Factors Associated With Peritoneal Dialysis Catheter Removal After the First Episode of Gram-Negative Peritonitis: A Ten Years Analysis

10.6221/AN.202006_34(2).0004

Chih-Han Liu；Chien-Te Lee；Wei-Hung Kuo；Ben-Chung Cheng；Chien-Hsing Wu；Ing-Kit Lee；Hwee-Yeong Ng

catheter removal ； first gram-negative peritonitis ； peritoneal dialysis ； intra-abdominal infection ； outcome study

Acta Nephrologica

34卷2期（2020 / 06 / 01）

80 - 87

英文

BACKGROUND: Gram-negative peritonitis in peritoneal dialysis (PD) patients is more severe and frequently associated with higher rate of catheter loss than gram-positive infection. The aims of our study were to investigate factors relevant to the catheter removal after first time gram-negative peritonitis. METHODS: Patients with first PD-related gram-negative peritonitis were included in this retrospective study. Patients were divided into catheter removed group and catheter preserved group. RESULTS: One hundred and forty-two patients were enrolled in the study. The leading causative organisms of the first episode of gram-negative peritonitis were Escherichia coli (38%). Compared to catheter preserved group (n = 107), catheter removal group (n = 35) had significantly longer time from PD initiation to the first gram-negative peritonitis episode (5.2 ± 3.8 years vs. 3.0 ± 2.4 years, P ＜ 0.001), polymicrobial peritonitis (25.7% vs. 11.2%, P = 0.036) and higher proportion of empiric antibiotic resistance (37.1% vs. 17.8%, P = 0.017). Multivariate analysis revealed longer duration of PD was an independent risk factor for PD catheter removal and appropriate empiric antibiotic treatment was associated with a 77% lower risk for catheter loss. CONCLUSION: About one-quarter of patients required catheter removal as the event outcome during the peritonitis. Duration of PD therapy and resistance of initial empiric antibiotic are the predictors associated with PD catheter loss.