The association between empirical antibiotic regimens and the outcome of peritoneal dialysis-related peritonitis: a multi-center, large-scale cohort study.

BACKGROUND: Peritoneal dialysis (PD)-related peritonitis is a common complication with high morbidity and mortality, and empirical antibiotic regimens vary across countries. Despite some research, inconsistent results and design limitations highlight the need to reassess the association between these regimens and outcomes. METHODS: This study was affiliated with the PD Telemedicine-assisted Platform (PDTAP) study. The primary outcome was peritonitis-associated death, and the secondary outcomes were peritonitis-associated hemodialysis transfer and subsequent peritonitis within 6 months. Propensity score matching and logistic regression were used to access the relationship between empirical antibiotic administration and outcomes. RESULTS: Altogether, 1431 patients experienced a first episode of peritonitis from June 1, 2016, to April 30, 2019. Among them, 1203 patients were assigned to the cefazolin-based group (n = 637) or to the vancomycin-based group (n = 566) based on administration of empirical antibiotics against Gram-positive bacteria. Compared to the cefazolin-based group, patients in the vancomycin-based group were older, had a longer PD duration, and reported higher income, along with a greater prevalence of diabetes, cardiovascular disease, and peritonitis history (P < 0.05 for all). Both groups exhibited similar rates of peritonitis-associated death and subsequent peritonitis within 6 months (P > 0.05 for all), however, the vancomycin-based group was more prone to to hemodialysis transfer (11.00% vs 16.31%, P = 0.010, for total peritonitis; 2.62% vs 9.01%, P = 0.004, for Gram-positive bacterial peritonitis). After propensity score matching analyses, the rates of death, hemodialysis transfer and subsequent peritonitis remained similar between the two groups (P > 0.05 for all). Additionally, multivariate logistic regression, after adjusting for confounders, revealed no significant difference in the outcomes between the two groups (P > 0.05 for all). In the sensitivity analysis, excluding culture-negative patients, the results remained similar. In cases of Gram-negative bacterial peritonitis, the use of third-generation cephalosporins also had no association with better prognosis, irrespective of propensity score matching analysis (P > 0.05 for all). CONCLUSION: Our study suggests that there is no significant difference in prognosis among different empirical antibiotic regimens for peritonitis.