Repeated Peritoneal Dialysis–Associated Peritonitis: A Multicenter Registry Study (original) (raw)
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Repeat Peritonitis in Peritoneal Dialysis: Retrospective Review of 181 Consecutive Cases
Clinical Journal of the American Society of Nephrology, 2010
Background and objectives The clinical behavior of repeat-peritonitis episodes, defined as peritonitis with the same organism occurring more than 4 weeks after completion of therapy for a prior episode, is poorly understood. Design, setting, participants, & measurements We compared outcomes of 181 episodes of repeat peritonitis from 1995 to 2009 (Repeat Group) with 91 episodes of relapsing peritonitis (Relapsing Group) and 125 episodes of peritonitis preceded 4 weeks or longer by another episode with a different organism (Control Group). Results In Repeat Group, 24% were due to Staphylococcus aureus, as compared with 5.5% in Relapsing Group and 15% in Control Group. The majority of the organisms causing relapsing peritonitis were Gram negative (62%), whereas the majority of that in Repeat Group were Gram positive (56%). Repeat Group had a lower complete-cure rate (70.7% versus 54.9%) than Relapsing Group, but rates of primary response, catheter removal, and mortality were similar. Repeat Group had a higher primary response rate (89.0% versus 73.6%) and a lower rate of catheter removal (6.1% versus 15.2%) than Control Group, whereas the completecure rate and mortality were similar. Repeat Group had a higher risk of developing relapsing (14.3% versus 2.2%) and repeat peritonitis (26.1% versus 5.4%) than Control Group, whereas the risk of recurrent peritonitis was similar. Conclusions Repeat peritonitis is a distinct clinical entity. Although repeat-peritonitis episodes generally have a satisfactory response to antibiotic, they have a substantial risk of developing further relapsing or repeat peritonitis.
PREDICTORS OF OUTCOME FOLLOWING BACTERIAL PERITONITIS IN PERITONEAL DIALYSIS
Objective: No studies have been done to examine factors that predict the outcome of bacterial peritonitis during peritoneal dialysis (PD), beyond the contribution of the organism causing the peritonitis, concurrent exit-site or tunnel infection, and abdominal catastrophes. ♦ ♦ ♦ ♦ ♦ Design: In this study we examined several clinical and laboratory parameters that might predict the outcome of an episode of bacterial peritonitis. Between March 1995 and July 2000, we identified 399 episodes of bacterial peritonitis in 191 patients on dialysis.
The Association between Peritoneal Dialysis Modality and Peritonitis
Clinical Journal of the American Society of Nephrology, 2014
Background and objectives There is conflicting evidence comparing peritonitis rates among patients treated with continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD). This study aims to clarify the relationship between peritoneal dialysis (PD) modality (APD versus CAPD) and the risk of developing PD-associated peritonitis. Design, setting, participants, & measurements This study examined the association between PD modality (APD versus CAPD) and the risks, microbiology, and clinical outcomes of PD-associated peritonitis in 6959 incident Australian PD patients between October 1, 2003, and December 31, 2011, using data from the Australia and New Zealand Dialysis and Transplant Registry. Median follow-up time was 1.9 years. Results Patients receiving APD were younger (60 versus 64 years) and had fewer comorbidities. There was no association between PD modality and time to first peritonitis episode (adjusted hazard ratio [HR] for APD versus CAPD, 0.98; 95% confidence interval [95% CI], 0.91 to 1.07; P=0.71). However, there was a lower hazard of developing Gram-positive peritonitis with APD than CAPD, which reached borderline significance (HR, 0.90; 95% CI, 0.80 to 1.00; P=0.05). No statistically significant difference was found in the risk of hospitalizations (odds ratio, 1.12; 95% CI, 0.93 to 1.35; P=0.22), but there was a nonsignificant higher likelihood of 30-day mortality (odds ratio, 1.33; 95% CI, 0.93 to 1.88; P=0.11) at the time of the first episode of peritonitis for patients receiving APD. For all peritonitis episodes (including subsequent episodes of peritonitis), APD was associated with lower rates of culture-negative peritonitis (incidence rate ratio [IRR], 0.81; 95% CI, 0.69 to 0.94; P=0.002) and higher rates of gram-negative peritonitis (IRR, 1.28; 95% CI, 1.13 to 1.46; P=0.01). Conclusions PD modality was not associated with a higher likelihood of developing peritonitis. However, APD was associated with a borderline reduction in the likelihood of a first episode of Gram-positive peritonitis compared with CAPD, and with lower rates of culture-negative peritonitis and higher rates of Gram-negative peritonitis. Peritonitis outcomes were comparable between both modalities.
