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The following is a summary of “Linking clinical manifestations and causative organisms may provide clues for the treatment of peritoneal dialysis-associated peritonitis,” published in the September 2024 issue of Nephrology by Ren et al. 

Initial manifestations of peritoneal dialysis-associated peritonitis (PDAP) may vary by pathogen type. The study explored the link between clinical features and vancomycin susceptibility to guide initial antibiotic therapy. 

Researchers conducted a retrospective study to explore how initial PDAP symptoms vary by pathogen. 

They analyzed patients with culture-positive PDAP, dividing them into 2 groups: those with only cloudy effluent (PDAP-cloudy) and those with cloudy effluent plus abdominal pain and/or fever (PDAP-multi). They compared bacterial cultures and antibiotic sensitivity between groups and used logistic regression to identify predictors of vancomycin susceptibility. 

The results showed that among 162 culture-positive PDAP episodes, 30 were in the PDAP-cloudy group and 132 in the PDAP-multi group. All cases in the PDAP-cloudy group (30; 100%) had gram-positive infections, significantly higher than the PDAP-multi group (51.5%; P<0.001). Nearly all (29; 96.7%) in the PDAP-cloudy group were vancomycin-susceptible, compared to 67 (50.8%) in the PDAP-multi group (P<0.001). The specificity of PDAP-cloudy for vancomycin-sensitive peritonitis was 98.48%. Only 1 patient (3.3%) in the PDAP-cloudy group had vancomycin-resistant peritonitis caused by Enterococcus gallinarum. The presence of only cloudy effluent was an independent predictor of vancomycin susceptibility (OR = 27.678, 95% CI 3.191-240.103, P=0.003) along with several other factors, increasing the area under the curve (AUC) to 0.813 (95% CI 0.749–0.878, P<0.001). 

Investigators concluded that cloudy dialysate as the sole symptom at PDAP onset independently predicted vancomycin-sensitive infections, providing crucial insights for selecting initial antibiotic treatment. 

Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03756-y