Acinetobacter peritonitis in patients on CAPD: characteristics and outcome

Acinetobacter species are pleomorphic nonfermenting aerobic Gram negative bacilli which are important organisms causing peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). We describe the characteristics and outcome of Acinetobacter peritonitis (AP) over an 18 month study period. There were 13 episodes of AP (9 identified as variant anitratus, 1 as variant calcoaceticus, 1 as variant, 1 woffi and 2 unspecified) in 11 patients (7 females and 4 males, mean age +/- SEM, 50.1 +/- 4.2 years), accounting for 14.3% of the total number of episodes of peritonitis. Technique failure accounted for 8 cases of AP. The duration of CAPD before the onset of AP ranged from 2 to 13 months. Three patients had AP one month after a different episode of peritonitis. Treatment was successful with intraperitoneal (IP) gentamicin alone in 9 episodes, oral perfloxacin alone in 2, and combination IP ceftazidime and oral perfloxacin in 1. Nine patients responded to treatment without interruption of CAPD. Two patients who were treated with IP gentamicin alone had second episodes of AP 2 and 4 months after treatment and 1 patient converted to hemodialysis because of bowel adhesions after his second episode of AP. One patient had Candida superinfection after clearance of AP. In conclusion AP is a common cause of peritonitis and can be treated in most cases without interruption of CAPD and catheter removal. The use of oral quinolones may be more convenient and equally effective. Diabetes mellitus and technique failure may be important factors.