Peritonitis in the extended-care facility

Many patients with end-stage renal disease (ESRD) require admission to an extended-care facility (ECF). Few data are available concerning the development of peritonitis among continuous peritoneal dialysis (CPD) patients residing in an ECF. We retrospectively reviewed the charts of 77 CPD patients admitted to an ECF between November 1993 and 31 August 1997. A total of 25 episodes of peritonitis developed among CPD patients in the ECF during this period for an overall peritonitis rate of 1 episode in 19.8 patient-months. The CPD patients developing peritonitis in the ECF were similar in age and gender to the CPD patients residing in the ECF not developing peritonitis. There were more African-Americans among the group of CPD patients residing in the ECF who developed peritonitis than among the ECF residents who did not develop peritonitis (41% vs. 23%, respectively; P < 0.05). Patients developing peritonitis in the ECF resided in the ECF significantly longer than the remaining CPD patients not developing peritonitis in the ECF (106 vs. 77 days, respectively; P < 0.05). The overall rate of peritonitis in the ECF was lower than that seen in the community (1 episode in 19.8 patient-months vs. 1 episode in 10.0 patient-months, respectively). The rate of gram-positive peritonitis was lower than the rate of gram-positive peritonitis seen in the community setting (1 episode in 54.9 patient-months vs. 1 episode in 14.9 patient-months, respectively). The rate of culture-negative peritonitis was higher among the ECF patients than among patients developing community-acquired peritonitis (1 episode in 61.9 patient-months vs. 1 episode in 106.2 patient-months, respectively). The spectrum of organisms in the ECF was different than the spectrum noted among patients developing hospital-acquired peritonitis. Eleven of the 25 episodes of peritonitis were treated successfully at the ECF while the remaining 14 episodes of peritonitis were treated at an acute-care hospital. Continuous PD therapy was continued following 19 of the 25 episodes (76%), 1 patient transferred to hemodialysis, and 5 patients expired. We conclude that patients develop peritonitis in the ECF less frequently than in the community setting, with the spectrum of organisms different than the spectrum seen in the community and hospital settings. Seventy-six percent of the patients continue CPD therapy following an episode of peritonitis.