Related Experiment Videos
[Peritonitis in continuous ambulatory peritoneal dialysis. Microbiological and clinical evaluation]
S C Predari1, A B Abalo, J E Santoianni
1Instituto de Investigaciones Médicas Alfredo Lanari, Facultad de Medicina, Universidad de Buenos Aires, Argentina.
Abstract:
In 1976, Popovich et al. described a technique of peritoneal dialysis using bottled dialysate. Later Oreopoulos et al. modified the technique by using plastic bags. But peritonitis still is a major and potentially serious complication of peritoneal dialysis. We have evaluated a) microbiologic diagnostic methods for infectious peritonitis, b) incidence of etiologic agents, and c) the evolution during antimicrobial treatment. Eighteen patients with chronic renal failure of diverse causes were followed from initiation of the CAPD program since January 1981 until June 1988. There were 80 episodes of infectious peritonitis during 17 patient-years of dialysis with an overall incidence of peritonitis of 4.7 episodes/patient-year. The total volume centrifuged technique and culture of sediment showed a sensibility of 85% in 73 episodes where cultures were obtained. The 59.1% of episodes of peritonitis were caused by gram negative bacilli; 11.6% were due to Acinetobacter calcoaceticus and Gram positive cocci accounted for 37.3%. These results are different from those found in other countries because most of our patients had received antimicrobial agents which probably changed their body flora, some did not have manual ability, others were of bad hygienic habits and finally, all of them had frequent contact with hospital environment. The species most frequently isolated were coagulase negative staphylococci (12.8%), probably from patients' skin flora. (ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Peritonitis remains a serious complication of peritoneal dialysis. This study analyzed infectious peritonitis in chronic renal failure patients, identifying common causes and evaluating diagnostic methods for better management.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Context:
- Peritoneal dialysis (PD) is a crucial treatment for chronic renal failure (CRF).
- Infectious peritonitis is a significant complication of PD, potentially leading to treatment cessation.
- Continuous ambulatory peritoneal dialysis (CAPD) has evolved, but peritonitis remains a challenge.
Purpose:
- To evaluate microbiologic diagnostic methods for infectious peritonitis in CAPD patients.
- To determine the incidence and spectrum of etiologic agents causing peritonitis.
- To observe the evolution of peritonitis during antimicrobial therapy.
Summary:
- This study followed 18 CRF patients undergoing CAPD from 1981 to 1988, documenting 80 episodes of infectious peritonitis over 17 patient-years (incidence: 4.7 episodes/patient-year).
- The total volume centrifuged technique demonstrated 85% sensitivity for detecting causative agents.
- Gram-negative bacilli were the most frequent cause (59.1%), followed by Gram-positive cocci (37.3%), with coagulase-negative staphylococci being the most common Gram-positive isolate (12.8%).
Impact:
- Findings suggest unique etiologic profiles in this patient cohort, potentially influenced by prior antimicrobial exposure, hygiene, and hospital contact.
- Highlights the importance of accurate microbiologic diagnosis for effective peritonitis management in PD.
- Provides insights into the specific microbial landscape of peritonitis in a distinct patient population, aiding in targeted treatment strategies.