| Objective:To analyze the clinical features of culture-negative peritonitis in peritoneal dialysis-associated peritonitis(PDAP)and explore the risk factors leading to treatment failure.Methods:This study retrospectively collected clinical data of all PDAP patients in the Second Hospital of Jilin University,the Second Department of the First Hospital of Jilin University,Jilin Central Hospital and Jilin Provincial FAW General Hospital from January 1,2013 to December 31,2019,data from first-episode PDAP were also screened out.All PDAP patients and first-episode PDAP patients were divided into culture-negative group and culture-positive group according to the microbial culture results of peritoneal dialysis fluid.The baseline data of CNP patients,treatment outcomes,risk factors leading to treatment failure,and prognosis of the first episode of CNP were analyzed.Result:1.Study population: A total of 976 cases of PDAP onset in 4 centers were included in the study,including 219 cases in the culture-negative group and 757 cases in the culture-positive group,with a culture-negative rate of 22.4%.Among the first episodes of PDAP,there were 125 cases in the culture-negative group and 403 cases in the culture-positive group.2.Current treatment results: Among all 219 cases of CNP,179 cases(81.7%)were effective in initial treatment.185 cases(84.5%)were cured,11 cases(5.0%)relapsed,12 cases(5.5%)had catheter removal,and 11 cases(5.0%)had PDAP-related death.Among the 125 cases of the first episode of CNP,108 cases(86.4%)were effective in the initial treatment.106 cases(86.4%)were cured,8 cases(6.6%)relapsed,5 cases(4.0%)had catheter removal,and 6 cases(4.8%)had PDAP-related death.3.The impact of CNP on treatment outcomes: CNP was associated with a higher cure rate(OR=1.749,95%CI: 1.158-2.641,P=0.008)and a lower catheter removal rate(OR=0.442,95%CI: 0.232-0.843,P=0.013)in all patients with PDAP;In first-episode PDAP patients,CNP was associated with a higher initial treatment response rate(OR=1.815,95%CI: 1.006-3.275,P=0.048).4.Risk factors for CNP treatment failure: Serum albumin level(OR=0.882,95%CI: 0.815-0.955,P=0.002)and presence of diabetes mellitus(OR=0.057,95%CI:0.007-0.449,P=0.007)were statistically significant.In the first-episode CNP,peritoneal dialysis duration(OR=1.059,95%CI: 1.010-1.110,P=0.018),serum albumin level(OR=0.817,95%CI: 0.712-0.937,P=0.004)and presence of diabetes mellitus(OR=0.076,95%CI: 0.008-0.738,P=0.026)were statistically significant.5.Prognosis: Among the patients with the first-episode of CNP,35 died(the average survival time was 69.4 months,and the median survival time was 73.5 months).There were 20 cases of technical failure(the average follow-up time was 84.7 months),and the composite outcome was death or technical failure in 55 cases(the average follow-up time was 56.8 months,and the median follow-up time was 53.2 months).The first episode of CNP was associated with a lower risk of technical failure(HR=0.579,95%CI: 0.355-0.946,P=0.029).Conclusion:1.Lower serum albumin level and absence of diabetes are risk factors for CNP treatment failure;in first-episode CNP,longer PD duration is also a risk factor for treatment failure;2.In terms of prognosis,the first episode of CNP was associated with a lower risk of technical failure. |
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