Korean J Nephrol.  2010 Nov;29(6):742-751.

Clinical Significance and Outcomes of Initial No Growth Peritonitis from Peritoneal Dialysis Patients: Role of Mycobacterial or Fungal Peritonitis

• Lee SW
• Park JY
• Jeong JC
• Ahn SY
• Park JJ
• Seo WW
• Kim CH
• Lee S
• Hwang JH
• Joo KW
• Kim DK
• Ahn C
• Oh KH

Abstract

PURPOSE
Peritoneal dialysis associated peritonitis (PD peritonitis) is an important complication in maintaining. There have been only a few reports on the clinical outcome of initial no-growth peritonitis (INGP).
METHODS
We reviewed 332 episodes of PD peritonitis between January 2002 and August 2009. INGP was defined as PD peritonitis with no growth of etiologic microorganism within 3 days of peritonitis. INGP was compared with initial positive growth peritonitis (IPGP) in view of clinical manifestations and outcomes.
RESULTS
We divided PD peritonitis episodes into two groups: INGP (n=90) and IPGP (n=242). Peritonitis-related mortality was 5.6% in INGP, while 0.8% in IPGP (p=0.017). Further relapse was noted in INGP (10.0%) than in IPGP (vs. 4.1%; p=0.041). Salvage antibiotics were used more frequently in INGP (21.1%) than in IPGP (vs. 11.6%; p=0.027). Odds ratio of INGP to IPGP for peritonitis-related mortality was 7.14 (95% CI 1.36-37.51; p=0.017). Growth of mycobacteria or fungi increased the risk of peritonitis-related mortality with an odds ratio of 18.11 (95% CI 2.99-109.89; p=0.013). In multivariate analysis, growth of mycobacteria or fungi was the only independent risk factor for peritonitis-related mortality with an odds ratio of 10.63 (95% CI 1.27-88.75; p=0.029).
CONCLUSION
INGP revealed poorer outcome than IPGP. Higher growth rate of mycobacteria or fungi in INGP than in IPGP accounted for the poor outcome. Thus one should make vigorous efforts to detect surreptitious organism when there is no growth by 3 days, especially for the possibility of either mycobacteria or fungi.

Keyword

Peritoneal dialysis; Peritonitis; Mycobacterium; Fungi; Fatal outcome

MeSH Terms

Anti-Bacterial Agents
Fatal Outcome
Fungi
Isopropyl Thiogalactoside
Multivariate Analysis
Mycobacterium
Odds Ratio
Peritoneal Dialysis
Peritonitis
Recurrence
Risk Factors
Anti-Bacterial Agents
Isopropyl Thiogalactoside