Evolution of Peritoneal Dialysis-Associated Peritonitis: Pathogen, Antibiotic Resistance, and the Impact of Lymphocyte Count on Treatment Outcomes

Figures & data

Table 1 The Characteristics of the Peritoneal Dialysis-Associated Peritonitis Patients Between the 2002–2011 and 2014–2023 Groups

Characteristics	2002–2011 Group (n, %)	2014–2023 Group (n, %)	t/x²	P
Gender
Male	89 (52.7)	142 (48.30)	0.817	0.366
Age	61.10 ± 14.90	54.61 ± 14.06	0.831	0.001**
Dialysis age	19.72 ± 17.19	50.90 ± 35.41	90.558	0.001**
Primary renal diseases
Chronic nephritis	48 (28.4)	102 (34.70)	1.939	0.164
Diabetic nephropathy	67 (39.6)	78 (26.50)	8.581	0.003*
Hypertensive nephropathy	34 (20.1)	56 (19.00)	0.079	0.779
Obstructive nephropathy	5 (3.0)	14 (4.80)	0.887	0.346
Others	15 (8.9)	44 (15.00)	3.580	0.058

Notes: *P<0.05; **P<0.001.

Table 2 The Compositions of the Cause-Special Peritonitis Between the 2002–2011 and 2014–2023 Groups

Cause-Special Peritonitis	2002–2011 Group (n, %)	2014–2023 Group (n, %)	x²	P
Pathogenic peritonitis
Gram-positive cocci peritonitis	58 (34.32)	124 (42.18)	2.777	0.096
Staphylococcus	31 (18.34)	73 (24.83)	2.593	0.107
Staphylococcus aureus	5 (2.96)	12 (4.08)	0.383	0.536
Coagulase-negative Staphylococcus	26 (15.38)	61 (20.75)	2.023	0.155
Streptococcus	25 (14.79)	38 (12.93)	0.318	0.593
Enterococcus	2 (1.18)	13 (4.42)	2.253	0.133
Gram-negative bacillary peritonitis	45 (26.63)	59 (20.07)	2.651	0.103
Escherichia coli	28 (16.57)	27 (9.18)	5.590	0.018*
Klebsiella	5 (2.96)	4 (1.36)	0.722	0.396
Pseudomonas aeruginosa	4 (2.37)	13 (4.42)	1.281	0.258
Acinetobacter	5 (2.96)	2 (0.68)		0.105
Other	3 (1.78)	13 (4.42)	2.253	0.133
Gram-positive bacillus peritonitis	2 (1.18)	2 (0.68)		0.625
Gram-negative cocci peritonitis	1 (0.59)	5 (1.70)		0.423
Mycobacterium tuberculosis peritonitis	N	9 (3.06)	N	N
Fungi peritonitis	6 (3.55)	7 (2.38)	0.195	0.659
Polymicrobial peritonitis	4 (2.37)	10 (3.40)	0.392	0.531
Culture-negative peritonitis	53 (31.36)	78 (26.53)	1.234	0.267
Enteric peritonitis	39 (23.07)	40 (13.61)	6.803	0.009*
The catheter-related peritonitis	12 (7.10)	16 (5.44)	4.555	0.033*

Note: *P<0.05.

Figure 1 The change of antimicrobial sensitivity in gram-positive cocci and gram-negative bacillary peritonitis between the 2002–2011 and 2014–2023 groups.

