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Acinetobacter peritonitis in patients receiving continuous ambulatory peritoneal dialysis
J M Valdez1, M O Asperilla, R A Smego
1Department of Medicine, Albany Medical College, NY.
Abstract:
Little is written on peritonitis caused by Acinetobacter species in patients receiving continuous ambulatory peritoneal dialysis (CAPD). A retrospective review of medical records, dialysis unit charts, and microbiology culture logbooks identified 18 such patients treated at our hospital. All cases were community-acquired, and no common epidemiologic link between cases was detected. The most common manifestations were abdominal pain or tenderness (13 patients) and cloudy dialysate (six patients); only two patients had fever. Peritonitis without localized intra-abdominal abscess formation occurred in all instances. Intraperitoneal aminoglycoside therapy for 3 to 14 days (mean 10.7 days) eradicated infection in 14 cases. Two patients were successfully treated with 4 days of intraperitoneal gentamicin followed by 8 days of oral ciprofloxacin; another was cured with 10 days of IV ceftriaxone. Tenckhoff catheter removal was necessary in only one patient. Unlike pseudomonal or fungal peritonitis associated with CAPD, infection due to Acinetobacter species is generally responsive to antimicrobials alone.
Insights
Acinetobacter peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients is treatable with antibiotics alone. Most cases responded well to intraperitoneal aminoglycoside therapy, with catheter removal rarely needed.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Peritonitis is a serious complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Acinetobacter species peritonitis in CAPD patients is infrequently documented.
- Limited data exists on the effective management of Acinetobacter peritonitis in CAPD.
Purpose of the Study:
- To investigate the clinical manifestations, treatment, and outcomes of Acinetobacter peritonitis in CAPD patients.
- To evaluate the efficacy of antimicrobial therapy in eradicating Acinetobacter peritonitis.
- To compare Acinetobacter peritonitis outcomes with other common CAPD peritonitis pathogens.
Main Methods:
- Retrospective review of medical records, dialysis unit charts, and microbiology logs.
- Identification of 18 patients with Acinetobacter peritonitis undergoing CAPD.
- Analysis of clinical presentations, treatment regimens, and patient outcomes.
Main Results:
- All 18 cases were community-acquired with no identified epidemiological links.
- Common symptoms included abdominal pain/tenderness (13 patients) and cloudy dialysate (6 patients); fever was rare (2 patients).
- Intraperitoneal aminoglycoside therapy (mean 10.7 days) was successful in 14 cases; other antibiotics (gentamicin/ciprofloxacin, ceftriaxone) were also effective. Tenckhoff catheter removal was required in only one patient.
Conclusions:
- Acinetobacter peritonitis in CAPD patients is generally responsive to antimicrobial therapy alone.
- Treatment with intraperitoneal antibiotics is effective and often avoids the need for catheter removal.
- Unlike other CAPD peritonitis pathogens, Acinetobacter infections demonstrate good susceptibility to standard antimicrobial regimens.