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Relapsing and recurrent peritoneal dialysis-associated peritonitis: a multicenter registry study
Michael Burke1, Carmel M Hawley, Sunil V Badve
1Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia.
Summary
Relapsed and recurrent peritoneal dialysis (PD) peritonitis have distinct microbial causes but similar clinical outcomes. Treatment strategies yield comparable results, though catheter removal and transfer to hemodialysis are more frequent.
Area of Science:
- Nephrology
- Infectious Diseases
- Epidemiology
Background:
- Peritoneal dialysis (PD)-associated peritonitis can relapse or recur, but the factors influencing these outcomes are not well understood.
- Understanding the causes, predictors, and consequences of relapsed and recurrent PD peritonitis is crucial for improving patient management.
Purpose of the Study:
- To investigate the causes, predictors, and outcomes of relapsed and recurrent peritoneal dialysis (PD)-associated peritonitis.
- To compare the clinical characteristics and treatment responses of relapsed, recurrent, and uncomplicated PD peritonitis.
Main Methods:
- An observational cohort study utilized data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry.
- Included were all Australian PD patients from 2003-2007 experiencing their first episode of peritonitis.
- Defined relapse as the same organism or culture-negative episode within 4-5 weeks of prior therapy; recurrence as a different organism within 4-5 weeks.
Main Results:
- Of 6,024 patients, 356 had relapsed, 165 recurrent, and 2,021 control peritonitis.
- