Technique survival with Serratia peritonitis

Despite a decreasing incidence, peritonitis remains an important cause of peritoneal dialysis (PD) technique failure and transfer to hemodialysis. Infection with Serratia spp. has been suggested to be associated with a poor technique outcome in PD. We examined the data at our center to see if patients with Serratia peritonitis had a similar poor outcome. In this retrospective study, we reviewed all PD patients who presented at our center with peritonitis from January 1996 to December 2003. The case records of patients in whom the infecting organism was identified as Serratia were evaluated. We recorded age at the time of peritonitis and at the start of PD, sex, presence of diabetes mellitus, PD modality at the time of peritonitis, and duration of PD before the onset of peritonitis. For each episode of peritonitis, we recorded the type and duration of antibiotic therapy and the outcome. Over the study period, 52% of all peritonitis episodes involved gram-positive organisms; 29%, gram-negative organisms; and 19%, other organisms. Serratia spp. accounted for 16 episodes (3.68%). These 16 episodes of peritonitis occurred in 12 patients, with 3 repeat infections and 1 relapsing infection. The distribution between the sexes was equal, and the median age at diagnosis was 67 years (range: 37-79 years). Four patients with diabetes accounted for 6 of the 16 episodes (37.5%). In 7 episodes (43.8%), a Serratia exit-site infection preceded the peritonitis. In 4 episodes, catheter removal was required. A fifth patient developed sepsis and died. Technique survival was therefore 68.8% (11 of 16 episodes). We also compared the outcomes of different initial antibiotic regimens. With an initial regimen based on cefazolin-ceftazidime, as suggested in the 2000 guidelines of the International Society for Peritoneal Dialysis, technique survival was 60% (3 of 5 episodes). When the initial regimen included an aminoglycoside, the technique survival was 80% (8 of 10 episodes). Serratia-induced peritonitis was associated with a technique survival of 68.8% at our center.