Peritoneal dialysis-related peritonitis caused by gram-negative organisms: ten-years experience in a single center

OBJECTIVES: Concerns are increasing about the clinical characteristics of gram- negative bacterial peritonitis for providing reference for clinical diagnosis, treatment and prevention. METHODS: A retrospective analysis was performed examining patients who developed peritoneal dialysis-related peritonitis (PDRP) from 1 January 2009 to 31 December 2018. RESULTS: Among 898 PD patients, 677 episodes of peritonitis occurred in 344 patients. Over 10 years, the proportion of gram-negative bacterial peritonitis increased from 0% to 26.15% (p = .045). E. coli was the leading cause (38.51%) of the 148 cases of gram-negative bacterial peritonitis. The increase of E. coli peritonitis between the first 5 and the last 5 years was obvious (20.45% vs. 46.15%). The antimicrobial sensitivity of gram-negative organisms to cefotaxime decreased from 71.43% to 55.84% (p = .017). In the gram-negative group, the effluent white cell count (WCC) on the first day was larger (OR: 1.374;95%CI: 1.248–1.563; p < .001), the time required for the WCC to normalize was longer (OR: 1.100;95%CI: 1.037–1.189; p = .003), and the level of C-reactive protein (CRP) was higher (OR: 1.038;95%CI: 1.026–1.042; p < .001) than those in the gram-positive group. The complete cure rate and treatment failure rate of gram-negative bacteria peritonitis were 87.8% and 12.2% respectively. CONCLUSIONS: Over 10 years, the proportion of gram-negative bacterial peritonitis increased, with E. coli epidermidis being the most common pathogen. More effluent WCC on the first day, longer time required for the WCC to normalize, and higher level of CRP are more common for gram-negative bacterial peritonitis. Prognosis of gram-negative bacterial peritonitis is worse.