Table 3 Comparison of Prognosis Between the 2002–2011 and the 2014–2023 Groups

Cause-Special Peritonitis	2002–2011 Group			2014–2023 Group			x²	P
	Total	Cure (n, %)	Failure (n, %)	Total	Cure (n, %)	Failure (n, %)
Pathogenic peritonitis
Gram-positive cocci peritonitis	58	55 (94.83)	3 (5.17)	124	118 (95.16)	6 (4.84)	0.001	1.000
Staphylococcus
Staphylococcus aureus	5	4 (80.0)	1 (20.00)	12	10 (83.33)	2 (16.67)		1.000
Coagulase-negative staphylococci	26	25 (96.15)	1 (3.85)	61	59 (96.72)	2 (3.28)		1.000
Streptococcus	25	24 (96.00)	1 (4.00)	38	38 (100)	0		0.397
Enterococcus	2	2 (100)	0	13	11 (84.62)	2 (15.38)		1.000
Gram-negative bacillary peritonitis	45	42 (93.33)	3 (6.67)	59	34 (57.63)	25 (42.37)	16.543	0.001**
Escherichia coli	28	25 (89.29)	3 (10.71)	27	18 (66.67)	9 (33.33)	4.123	0.042*
Klebsiella	5	5 (100)	0	4	1 (25.00)	3 (75.00)		0.048*
Pseudomonas aeruginosa	4	4 (100)	0	13	4 (30.77)	9 (69.23)		0.029*
Acinetobacter	5	5 (100)	0	2	1 (50.00)	1 (50.00)		0.286
Other	3	3 (100)	0	13	10 (76.92)	3 (23.08)		1.000
Gram-positive bacillary peritonitis	2	2 (100)	0	2	2 (100)	0		N
Gram-negative cocci peritonitis	1	1 (100)	0	5	4 (80.00)	1 (20.00)		N
Mycobacterium tuberculosis peritonitis	N	N	N	9	5 (55.56)	4 (44.44)		N
Fungi peritonitis	6	0	6 (100)	7	0	7 (100)		N
Polymicrobial peritonitis	4	3 (75.00)	1 (25.00)	10	6 (60.00)	4 (40.00)		1.000
Culture-negative peritonitis	53	49 (92.45)	4 (7.55)	78	70 (89.74)	8 (10.26)	0.048	0.598
Enteric peritonitis	39	34 (87.18)	5 (12.82)	40	34 (85.00)	6 (15.00)	0.078	0.780
Catheter-related peritonitis	12	11 (91.67)	1 (8.33)	16	12 (75.00)	4 (25.00)		0.355

Notes: *P<0.05; **P<0.001.

Table 4 Significant Risk Factors for the Gram-Negative Bacillary Peritonitis Prognosis During 2014–2023

Variables	Univariable Logistic Regression			Multivariate Logistic Regression
	OR	95% CI	P	OR	95% CI	P
Sex (Male or Female)	0.713	0.251–2.021	0.524	0.529	0.128–2.186	0.529
Age (per 1 year greater)	1.004	0.970–1.040	0.801	0.996	0.947–1.047	0.880
Dialysis age (per 1 months greater)	1.017	1.002–1.032	0.028*	1.014	0.996–1.033	0.132
Etiology of kidney failure
Chronic nephritis	Reference	Reference	Reference	Reference	Reference	Reference
Diabetic nephropathy	0.556	0.214–2.491	0.443	0.346	0.038–3.146	0.346
Hypertensive nephropathy	0.682	0.175–2.661	0.581	0.777	0.144–4.199	0.769
Obstructive nephropathy	2.500	0.191–32.802	0.485	3.068	0.131–71.993	0.486
Other	1.250	0.236–6.633	0.793	2.347	0.319–17.252	0.402
CCI	1.021	0.849–1.229	0.822	1.485	0.870–2.534	0.147
Leukocyte count (per 1×10^6/L greater)	0.909	0.806–1.026	0.123
Neutrophil count (per 1×10^6/L greater)	0.926	0.820–1.045	0.215
Lymphocyte count (per 1×10^6/L greater)	0.034	0.003–0.361	0.005*	0.030	0.003–0.336	0.004*
Monocyte count (per 1×10^6/L greater)	0.109	0.007–1.596	0.105
Erythrocyte count (per 1×10^9/L greater)	1.126	0.568–2.233	0.733
Hemoglobin (per 1g/L greater)	0.997	0.969–1.026	0.849
CRP (per 1 mg/L greater)	1.001	0.995–1.007	0.715
Total protein (per 1g/L greater)	1.013	0.954–1.075	0.675
Albumin (per 1g/L greater)	1.003	0.922–1.090	0.951
Globulin (per 1g/L greater)	1.076	0.952–1.216	0.243
Urea nitrogen (per 1 mmol/L greater)	1.051	0.964–1.146	0.259
Creatinine (per 1 umol/L greater)	1.000	0.998–1.002	0.803
Uric acid (per 1 umol/L greater)	1.000	0.993–1.006	0.941
Potassium (per 1 mmol/L greater)	0.934	0.445–1.958	0.856
Sodium (per 1 mmol/L greater)	0.893	0.775–1.029	0.118
Chlorine (per 1 mmol/L greater)	0.987	0.874–1.116	0.840
Calcium (per 1 mmol/L greater)	0.791	0.072–8.742	0.849
PDE leukocytes (per 1×10^6/L greater)	1.000	1.000–1.000	0.826

