[Peritonitis related to peritoneal dialysis: evaluation of 179 attacks]

One of the leading problems encountered in patients undergoing peritoneal dialysis is infectious complications including peritonitis. We aimed to investigate the etiology, clinical presentation and therapy of peritonitis attacks in patients undergoing peritoneal dialysis (PD) in two ultimate hospitals in Eskisehir (located at middle Anatolia region of Turkey) over seven years. We determined 179 peritonitis attacks in 74 (62.2%) of 119 patients undergoing PD. The average annual peritonitis incidence in PD patients was found as 0.4. Of 42 patients with multiple peritonitis attacks, seven (16.7%) had relapsing and eight (19%) had recurrent peritonitis. Four (2.2%) of the 179 peritonitis attacks were evaluated as nosocomial peritonitis. The most common findings were abdominal pain (80.4%), cloudy peritoneal fluid (70.9%), increased erythrocyte sedimentation rates (69.3%) and elevated CRP levels (57.5%). Co-morbidities, initial serum albumin reduction, obesity or overweight status and duration of PD catheterization were found as risk factors related to the development of peritonitis in PD patients. The most common causative microorganisms were coagulase-negative staphylococci (21.8%), Staphylococcus aureus (8.9%), Enterococcus spp. (5.6%) and Escherichia coli (3.3%). Eighty two (45.8%) of 179 peritonitis attacks were culture-negative. The antimicrobial agents which have been used for the therapy of peritonitis attacts were cefazolin+ceftazidim (27.9%), cefazolin+amikacin (24%), ceftazidim+vancomycin (9.5%), vancomycin+amikacin (7.3%), vancomycin+amikacin+cefazolin (5.6%), vancomycin alone (5%) and the others (20.7%). Ten (5.6%) patients were placed under hemodialysis due to peritonitis, and seven of 179 attacks in 74 patients who developed peritonitis were fatal (fatality rate: 3.9%). It could be concluded that the patients to undergo PD should be given education about the process, as well the microbiological evaluation of these patients should be looked over. Since gram-positive bacteria were commonly responsible for peritonitis following PD, empirical treatment with vancomycin would lead to more successful results.