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Three-year analysis of microbial aetiology and antimicrobial susceptibilities of PD peritonitis
Heidi Leppänen1, Kaj P Metsärinne, Jukka Nikoskelainen
1Department of Internal Medicine, Turku University Central Hospital, Turku, Finland.
Abstract:
The first-line antibiotic treatment of peritoneal dialysis (PD) peritonitis has to cover the most common causative microorganisms. Our aim was to analyse antimicrobial sensitivities of different empirical protocols for initial therapy of PD peritonitis. We analysed the aetiological microorganisms of PD peritonitis and their antimicrobial sensitivities during a 36-month period. Clinical characteristics of the cases were recorded. Altogether 86 PD peritonitides were diagnosed during the study period. In 58 cases, microbial cultures were positive with 72 different causative agents. 28 cases (33%) were culture-negative. Over-representation of icodextrin users was noted among the culture-negative cases. Staphylococcus aureus was the most frequent causative agent, often leading to severe course of illness. Of antimicrobial protocols for initial treatment of peritonitis tested in vitro, the combination of a first-generation cephalosporin and an aminoglycoside was superior to the combination of a first-generation cephalosporin and ceftazidime as well as to fluoroquinolone monotherapy but similar to the combination of vancomycin and ceftazidime. Based on antimicrobial sensitivities we continue using an aminoglycoside in the empirical treatment of PD peritonitis. In the present material, users of icodextrin PD fluid were over-represented among patients with culture-negative peritonitis.
Insights
Empirical antibiotic treatment for peritoneal dialysis (PD) peritonitis should target common pathogens. A cephalosporin-aminoglycoside combination showed superior antimicrobial activity against PD peritonitis pathogens compared to other common regimens.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Peritoneal dialysis (PD) peritonitis requires effective first-line antibiotic therapy targeting common causative microorganisms.
- Antimicrobial resistance patterns necessitate ongoing evaluation of empirical treatment protocols.
Purpose of the Study:
- To analyze the antimicrobial sensitivities of various empirical antibiotic protocols used for the initial treatment of PD peritonitis.
- To identify the most effective antibiotic strategy based on local microbial patterns.
Main Methods:
- Retrospective analysis of 86 PD peritonitis cases over 36 months.
- Identification of etiological microorganisms and assessment of their in vitro antimicrobial sensitivities.
- Comparison of the efficacy of different empirical antibiotic protocols.
Main Results:
- Staphylococcus aureus was the most frequent pathogen, often associated with severe illness.
- The combination of a first-generation cephalosporin and an aminoglycoside demonstrated superior in vitro efficacy compared to other tested regimens, except vancomycin-ceftazidime.
- Culture-negative peritonitis was over-represented in icodextrin PD fluid users.
Conclusions:
- The combination of a first-generation cephalosporin and an aminoglycoside remains a highly effective empirical treatment for PD peritonitis.
- Continued use of aminoglycosides in empirical treatment is supported by current antimicrobial sensitivity data.
- Icodextrin use may be associated with an increased risk of culture-negative peritonitis.
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