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Peritoneal dialysis--associated peritonitis caused by gram-negative bacteria: characteristics similar to spontaneous
K Suzuki1, I Horigome, Y Shishido
1Kidney Center, Sendai Shakaihoken Hospital, Miyagi, Japan.
Abstract:
The aim of the study was to investigate the characteristics of PD-related peritonitis caused by gram-negative bacteria (GNP). We retrospectively studied the medical records of 164 patients (114 males, 50 females; mean age 46 +/- 15 years) who continued PD beyond 5 months between 1984 and 1998. The average observation time was 40 +/- 28 months (total of 6609 patient-months). A total of 166 episodes of peritonitis occurred during that time (mean incidence: 1 episode/40 patient-months). Of these, 35 were GNPs, and GNP incidence stayed almost constant over time. Most GNP patients (63%) recovered without complication with an average of 14 days' antibiotic treatment. In only 4 cases was PD abandoned. Clinical features of GNP were similar to those of spontaneous bacterial peritonitis (SBP). The unchanged incidence of GNP over time with advanced connection devices suggests that there are important mechanisms promoting micro-organisms of endogenous origin into the peritoneal cavity in PD patients.
Insights
Gram-negative bacterial peritonitis (GNP) in peritoneal dialysis (PD) patients often resolves with antibiotics. Unchanged GNP incidence suggests endogenous microbial transfer into the peritoneal cavity is a key factor.
Area of Science:
- Nephrology
- Infectious Diseases
- Peritoneal Dialysis
Background:
- Peritonitis is a common complication of peritoneal dialysis (PD).
- Gram-negative bacteria (GNP) are a significant cause of PD-related peritonitis.
- Understanding GNP characteristics is crucial for managing PD patients.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of gram-negative bacterial peritonitis (GNP) in patients undergoing continuous peritoneal dialysis (PD).
- To analyze the incidence and contributing factors of GNP over time.
- To compare clinical features of GNP with spontaneous bacterial peritonitis (SBP).
Main Methods:
- Retrospective analysis of medical records of 164 PD patients (1984-1998).
- Inclusion criteria: continued PD beyond 5 months.
- Data collected on peritonitis episodes, incidence, treatment, and outcomes.
Main Results:
- 35 out of 166 peritonitis episodes were caused by GNP.
- GNP incidence remained constant over the study period.
- 63% of GNP cases resolved with 14 days of antibiotics; PD was abandoned in only 4 cases.
- Clinical features of GNP resembled spontaneous bacterial peritonitis (SBP).
Conclusions:
- Gram-negative bacterial peritonitis (GNP) in PD patients generally has a favorable prognosis with antibiotic treatment.
- The consistent incidence of GNP, even with improved connection devices, points to endogenous microbial translocation as a primary mechanism.
- Further research into endogenous sources is warranted to prevent GNP in PD patients.