The Journal of Pediatrics, 1984
The frequency and cause of peritonitis in 18 children receiving continuous ambulatory peritoneal dialysis (CAPD) and nine children receiving continuous cycling peritoneal dialysis (CCPD) are described. Cumulative CAPD and CCPD experience demonstrated 58 episodes of peritonitis in 294 patient treatment months (one case per 5.1 patient treatment months). Total hospitalization for the treatment of peritonitis was 0.18 days per patient treatment month. Life table analysis revealed no significant difference in the peritonitis-free "survival" between the two modalities. Gram-negative organisms accounted for a significantly increased percentage of the peritonitis in CAPD compared with CCPD (65% vs 17%) (P less than 0.001). Thirty-seven percent of the gram-negative infections in the CAPD population were in children with nephrostomies. Factors predisposing to peritonitis were identified in 76% of cases occurring with CAPD. Peritonitis remains the major contributor to the morbidity associated with peritoneal dialysis, regardless of the technique. The resultant frequency of hospitalization is not prohibitive. Attention to the "high-risk" pediatric patient and education directed at several well-recognized predisposing factors may yield improved results.
Microbiology of Peritonitis in Peritoneal Dialysis Patients with Multiple Episodes
Peritoneal Dialysis International, 2012
Background Peritoneal dialysis (PD)–associated peritonitis clusters within patients. Patient factors contribute to peritonitis risk, but there is also entrapment of organisms within the biofilm that forms on PD catheters. It is hypothesized that this biofilm may prevent complete eradication of organisms, predisposing to multiple infections with the same organism. Methods Using data collected in the Canadian multi-center Baxter POET (Peritonitis, Organism, Exit sites, Tunnel infections) database from 1996 to 2005, we studied incident PD patients with 2 or more peritonitis episodes. We determined the proportion of patients with 2 or more episodes caused by the same organism. In addition, using a multivariate logistic regression model, we tested whether prior peritonitis with a given organism predicted the occurrence of a subsequent episode with the same organism. Results During their time on PD, 558 patients experienced 2 or more peritonitis episodes. Of those 558 patients, 181 (32%) ...
Journal of clinical nephrology and renal care, 2020
Peritoneal dialysis related peritonitis is a major risk factor for drop-out of patients on continuous ambulatory peritoneal dialysis. Data on factors affecting outcome of chronic peritoneal dialysis related peritonitis and microbiology is limited. In this regard, a retrospective, observational study was conducted at Post Graduate Institute of Medical Education and Research, Chandigarh, India, wherein we reviewed medical records of chronic peritoneal dialysis patients for 3 years between 01 July 2015 and 30 June 2018. We abstracted data pertaining to social, demographic and clinical characteristics of patients, occurrence of peritonitis including microbiological spectrum and outcomes. Conventional culture method involving manual inoculation was used in initial 1½ years, after which automated culture (BACTEC) was used. A total of 334 chronic peritoneal dialysis patients were screened retrospectively for infective peritonitis. Out of these, 74 patients had 97 episodes of peritonitis; 54 patients had single episode and 19 had two episodes (repeat-16 and relapsing-3) and none had preceding or ongoing exit site or tunnel infection. Occurrence of peritonitis was highest during monsoon (36%) and least during autumn (12%). Cumulative culture positivity was 39.2% with gram-positivity in 60.5% patients. Predominant microorganism was Staphylococcus epidermidis (23.7%) followed by Escherichia coli (13.2%). 51 patients (74 episodes) recovered with antibiotic therapy alone, while 23 patients required peritoneal catheter removal in view of refractory (n-20)/ fungal (n-3) peritonitis. 6.8% patients had peritonitis related mortality. Outcome with respect to recovery was comparable (76.3%) in culture positive and culture negative episodes.