Notes: *P<0.05.

Abbreviations: CCI, Charlson Comorbidity index; CRP, C-reactive protein; PDE, peritoneal dialysis effluent; OR, odd ratio; CI, confidence interval.

Table 5 Significant Risk Factors for the Gram-Negative Bacillary Peritonitis Prognosis During 2014–2019

Variables	Univariable Logistic Regression			Multivariate Logistic Regression
	OR	95% CI	P	OR	95% CI	P
Sex (Male or Female)	1.000	0.222–4.502	1.000	0.323	0.036–2.930	0.315
Age (per 1 year greater)	0.999	0.948–1.053	0.964	1.014	0.951–1.082	0.663
Dialysis age (per 1 months greater)	1.019	0.997–1.041	0.094	1.008	0.979–1.039	0.574
Etiology of kidney failure
Chronic nephritis	Reference	Reference	Reference	Reference	Reference	Reference
Diabetic nephropathy	1.000	0.098–10.166	1.000	1.991	0.096–41.128	0.656
Hypertensive nephropathy	1.389	0.194–9.967	0.744	5.166	0.318–83.808	0.248
Obstructive nephropathy	0.001	–	1.000	0.001	–	1.000
Other	2.500	0.194–32.194	0.482	2.253	0.080–63.494	0.634
CCI	0.941	0.519–1.705	0.840	1.096	0.500–2.402	0.819
Leukocyte count (per 1×10^6/L greater)	0.897	0.752–1.070	0.228
Neutrophil count (per 1×10^6/L greater)	0.910	0.762–1.087	0.297
Lymphocyte count (per 1×10^6/L greater)	0.047	0.002–1.126	0.059	0.014	0.001–1.421	0.070
Monocyte count (per 1×10^6/L greater)	0.388	0.013–11.167	0.581
Erythrocyte count (per 1×10^9/L greater)	2.200	0.640–7.564	0.211
Hemoglobin (per 1g/L greater)	1.019	0.973–1.066	0.429
CRP (per 1 mg/L greater)	1.001	0.994–1.008	0.752
Total protein (per 1g/L greater)	0.988	0.908–1.076	0.780
Albumin (per 1g/L greater)	0.964	0.864–1.075	0.507
Globulin (per 1g/L greater)	1.099	0.915–1.321	0.311
Urea nitrogen (per 1 mmol/L greater)	0.951	0.807–1.121	0.552
Creatinine (per 1 umol/L greater)	0.998	0.995–1.002	0.344
Uric acid (per 1 umol/L greater)	0.994	0.982–1.005	0.271
Potassium (per 1 mmol/L greater)	1.393	0.473–4.099	0.547
Sodium (per 1 mmol/L greater)	0.832	0.686–1.008	0.061
Chlorine (per 1 mmol/L greater)	0.936	0.794–1.102	0.426
Calcium (per 1 mmol/L greater)	1.478	0.030–71.831	0.844
PDE leukocytes (per 1×10^6/L greater)	1.000	1.000–1.000	0.753

Abbreviations: CCI, Charlson Comorbidity index; CRP, C-reactive protein; PDE, peritoneal dialysis effluent; OR, odd ratio; CI, confidence interval.