Blood Neutrophil Counts and Dialysate with Specific Organisms Are Independent
Risk Factors for Treatment Failure of Peritoneal Dialysis-related Peritonitis
Yu-Hsien Lai*, Jen-Pi Tsai**, Tsu-Wang Shen***, Chih-Hsien Wang*,****, Bang-Gee
Hsu*,****, Te-Chao Fang*,****
*Division of Nephrology, Department of Internal Medicine, Buddhist Tzu Chi General
Hospital, Hualien, Taiwan;
**Division of Nephrology, Department of Internal Medicine, Buddhist Tzu Chi General
Hospital, Dalin, Taiwan;
***Department of Medical Informatics, Medical College, Tzu Chi University, Hualien,
Taiwan;
****Division of Nephrology, Department of Internal Medicine, Buddhist Tzu Chi
General Hospital, Hualien, Taiwan
Running title: PD-related peritonitis
Correspondence and reprint request to:
Te-Chao Fang MD & PhD
Division of Nephrology,
Buddhist Tzu Chi General Hospital,
707, Section 3, Chung Yang Rd,
Hualien 97004,
Taiwan
Tel: +886-3-8561825 ext :2253
Fax: +886-3-8564673
E-mail: fangtechao@yahoo.com.tw
1
Abstract
Objectives: To find the independent risk factor(s) of treatment failure (either catheter
removal or death) in PD-related peritonitis.
Methods: Seventy five end stage renal disease patients undergoing long term PD with
peritonitis from 1997 to 2006 were recruited. The baseline characteristics and the initial
clinical manifestations of peritonitis between PD-related peritonitis with treatment
success and treatment failure were analyzed. Treatment success of PD-related peritonitis
meant recovery from peritonitis and treatment failure was defined as one of the following:
death of the patient owing to peritonitis, and catheter removal with a shifted to
hemodialysis.
Results: There were 46 episodes of PD-related peritonitis during this 10-year period. The
most common organism for PD-related peritonitis was Gram-positive (34.7%). The
percentage of culture-negative was 19.6%. The treatment failure for PD-related
peritonitis was 30.5% (14/46) including 6.5% (3/46) mortality and 24% (11/46) catheter
removal. Treatment failure was significantly associated with higher blood neutrophil
counts (p=0.045) and dialysate culture with Fungi, Mycobacterial species, polymicrobial
organisms and Pseudomonas species (FMPP) (p＜0.001). Multivariate logistic regression
analysis showed that treatment failure was significantly associated with blood neutrophil
counts (log-transformed) (adjusted odds ratio=216, p=0.018) and specific organisms
FMPP (adjusted odds ratio=40.6, p=0.001).
Conclusion: Blood neutrophil counts and dialysate culture with specific organisms FMPP
were independent risk factors for treatment failure in PD patients with peritonitis.
Key Words: End stage renal failure, Peritoneal dialysis, Peritonitis
2
血中嗜中性白血球數及透析液特定菌種為腹膜透析相關之腹膜炎治療
失敗的獨立危險因子
賴宇軒 蔡任弼 沈祖望 王智賢 徐邦治 方德昭
主旨：了解腹膜透析相關之腹膜炎治療失敗(管路移除或死亡)的獨立危險因子。
方法： 本研究包括自 1997 年至 2006 年期間之 75 位末期腎臟衰竭患者，接受長期
腹膜透析治療並感染有腹膜炎。對於腹膜炎治療成功及失敗的患者，分析他們的臨
床特徵及腹膜炎的初步臨床表現。所謂治療成功的腹膜炎代表腹膜炎之完全治癒，
而治療失敗的定義為下列其一：因腹膜炎而死亡之病患或管路移除而改接受血液透
析的病患。
結果：這 10 年期間共發生了 46 次因腹膜透析而感染的腹膜炎。在腹膜透析相關腹
膜炎之最常見的菌種為革蘭氏陽性菌（34.7％）。 培養結果為陰性的比例為 19.6
％。腹膜透析相關之腹膜炎治療失敗的比例為 30.5％ (14/46 例）
，其中包括 6.5 ％
(3/46 例）的死亡率和 24 ％ （11/46 例）的管路移除率。腹膜透析相關之腹膜炎
的治療失敗病患有明顯較高的嗜中性白血球數量(p= 0.045）及透析藥水之培養結果
為黴菌，分枝桿菌，多種致病菌和綠膿桿菌(FMPP）(p<0.001）。多因素羅吉斯回歸
分析顯示治療失敗與較高的嗜中性白血球數量(對數轉換) 與透析液特定菌種(FMPP)
明顯有關。
結論：血液中嗜中性白血球數量及透析液特定菌種(FMPP)為腹膜透析相關之腹膜炎
治療失敗的獨立危險因子。
關鍵詞：末期腎臟衰竭，腹膜透析，腹膜炎
3
INTRODUCTION
It has now been over three decades since the technique of continuous ambulatory
peritoneal dialysis (CAPD) was first described. Over this period, many patients
throughout the world have been maintained successfully on peritoneal dialysis (PD) for
long periods. The popularity of PD has recently increased because of its simplicity,
convenience, and relatively low cost. Peritonitis was common following the initial
development of PD, but the incidences have decreased remarkably during the past years,
