Clinical Characteristics And Treatment Outcome Of Culture-negative Peritonitis

Objective:To review the data of patients with Peritoneal Dialysis Associated Peritonitis(PDAP),and to compare the clinical data and prognosis of culture-negative peritonitis(CNP)and culture-positive patients.Provide an appropriate treatment strategy of CNP.Method:This study retrospectively collected 118 cases with peritonitis who received regular peritoneal dialysis at the Peritoneal Center of the Second Hospital of Jilin University from January 2013 to December 2018.According to the culture results,they were divided into CNP group(culture negative group)and CPP group(culture positive group).In the CPP group,Gram-positive bacteria group(G+ group)and Gram-negative bacteria group(G-group)were classified according to the pathogenic bacteria.The clinical data,laboratory results and prognosis of each group were recorded and compared,and the clinical features and prognosis of CNP patients were summarized.Results:1.The general situation:There was no significant difference in age,sex,dialysis age,BMI,recent antibiotic therapy,and primary kidney disease types between the CNP group and the CPP group.The G-group diabetic nephropathy patients were more than the G+ group,the difference was statistically significant(P<0.05).2.Biochemical indicators:The CNP group had higher serum iron than the CPP group,and the difference was statistically significant(P<0.05).The procalcitonin,the first-time WBC count and the mean WBC count of PD effluent for the first 3 days in the CNP group and G+ group were lower than G-group,and the difference was statistically significant(P<0.05).3.PD effluent culture and drug susceptibility results:69 cases of pathogenic bacteria culture were negative,109 cases were positive,and the negative rate of culture was 38.8%,showing a decreasing trend year by year.61 cases of G+ bacteria(62 strains),mainly Staphylococcus epidermidis,Staphylococcus aureus,Staphylococcus haemolyticus,sensitive rate to vancomycin,linezolid,tigecycline 100.0%,for penicillin,clindamycin,erythromycin,Compound sulfamethoxazole has a high rate of resistance,both ex-ceeding 50.0%.38 cases of G-bacteria(39 strains),mainly Escherichia coli,Enter-obacter cloacae and Pseudomonas aeruginosa,the sensitivity rate to meropenem and imipenem was 100.0%.The resistance rate of Escherichia coli to cefuroxime sodium,cefuroxime axetil,ceftriaxone,piperacillin,ampicillin,compound sulfamethoxazole,levofloxacin and gentamicin was higher than 50.0%.The resistance rate of Enterobacter cloacae to cefuroxime sodium,cefuroxime axetil and ceftezole was higher,exceeding 50.0%.4.Initial treatment regimen and effective rate:The overall effective rate of the initial treatment regimen in the CNP and G+ groups was higher than that in the G-group,and the difference was statistically significant(P<0.05).The initial treatment regimen of vancomycin + third-generation cephalosporin in CNP group was higher than that of first-generation cephalosporin + third-generation cephalosporin,the difference was statistically significant(P<0.05).The initial treatment of vancomycin combined with other antibiotics was more effective than the first-generation cephalosporin + third-generation cephalosporins,and the difference was statistically significant(P<0.05).In patients treated with vancomycin + third-generation cephalosporin,the initial treatment eff-iciency of CNP group and G+ group was higher than that of G-group,and the difference was statistically significant(P<0.05).In patients treated with first-generation cephalosporin + third-generation cephalosporin,the initial treatment efficiency of CNP group and G-group was lower than that of G+ group,the difference was statistically significant(P<0.05).In the CNP group,there was no statistically significant difference in the cure rate after the initial treatment with first-generation cephalosporin + third-generation cephalosporin failed and was changed to other treatment regimens(P>0.05).5.Prognosis:The treatment time in the CNP group and the G+ group was shorter than that in the G-group,and the difference was statistically significant(P<0.05).There was no significant difference in the overall prognosis between the CNP group and the CPP group in terms of cure rate,relapsing rate,persistent infection rate,treatment failure rate,catheter removal rate and mortality(P>0.05).The overall prognosis of CNP group,G+ group and G-group was not statistically significant(P>0.05).Conclusion:Compared with the G-group,the CNP group and the G+ group were more similar in clinical features and prognosis.Considering the possibility of CNP infection for G+bacteria.It is better to choose vancomycin for initial treatment of CNP patients.