TY - JOUR
T1 - Culture-Negative Peritonitis in Peritoneal Dialysis Patients in Australia
T2 - Predictors, Treatment, and Outcomes in 435 Cases
AU - Fahim, Magid
AU - Hawley, Carmel M.
AU - McDonald, Stephen
AU - Brown, Fiona G.
AU - Rosman, Johan B.
AU - Wiggins, Kathryn J.
AU - Bannister, Kym M.
AU - Johnson, David W.
N1 - Funding Information:
Financial Disclosure: Dr Johnson is a consultant for Baxter Healthcare Pty Ltd and has previously received research funds from this company; he has also received speakers' honoraria and research grants from Fresenius Medical Care . Dr Bannister is a consultant for Baxter Healthcare Pty Ltd. Dr McDonald has received speaking honoraria from Amgen Australia, Fresenius Australia, and Solvay Pharmaceuticals and travel grants from Amgen Australia , Genzyme Australia , and Jansen-Cilag . The remaining authors report that they have no relevant financial interests.
PY - 2010/4
Y1 - 2010/4
N2 - Background: Reports of culture-negative peritoneal dialysis (PD)-associated peritonitis have been sparse, conflicting, and limited to small single-center studies. The aim of this investigation is to examine the frequency, predictors, treatment, and outcomes of culture-negative PD-associated peritonitis. Study Design: Observational cohort study using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data. Setting & Participants: All Australian PD patients between October 1, 2003, and December 31, 2006. Predictors: Demographic, clinical, and facility variables. Outcomes & Measurements: Culture-negative PD-associated peritonitis occurrence, relapse, hospitalization, catheter removal, hemodialysis transfer, and death. Results: Of 4,675 patients who received PD in Australia during the study period, 435 episodes of culture-negative peritonitis occurred in 361 individuals. Culture-negative peritonitis was not associated with demographic or clinical variables. A history of previous antibiotic treatment for peritonitis was more common with culture-negative than culture-positive peritonitis (42% vs 35%; P = 0.01). Compared with culture-positive peritonitis, culture-negative peritonitis was significantly more likely to be cured using antibiotics alone (77% vs 66%; P < 0.001) and less likely to be complicated by hospitalization (60% vs 71%; P < 0.001), catheter removal (12% vs 23%; P < 0.001), permanent hemodialysis therapy transfer (10% vs 19%; P < 0.001), or death (1% vs 2.5%; P = 0.04). Relapse rates were similar between the 2 groups. Patients with relapsed culture-negative peritonitis were more likely to have their catheters removed (29% vs 10% [P < 0.001]; OR, 3.83; 95% CI, 2.00-7.32). Administration of vancomycin or cephalosporin in the initial empiric antibiotic regimen and the timing of catheter removal were not significantly associated with clinical outcomes. Limitations: Limited covariate adjustment. Residual confounding and coding bias could not be excluded. Conclusions: Culture-negative peritonitis is a common complication with a relatively benign outcome. A history of previous antibiotic treatment is a significant risk factor for this condition.
AB - Background: Reports of culture-negative peritoneal dialysis (PD)-associated peritonitis have been sparse, conflicting, and limited to small single-center studies. The aim of this investigation is to examine the frequency, predictors, treatment, and outcomes of culture-negative PD-associated peritonitis. Study Design: Observational cohort study using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data. Setting & Participants: All Australian PD patients between October 1, 2003, and December 31, 2006. Predictors: Demographic, clinical, and facility variables. Outcomes & Measurements: Culture-negative PD-associated peritonitis occurrence, relapse, hospitalization, catheter removal, hemodialysis transfer, and death. Results: Of 4,675 patients who received PD in Australia during the study period, 435 episodes of culture-negative peritonitis occurred in 361 individuals. Culture-negative peritonitis was not associated with demographic or clinical variables. A history of previous antibiotic treatment for peritonitis was more common with culture-negative than culture-positive peritonitis (42% vs 35%; P = 0.01). Compared with culture-positive peritonitis, culture-negative peritonitis was significantly more likely to be cured using antibiotics alone (77% vs 66%; P < 0.001) and less likely to be complicated by hospitalization (60% vs 71%; P < 0.001), catheter removal (12% vs 23%; P < 0.001), permanent hemodialysis therapy transfer (10% vs 19%; P < 0.001), or death (1% vs 2.5%; P = 0.04). Relapse rates were similar between the 2 groups. Patients with relapsed culture-negative peritonitis were more likely to have their catheters removed (29% vs 10% [P < 0.001]; OR, 3.83; 95% CI, 2.00-7.32). Administration of vancomycin or cephalosporin in the initial empiric antibiotic regimen and the timing of catheter removal were not significantly associated with clinical outcomes. Limitations: Limited covariate adjustment. Residual confounding and coding bias could not be excluded. Conclusions: Culture-negative peritonitis is a common complication with a relatively benign outcome. A history of previous antibiotic treatment is a significant risk factor for this condition.
KW - Antibiotics
KW - bacteria
KW - microbiology
KW - outcomes
KW - peritoneal dialysis
KW - peritonitis
UR - http://www.scopus.com/inward/record.url?scp=77949775657&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2009.11.015
DO - 10.1053/j.ajkd.2009.11.015
M3 - Article
C2 - 20110144
AN - SCOPUS:77949775657
SN - 0272-6386
VL - 55
SP - 690
EP - 697
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 4
ER -