probably as a result of improvements in connection technology. Peritonitis rates
nowadays are less than 20 patient-months per episode in most series.1,
2
PD-related
peritonitis is also a significant cause of death in patients undergoing PD. However, the
mortality rate varied and it was around 1-16% of episode in different studies.3-5
Outcome of peritonitis is strongly influenced by the characteristics of the causative
organisms that revealed a lower resolution rate in Gram-negative organisms compared to
Gram-positive organisms and had a higher mortality rate related to fungal peritonitis.6 In
addition, diabetes, old age, lower level of serum albumin, gender, depression, poor
residual renal function and baseline inflammatory status [as estimated from C-reactive
protein (CRP)] were significant determinants for death.7, 8
Based on the United States Renal Data System 2007 Annual Data Report, the highest
rate of incident end stage renal disease (ESRD) for 2005 is reported by Taiwan, at 404 per
million population, and Taiwan also reports the highest prevalent rate for 2005, at 1830
per million population.9 In addition, the prevalent PD population in Taiwan ESRD
patients is 7.8%.9 Early predictions of outcomes have major potential implications
regarding the management of PD-related peritonitis, therefore we analyzed the baseline
4
characteristics and initial clinical manifestations of treatment success and treatment
failure in PD-related peritonitis and tried to find the independent risk factor(s) of
treatment failure in PD-related peritonitis.
5
MATERIALS AND METHODS
This prospective and observational study was conducted with the medical records of 75
ESRD patients treated with PD who were recruited from January 1997 and December
2006 at Tzu Chi General Hospital, Hualien, Taiwan. In total, 46 episodes of peritonitis
were identified and the data were analyzed.
A diagnosis of peritonitis was based on at least two of the following criteria10: (1)
symptoms and signs of peritoneal inflammation; (2) cloudy peritoneal dialysis effluent
(PDE) with WBC >100 cells/μL and 50% neutrophils; and (3) demonstration of
organisms in the PDE by positive Gram stain or culture. All the patients with peritonitis
were treated according to the updated recommendations for treatment of PD-related
peritonitis from International Society of Peritoneal Dialysis (ISPD) guidelines.10-12
Bacterial culture of PDE was performed throughout the period according to the
recommendations of the ISPD. Isolation and identification of bacteria, as well as
determination of antibiotic sensitivities, were performed according to the ISPD
guidelines.12
The baseline characteristics of PD-related peritonitis consisted of age, gender, primary
disease of ESRD, previous hemodialysis (HD) history, mode of PD therapy, need for a
dialysis partner, dialysis adequacy (weekly Kt/V, weekly creatinine clearance), and
residual renal creatinine clearance, baseline peritoneal equilibration test (PET),
normalized protein nitrogen appearance (nPNA), and the duration of follow-up on PD
(months). The initial clinical manifestations of PD-related peritonitis included
simultaneous an exit-site infection, body temperature, pulse rate, respiratory rate,
systemic inflammatory response syndrome (SIRS), systolic blood pressure (SBP),
6
diastolic blood pressure (DBP), albumin, hemogram, dialysate fluid examination, and the
culture organisms from the initial dialysate of peritonitis. The culture results of dialysate
were divided into FMPP and Non-FMPP groups. Here, FMPP was representative of
fungal organisms, Mycobacterial species, polymicrobial organisms, and Pseudomonas
species.
Treatment success of PD-related peritonitis meant recovery from peritonitis and
treatment failure was defined as one of the following: death of the patient owing to
peritonitis, and catheter removal with a shifted to HD during this hospitalization.
