Positive dialysate gram stain predicts outcome of empirical antibiotic therapy for peritoneal dialysis-associated peritonitis

Chin Chan Lee, Chiao Yin Sun, Kuo Chuan Chang, Mai Szu Wu

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Empirical antibiotic treatment with a first-generation cephalosporin plus gentamicin for peritoneal dialysis (PD)-associated peritonitis before culture results are available is still wildly used due to concerns regarding the economic burden and antibiotic-resistant bacterial infections. The aim of this study is to define the factors that predict the outcome of empirical antibiotic therapy for PD peritonitis. This is a retrospective study of patients with PD peritonitis over the last 10 years. Patients who had been treated empirically with intermittent intraperitoneal first-generation cephalosporin and gentamicin were enrolled. Eighty-three patients had 192 episodes of PD peritonitis. In total, 159 peritonitis episodes were treated with intraperitoneal antibiotics combined with first-generation cephalosporin and gentamicin empirically. Twenty-five peritonitis episodes had no pathogens identified by dialysate culture. In total, 122 (122/159, 76.7%) PD peritonitis episodes were caused by bacteria, 9 (9/159, 5.7%) were fungal, and 3 (3/159, 1.9%) were Mycobacterium tuberculosis peritonitis. Sixty-four (64/159, 40.3%) peritonitis episodes were successfully cured by empirical intraperitoneal antibiotic therapy. Empirical antibiotic treatment failed in 95 episodes (95/159, 59.7%). The positive rates of dialysate Gram stain in the empirical treatment success and failure groups were 15.6% and 40.0%, respectively (P = 0.001). The odds ratio of empirical treatment failure with a positive bacteria Gram stain was 3.60 (95% CI: 1.65-7.82). The dialysate Gram staining result was a significant predictor of empirical antibiotics treatment outcome for PD-associated peritonitis. Therefore, using an empirical antibiotic regimen for patients with an initial positive bacterial Gram stain of the dialysate should be introduced cautiously.

Original languageEnglish
Pages (from-to)201-208
Number of pages8
JournalTherapeutic Apheresis and Dialysis
Volume14
Issue number2
DOIs
Publication statusPublished - Apr 2010
Externally publishedYes

Fingerprint

Dialysis Solutions
Peritoneal Dialysis
Peritonitis
Anti-Bacterial Agents
Cephalosporins
Gentamicins
Therapeutics
Treatment Failure
Gram's stain
Bacteria
Mycobacterium tuberculosis
Bacterial Infections
Retrospective Studies
Odds Ratio
Economics
Staining and Labeling

Keywords

  • Dialysate
  • Empirical antibiotic treatment
  • Gram stain
  • Peritoneal dialysis
  • Peritonitis

ASJC Scopus subject areas

  • Hematology
  • Nephrology

Cite this

Positive dialysate gram stain predicts outcome of empirical antibiotic therapy for peritoneal dialysis-associated peritonitis. / Lee, Chin Chan; Sun, Chiao Yin; Chang, Kuo Chuan; Wu, Mai Szu.

In: Therapeutic Apheresis and Dialysis, Vol. 14, No. 2, 04.2010, p. 201-208.

Research output: Contribution to journalArticle

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abstract = "Empirical antibiotic treatment with a first-generation cephalosporin plus gentamicin for peritoneal dialysis (PD)-associated peritonitis before culture results are available is still wildly used due to concerns regarding the economic burden and antibiotic-resistant bacterial infections. The aim of this study is to define the factors that predict the outcome of empirical antibiotic therapy for PD peritonitis. This is a retrospective study of patients with PD peritonitis over the last 10 years. Patients who had been treated empirically with intermittent intraperitoneal first-generation cephalosporin and gentamicin were enrolled. Eighty-three patients had 192 episodes of PD peritonitis. In total, 159 peritonitis episodes were treated with intraperitoneal antibiotics combined with first-generation cephalosporin and gentamicin empirically. Twenty-five peritonitis episodes had no pathogens identified by dialysate culture. In total, 122 (122/159, 76.7{\%}) PD peritonitis episodes were caused by bacteria, 9 (9/159, 5.7{\%}) were fungal, and 3 (3/159, 1.9{\%}) were Mycobacterium tuberculosis peritonitis. Sixty-four (64/159, 40.3{\%}) peritonitis episodes were successfully cured by empirical intraperitoneal antibiotic therapy. Empirical antibiotic treatment failed in 95 episodes (95/159, 59.7{\%}). The positive rates of dialysate Gram stain in the empirical treatment success and failure groups were 15.6{\%} and 40.0{\%}, respectively (P = 0.001). The odds ratio of empirical treatment failure with a positive bacteria Gram stain was 3.60 (95{\%} CI: 1.65-7.82). The dialysate Gram staining result was a significant predictor of empirical antibiotics treatment outcome for PD-associated peritonitis. Therefore, using an empirical antibiotic regimen for patients with an initial positive bacterial Gram stain of the dialysate should be introduced cautiously.",
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