Clinical characteristics and prognosis of peritoneal dialysis-associated peritonitis caused by non-fermenting Gram-negative bacteria: a single-center retrospective analysis.

Abstract

This study compared the clinical characteristics and prognosis of peritoneal dialysis-associated peritonitis (PDAP) caused by non-fermenting Gram-negative bacteria (NF-GNB) versus fermenting Gram-negative bacteria (F-GNB). We analyzed 32 episodes of NF-GNB PDAP at our center from January 2010 to December 2024 and matched them 1:1 with F-GNB PDAP episodes by sex, age, and dialysis duration. The NF-GNB group had a higher prevalence of diabetes and a higher Charlson comorbidity index, but lower serum albumin, parathyroid hormone, neutrophil-to-lymphocyte ratio, calcium, and admission body temperature (all p < 0.05). The overall medical cure rate was lower in the NF-GNB group than in the F-GNB group (53.1% vs. 81.3%, p = 0.017). In the NF-GNB group, markedly elevated inflammatory markers (blood white blood cell count ≥ 10 × 10 9 /L, C-reactive protein ≥ 90 mg/L, or dialysate white blood cell count on day 3 ≥ 264/μL) or hypoalbuminemia (albumin < 30 g/L) might be associated with a higher risk of treatment failure. All-cause mortality during follow-up was higher in the NF-GNB group than in the F-GNB group (58.6% vs. 30.0%, p = 0.027), and lower survival was confirmed by Kaplan-Meier analysis (log-rank χ 2 = 4.343, p = 0.037). NF-GNB infection (HR = 3.40, 95% CI: 1.05-11.00, p = 0.041) and lower Kt/V (HR = 12.54, 95% CI: 2.32-67.94, p = 0.003) might be associated with a higher risk of mortality. In conclusion, patients with NF-GNB PDAP have more comorbidities, poorer nutritional status, and worse clinical prognosis than those with F-GNB infection.