Dialysate White Blood Cell Change after Initial Antibiotic Treatment Represented the Patterns of Response in Peritoneal Dialysis-Related Peritonitis

Abstract

Background. Patients with peritoneal dialysis-related peritonitis usually have different responses to initial antibiotic treatment. This study aimed to explore the patterns of response by using the changes of dialysate white blood cell count on the first five days of the initial antibiotic treatment. Materials and Methods. A retrospective cohort study was conducted. All peritoneal dialysis-related peritonitis episodes from January 2014 to December 2015 were reviewed. We categorized the patterns of antibiotic response into 3 groups: early response, delayed response, and failure group. The changes of dialysate white blood cell count for each pattern were determined by multilevel regression analysis. Results. There were 644 episodes in 455 patients: 378 (58.7%) of early response, 122 (18.9%) of delayed response, and 144 (22.3%) of failure episodes. The patterns of early, delayed, and failure groups were represented by the average rate reduction per day of dialysate WBC of 68.4%, 34.0%, and 14.2%, respectively (p value < 0.001 for all comparisons). Conclusion. Three patterns, which were categorized by types of responses, have variable rates of WBC declining. Clinicians should focus on the delayed response and failure patterns in order to make a decision whether to continue medical therapies or to aggressively remove the peritoneal catheter.

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

“…Three patterns of treatment outcome were analysed: early response, delayed response (defined by gradual decline in effluent white cell count but still above 100/mL on day 5) and treatment failure (defined as peritonitis not cured by antibiotics, change to haemodialysis either temporarily or permanently or peritonitis-associated death). 296 This study highlighted the varying rate or trajectory of effluent white cell count decline. In one-fifth of the cases, patients showed delayed response with 34% reduction of effluent white cell count by day 5, without the need for PD catheter removal.…”

“…In one-fifth of the cases, patients showed delayed response with 34% reduction of effluent white cell count by day 5, without the need for PD catheter removal. 296 Thus, expectant of peritonitis episodes with longer antibiotic treatment duration without immediate catheter removal can be an option if the effluent white cell count is decreasing, albeit not reaching the nadir 100/mL by day 5.…”

A Clinical Risk Prediction Tool for Peritonitis-Associated Treatment Failure in Peritoneal Dialysis Patients

“…These factors have been previously recognised to be predictors of peritonitis-related treatment failure 10 , 12 , 13 , 15 , 20 . Not surprisingly, dialysate leukocyte count, especially on day 5, is the strongest predictor (responsible for 88% of predictive model), which reflects the response to treatment in PD-related peritonitis 13 , 21 .…”

Peritoneal Dialysis–Related Infections

“…This expectant approach is largely driven by the findings of substantial variation in trajectory of the effluent white cell count 70 and the possibility of delayed response. 71 An observational study of 644 peritonitis episodes tracked the longitudinal change of effluent white cell count and categorized three patterns of treatment outcome: early response, delayed response (defined by gradual decline in effluent white cell count but still above 100/ µ l on day 5), and treatment failure (defined as peritonitis not cured by antibiotics, change to hemodialysis [temporarily/permanently], or peritonitis-associated death). One fifth of the patients showed delayed response with 34% reduction of effluent white cell count by day 5, without the need for PD catheter removal.…”