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

Korean Journal of Nephrology 2010;29(6):742-751.

Seong-Woo Lee, M.D.1, Jae-yoon Park, M.D.1, Jong Cheol Jeong, M.D.1, Shin-young Ahn, M.D.1, Jin Joo Park, M.D.1, Won-woo Seo, M.D.1, Chi-hoon Kim, M.D.1, Sahmin Lee, M.D.1, Jin-ho Hwang, M.D.1, Kwon-Wook Joo, M.D., Ph.D.1, 2, Dong Ki Kim, M.D.1, Curie Ahn

Department of Internal Medicine¹
Seoul National University Hospital, Seoul, Korea Kidney Research Institute²
Seoul National University College of Medicine, Seoul, Korea Transplantation Research Institute³
Seoul National University College of Medicine, Seoul, Korea

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

Department of Internal Medicine1, Seoul National University Hospital, Seoul, Korea Kidney Research Institute2, Seoul National University College of Medicine, Seoul, Korea Transplantation Research Institute3, Seoul National University College of Medicine,

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.

Key Words: Peritoneal dialysis, Peritonitis, Mycobacterium, Fungi, Fatal outcome