Statistical Analysis
Data are expressed as means ± standard deviation (SD). To compare means of
continuous variables, Student’s t test was applied. Category variables were analyzed
using chi-square analysis or Fisher’s exact test. Statistical significance was defined as
P-values <0.05. All statistically significant variables (P<0.05) were put into a multiple
logistic regression model to identify the independent risk factors associated with
treatment failure of PD-related peritonitis, and when the distribution of continuous
variables was skewed, logarithmic (log) transformation was used to gain normal
distribution. Statistical analysis was produced with the help of the SPSS 12.0 software
(SPSS Inc., Chicago, Illinois, USA).
7
RESULTS
Total 46 episodes of peritonitis suffered by 75 patients (follow-up 4008 patient
months) were analyzed. Figure 1 shows the annular rates of PD-related peritonitis
between 1997 and 2006. The rate of peritonitis was from 29.06 patient-months per
episode to 126.03 patient-months per episode during this period and the mean rate was
61.48 patient-months per episode.
The incidences and outcomes of treatment for PD-related peritonitis based on
organism analysis are summarized in Table 1. The total number of PD-related peritonitis
during this period was 46 episodes and the highest incidence was caused by
Gram-positive pathogens (34.7%). The rate of treatment success with antibiotic was
69.5%. The treatment failure for PD-related peritonitis was 30.5% and the mortality was
6.5%.
The baseline characteristics of PD-related peritonitis with treatment success and
treatment failure are summarized in Table 2. There were no significant differences in age,
gender, primary disease of ESRD, previous HD history, mode of PD, need for a dialysis
partner, dialysis adequacy, residual renal function, baseline PET, nPNA, and the duration
of follow-up on PD treatments between PD-related peritonitis with treatment success and
treatment failure.
The differences of initial clinical manifestations of peritonitis between PD-related
peritonitis with treatment success and treatment failure are shown in Table 3. There were
no significant differences in simultaneous an exit-site infection, body temperature, pulse
rate, respiratory rate, SIRS, SBP, DBP, albumin, dialysate fluid WBC and neutrophil
counts between treatment success and treatment failure of PD-related peritonitis.
8
However, the blood neutrophil count (cells/μl) was significantly higher in the treatment
failure group of PD-related peritonitis than that in the treatment success group (p=0.045).
The treatment failure rate of the dialysate culture with FMPP was significant higher than
that of the dialysate culture with non-FMPP (p＜0.001).
Multivariate logistic regression analysis to assess the effect of risk factors on the
treatment failure of PD-related peritonitis is summarized in Table 4. As shown in Table 4,
blood neutrophil counts and FMPP were found to be independent risk factors for
treatment failure of PD-related peritonitis.
9
DISCUSSION
Numerous studies have reported that the outcome of peritonitis is strongly influenced
by the characteristics of the causative organisms.2, 5, 6, 13-15 In addition, diabetes, old age,
lower level of serum albumin, gender, depression, poor residual renal function and
baseline inflammatory status (as estimated from CRP) were significant determinants for
death.7, 8 In this present study, we found that blood neutrophil counts and dialysate culture
with specific organisms FMPP were independent risk factors to predict treatment failure
of PD-related peritonitis. More importantly, there has not been any study to report that the
blood neutrophil count is a predictor for the treatment failure of PD-related peritonitis.
Recently, a study showed that peritoneal dialysate white count ≧ 1090/mm3 on day 3,
but not day 1, was an independent prognostic marker for treatment failure of PD
related-peritonitis (Tenchhoff catheter removal or death).16 Till now, there has been no
study to examine the role of blood neutrophil count on the treatment outcomes of
PD-related peritonitis. Our study showed initial blood neutrophil counts (day 1) was an
independent risk factor for treatment failure of PD-related peritonitis. Therefore, blood
neutrophil counts can predict treatment failure of PD-related peritonitis than the previous
report.16 PD-related peritonitis was recognized as a local infection and it has been
suggested to treat PD-related peritonitis with antibiotics via intraperitoneal route.
10-12
In
this present study, the blood neutrophil count is a significant predictor for treatment
failure in PD-related peritonitis, implying an increase in blood neutrophil count in
PD-related peritonitis may need a more aggressive intervention; for example, the
administration of antibiotics via intravenous instead of peritoneal route.
It has been reported that the peritoneal catheter was removed in 16-20% of the
10
PD-related peritonitis,17 and 1-16% of the PD-related peritonitis resulted in death.3-5 This
study showed the treatment failure (catheter removal and mortality) of PD-related
peritonitis was 30.5% including 6.5% mortality and 24% catheter removal.
Previous studies have reported that infection caused by fungi, Mycobacterial species,
Gram-negative organism, Pseudomonas species, and Staphylococcus aureus carried the
poorer outcomes of PD-related peritonitis.2,
5, 6, 13-15
We followed the updated
recommendations for treatment of PD-related peritonitis from ISPD guidelines which
suggested a catheter should be removed if dialysate culture revealed with FMPP.[12-14]
Our present study also revealed that infections caused by specific organisms FMPP were
significant risk factors for treatment failure of PD-related peritonitis.
Regarding the organisms of PD-related peritonitis, it has been reported that
Gram-positive organisms accounted for around 40-65% of peritonitis episodes.2,
17
Predominant among these Gram-positive organisms were the Staphylococcus species,
including coagulase-negative Staphylococci and Staphylococcus aureus. Streptococcal
species causes roughly 6-16% of the cases of PD peritonitis.18 Our study showed that the
highest incidence was caused by Gram-positive pathogens (34.7%) with predominantly
Staphylococcus species (26%). The percentage of Staphylococcus species in our study
was similar to another report which Staphylococcus species caused 24% of PD-related
peritonitis.19
Considering Gram-negative peritonitis, it may result from touch contamination, an
exit-site infection, and possibly a bowel source such as constipation, colitis, and
transmural migration. It has been reported that Gram-negative organisms account for
20-30% of all PD-related peritonitis.13, 17 In this present study, 30.3% of peritonitis was
11
caused by Gram-negative organisms.
Turning to culture-negative peritonitis, the percentage of culture-negative peritonitis
reported in this present study was 19.6%. In 2005, the recommendations from ISPD
committee were suggested that the quality indicator for evaluation of the culture methods
should result in a culture-negative rate of < 20%.20 Moreover, the ISPD Committee
suggested that the overall peritonitis rate should be more than 18 patient-months per one
episode.12 This present study revealed the rate of peritonitis was varying from 29.06
patient-months per episode (0.41 per year) to 126.03 patient-months (0.095 per year) per
episode during this period. Therefore, the rate of PD-related peritonitis in our group was
lower than that of ISPD recommendations.
12
CONCLUSIONS
Our present study demonstrated that blood neutrophil counts and dialysate culture with
specific organisms FMPP were independent risk factors of treatment failure in PD-related
peritonitis. More importantly, there has not been any study to report that the blood
neutrophil count is a predictor for the treatment failure of PD-related peritonitis. In the
future, it is important to examine whether aggressive intervention in response to higher
blood neutrophil count and dialysate culture with special organism (FMPP) can translate
into clinical benefit.
13
ACKNOWLEDGMENTS
This study was presented at the 2008 Annual Meeting, Taiwan Society of Nephrology
(Taipei, Taiwan, December 13 - 14, 2008).
Declaration of Interest: No conflicts of interest.
14
REFERENCES
1.
Szeto CC, Leung CB, Chow KM, et al.: Change in bacterial aetiology of peritoneal
dialysis-related peritonitis over 10 years: experience from a centre in South-East Asia.
Clin Microbiol Infect 2005; 11: 837-9.
2.
Troidle L, Finkelstein F: Treatment and outcome of CPD-associated peritonitis. Ann
Clin Microbiol Antimicrob 2006; 5: 6.
3.
Fried LF, Piraino B. Peritonitis. In: Gokal R, Khanna R, Krediet R, Nolph K, eds.
Textbook of Peritoneal Dialysis. Dordrecht: Kluwer Academic; 2000:545-64.
4.
Szeto CC, Kwan BC, Chow KM, et al.: Coagulase negative staphylococcal
peritonitis in peritoneal dialysis patients: review of 232 consecutive cases. Clin J Am Soc
Nephrol 2008; 3: 91-7.
5.
Troidle L, Gorban-Brennan N, Kliger A, Finkelstein F: Differing outcomes of
gram-positive and gram-negative peritonitis. Am J Kidney Dis 1998; 32: 623-8.
6.
Barretti P, Bastos KA, Dominguez J, Caramori JC: Peritonitis in Latin America.
