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Polymicrobial peritonitis in continuous ambulatory peritoneal dialysis patients
1Department of Medicine, Section of Nephrology, Rush-Presbyterian St Luke's Medical Center, Chicago, IL, USA.
Abstract:
We retrospectively evaluated 232 continuous ambulatory peritoneal dialysis (CAPD) patients entering our program from January 1, 1987, to December 31, 1997, for polymicrobial peritonitis. Polymicrobial peritonitis occurred in 16% of the patients (polymicrobial-peritonitis group), whereas 52% of the patients had peritonitis episodes with only a single organism (single-organism group), and 32% of the patients had no episode of peritonitis. Polymicrobial peritonitis accounted for 8% of the 554 peritonitis episodes, occurred after 23 +/- 20 months on peritoneal dialysis (PD), and was preceded by greater than three episodes of peritonitis in 73% of the patients. Peritonitis rates were greater in the polymicrobial-peritonitis group compared with patients in the single-organism group (1.8 versus 1.2 episodes/patient-year; P: < 0.001). The majority of polymicrobial infections involved gram-negative and/or fungal pathogens, but in 21% of the episodes, only gram-positive organisms were identified. An intra-abdominal process was identified in only 7% of the patients. Catheter loss overall was greatest in the polymicrobial-peritonitis group (65% versus single-organism group, 30% versus patients without peritonitis, 5%; P < 0.001), but only 33% of the polymicrobial infections resulted in catheter loss. At last follow-up, 70% of the patients in the polymicrobial-peritonitis group had permanently transferred to hemodialysis compared with 25% from the single-organism group and 15% from the no-peritonitis group (P < 0.001). In conclusion, polymicrobial peritonitis is an infrequent but serious complication of CAPD that occurs late in the course of PD and is often preceded by recurrent episodes of peritonitis. Polymicrobial peritonitis is rarely the result of a catastrophic intra-abdominal process, and although the majority of patients can be successfully treated without catheter removal, the long-term prognosis is poor, with a high rate of transfer to hemodialysis.
Insights
Polymicrobial peritonitis is a serious complication in continuous ambulatory peritoneal dialysis (CAPD) patients, often occurring late and preceded by recurrent infections. While treatable, it leads to a poor long-term prognosis with high rates of hemodialysis transfer.
Area of Science:
- Nephrology
- Infectious Diseases
- Dialysis
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a common renal replacement therapy.
- Peritonitis is a significant complication of CAPD, impacting patient outcomes.
- Polymicrobial peritonitis represents a distinct and potentially severe form of CAPD-related infection.
Purpose of the Study:
- To retrospectively evaluate the incidence, characteristics, and outcomes of polymicrobial peritonitis in CAPD patients.
- To compare polymicrobial peritonitis with single-organism peritonitis and no peritonitis in terms of clinical course and sequelae.
- To identify risk factors and long-term consequences associated with polymicrobial peritonitis in CAPD.
Main Methods:
- Retrospective analysis of 232 CAPD patients from January 1, 1987, to December 31, 1997.
- Categorization of patients into polymicrobial peritonitis, single-organism peritonitis, and no peritonitis groups.
- Evaluation of peritonitis rates, causative organisms, identified intra-abdominal processes, catheter loss, and transfer to hemodialysis.
Main Results:
- Polymicrobial peritonitis occurred in 16% of patients, accounting for 8% of all peritonitis episodes.
- These infections occurred late (23 months) and were often preceded by >3 peritonitis episodes (73%).
- Higher peritonitis rates (1.8 vs. 1.2 episodes/patient-year), greater catheter loss (65% vs. 30%), and significantly higher transfer to hemodialysis (70% vs. 25%) were observed in the polymicrobial group.
Conclusions:
- Polymicrobial peritonitis is an infrequent but serious late complication of CAPD, often linked to recurrent peritonitis.
- Intra-abdominal processes are rarely the cause; infections are typically polymicrobial involving gram-negative, fungal, or gram-positive organisms.
- Despite potential successful treatment without catheter removal, long-term outcomes are poor, necessitating a high rate of transfer to hemodialysis.