Comparison of the efficacy of different antibiotics strategy on peritoneal dialysis-related peritonitis

Objective To compare the efficacy of different antibiotics strategy, introperitoneal (IP) cefazolin plus third-generation cephalosporin versus IP Vancomycin plus third-generation cephalosporin on peritoneal dialysis (PD)-related peritonitis. Methods All episodes of PD-associated peritonitis happened in prevalent PD patients between January 2008 and December 2012 were recruited from the PD Center of Peking University First Hospital. According to their empiric antibiotics scheme, episodes were divided into group A (where IP cefazolin plus third-generation cephalosporins were administrated) and group B (where IP Vancomycin plus third-generation cephalosporins were administrated). Multivariable logistic regression model was used to explore the influence of different empiric antibiotics scheme on peritonitis outcome. Results Patients in Group B had significantly lower level of serum albumin (33.5±6.0 vs 35.3±5.2 g/L) and cholesterol (4.6±1.3 vs 4.9±1.1 mmol/L) than those in group A. In group A, the percentage of gram-positive bacteria was similar to group B (43.2% vs 43.3%, P＝0.96), but gram-negative bacteria was numerically lower (16.9% vs 24.7%, P＝0.08). Different empiric antibiotics strategy was not independent predictor of peritonitis outcome [OR＝1.07, 95%CI(0.45, 2.56), P＝0.87]. Conclusion Both cefazolin and vancomycin can be selected as first-line empiric antibiotic covering gram-positive organisms in the treatment of PD related peritonitis.