Perit Dial Int 2007; 27: 332-9.
7.
Han SH, Lee SC, Ahn SV, et al.: Improving outcome of CAPD: twenty-five years'
experience in a single Korean center. Perit Dial Int 2007; 27: 432-40.
8.
Perez Fontan M, Rodriguez-Carmona A, Garcia-Naveiro R, Rosales M, Villaverde P,
Valdes F: Peritonitis-related mortality in patients undergoing chronic peritoneal dialysis.
Perit Dial Int 2005; 25: 274-84.
9.
Collins AJ, Foley R, Herzog C, et al.: Excerpts from the United States Renal Data
System 2007 annual data report. Am J Kidney Dis 2008; 51: S1-320.
15
10. Keane WF, Alexander SR, Bailie GR, et al.: Peritoneal dialysis-related peritonitis
treatment recommendations: 1996 update. Perit Dial Int 1996; 16: 557-73.
11. Keane WF, Bailie GR, Boeschoten E, et al.: Adult peritoneal dialysis-related
peritonitis treatment recommendations: 2000 update. Perit Dial Int 2000; 20: 396-411.
12. Piraino B, Bailie GR, Bernardini J, et al.: Peritoneal dialysis-related infections
recommendations: 2005 update. Perit Dial Int 2005; 25: 107-31.
13. Szeto CC, Chow KM: Gram-negative peritonitis--the Achilles heel of peritoneal
dialysis? Perit Dial Int 2007; 27 Suppl 2: S267-71.
14. Bunke CM, Brier ME, Golper TA: Outcomes of single organism peritonitis in
peritoneal dialysis: gram negatives versus gram positives in the Network 9 Peritonitis
Study. Kidney Int 1997; 52: 524-9.
15. Lo SHK, Chan CK, Shum HP, Chow VCC, Mo KL, Wong KS: Risk factors for poor
outcome of fungal peritonitis in chinese patients on continuous ambulatory peritoneal
dialysis. Perit Dial Int 2003; 23 Suppl 2: S123-6.
16. Chow KM, Szeto CC, Cheung KK, et al.: Predictive value of dialysate cell counts in
peritonitis complicating peritoneal dialysis. Clin J Am Soc Nephrol 2006; 1: 768-73.
17. Mujais S: Microbiology and outcomes of peritonitis in North America. Kidney Int
Suppl 2006; 70: S55-62.
18. Shukla A, Abreu Z, Bargman JM: Streptococcal PD peritonitis--a 10-year review of
one centre's experience. Nephrol Dial Transplant 2006; 21: 3545-9.
19. Malik GH, Al-Harbi AS, Al-Mohaya SA, et al.: Chronic peritoneal dialysis: a
single-center experience. . Perit Dial Int 2003; 23 Suppl 2: S188-91.
20. Boeschoten EW, Ter Wee PM, Divino J: Peritoneal dialysis-related infections
16
recommendations 2005--an important tool for quality improvement. Nephrol Dial
Transplant 2006; 21 Suppl 2: ii31-3.
17
Table
Table 1. Incidences and outcomes of treatment for PD-related peritonitis based on
organism analysis
Organisms
Bacteria
Gram-positive
Staphylococcus aureus
OSSA
ORSA
Staphylococcus epidermidis
Streptococcus species
Gram-negative
E Coli
Pseudomonas species
Klebsiella species
Pasteurella species
Bacteroides fragilis
Mycobacterial species
Candida and other fungi
Polymicrobial organisms
Culture-negative
Total
Case
Number
(%)
Success
Number
(%)
Failure but
survival
Number
(%)
Death
Number
(%)
6 (13)
2 (4.3)
4 (8.7)
4 (8.7)
4
2
4
4
1
1
5 (10.9)
3 (6.5)
2 (4.3)
2 (4.3)
2 (4.3)
3 (6.5)
1 (2.2)
3 (6.5)
9 (19.6)
46
4
1
1
2
1
1
2
1
1
3
1
1
2
8
1
32
11 (24%)
3 (6.5%)
(69.5%)
OSSA: oxacillin-sensitive Staphylococcus aureus; ORSA: oxacillin-resistant
Staphylococcus aureus.
