 5 between the two groups (95.2% in the combination group vs93.7% in the monotherapy group, p=0.82). However, cumulative probability of primary response by the Kaplan–Meier analysis in the combination group was higher than in the monotherapy group (p=0.02). Adjusted HR of serum potassium level to predict a primary response was 1.83 according to multivariate analysis (p=0.03). There was no difference between the two groups in terms of peritonitis relapse or catheter removal. Conclusion This is the first study to compare clinical outcomes between cefazolin plus ceftazidime versus cefazolin monotherapy in culture-negative peritonitis. Our results suggest that if peritonitis is resolving at day 3, discontinuation of ceftazidime could yield favorable treatment outcomes and might be appropriate for subsequent management. However, the risk of not having gram-negative coverage should be considered.

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Multicentre registry data analysis comparing outcomes of culture-negative peritonitis and different subtypes of culture-positive peritonitis in peritoneal dialysis patients

Cited by 29 publications

References 22 publications

Comparison of clinical features and outcomes in peritoneal dialysis-associated peritonitis patients with and without diabetes: A multicenter retrospective cohort study

Comparison of clinical features and outcomes in peritoneal dialysis-associated peritonitis patients with and without diabetes: A multicenter retrospective cohort study

Poorer clinical outcomes of early‐onset peritonitis in elderly peritoneal dialysis patients: A longitudinal and multicenter study

Cefazolin Plus Ceftazidime versus Cefazolin Monotherapy in the Treatment of Culture-Negative Peritonitis: A Retrospective Cohort Study

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