18
Table 2. Comparison of baseline characteristics between PD-related peritonitis with
treatment success and treatment failure
Parameter
Success (n=32)
Failure (n=14)
P value
Age (y/o)
53.41 ± 2.97
55.29 ± 5.11
0.739
Gender
0.335
Male
15 (32.6%)
4 (8.7%)
Female
17 (37.0%)
10 (21.7%)
Primary disease of
0.730
ESRD
DM
10 (21.7%)
6 (13.0%)
GN
15 (32.6%)
6 (13.0%)
HTN
5 (10.9%)
2 (4.3%)
Others
2 (4.3%)
0 (0%)
Previous HD history
0.753
Yes
12 (26.1%)
6 (13.0%)
No
20 (43.5%)
8 (17.4%)
Mode of PD
0.286
APD
11 (23.9%)
2 (4.3%)
CAPD
21 (45.7%)
12 (26.1%)
Need for a dialysis
0.465
partner
Yes
6 (13.0%)
4 (8.7%)
No
26 (56.5%)
10 (21.7%)
Dialysis adequacy
Weekly Kt/V
2.06 ± 0.09
1.99±0.14
0.667
Weekly CCr (ml/min)
57.68±2.93
58.44±4.65
0.889
Residual CCr (ml/min)
1.30±0.29
1.04±0.38
0.60
Baseline PET (D/P
0.66±0.03
0.70±0.04
0.453
creatinine)
nPNA
0.99±0.06
1.15±0.10
0.172
Duration of follow-up
29.5±3.6
33.5±7.5
0.583
on PD (months)
ESRD: end-stage renal disease; DM: diabetes mellitus; GN: glomerulonephritis; HTN:
hypertension; HD: hemodialysis; PD: peritoneal dialysis; APD: automated peritoneal
dialysis; CAPD: continuous ambulatory peritoneal dialysis; Ccr: creatinine clearance;
PET: peritoneal equilibrium test; nPNA: normalized protein nitrogen appearance.
19
Table 3. Comparison of initial clinical manifestations of peritonitis between PD-related
peritonitis with treatment success and treatment failure
Parameter
Success (n=32)
Failure (n=14)
P value
Simultaneous an exit-site
0.753
infection
Yes
1 (2.2%)
0 (0%)
No
31 (67.4%)
14 (30.4%)
Body temperature (°C)
36.8 ± 0.15
36.9±0.24
0.676
Pulse rate (beat/min)
89.3 ±2.5
91.5 ±3.6
0.625
Respiratory rate (times/min)
21.3 ±0.4
20.7 ±0.5
0.434
SIRS
0.467
Yes
7 (15.2%)
5 (10.9%)
No
25 (54.3%)
9 (19.6%)
Systolic BP (mmHg)
111.6 ± 4.3
127.6 ± 7.3
0.055
Diastolic BP (mmHg)
68.9 ± 2.9
73.1 ±4.1
0.417
Albumin (g/dL)
3.47 ± 0.10
3.16±0.14
0.089
Hemogram
0.155
WBC (cells/μL)
9606.3 ±809.5
13557.1±2397.8
0.053
Neutrophil (cells/μL)
7849.2±775.1
11409.2±1940.6
0.045
Hemoglobin (g/dL)
9.8±0.2
10.2±0.6
0.583
Dialysate Fluid
WBC (cells/μL)
3571.7± 670.8
3120.2±991.6
0.710
Neutrophil (cells/μL)
3258.7±645.1
2644.4±883.8
0.592
Special Organisms: FMPP
<0.001
Yes
2 (4.3 %)
8(17.4%)
No
30 (65.2%)
6 (13.0%)
SIRS: systemic inflammatory reaction syndrome; BP: blood pressure; WBC: white blood
cells; FMPP: fungi, Mycobacterial species, polymicrobial organisms, and Pseudomonas
species.
20
Table 4 Multivariate logistic regression analysis to assess the effect of risk factors on the
treatment failure of PD-related peritonitis
Variables
Adjusted OR 95% C.I.
β, Standardized P value
Coefficient
Blood neutrophil count 216.0
2.53-18442.15
5.376
0.018
4.61-358.38
3.705
0.001
(log-transformed)
FMPP
40.6
FMPP: fungal organisms, Mycobacterial species, polymicrobial organisms, and
Pseudomonas species.
Dependent variable: treatment failure of PD-related peritonitis.
Independent variable: blood neutrophil count, FMPP.
21
Figure legends
Figure 1. Annual rates of PD-related peritonitis between 1997 and 2006.
22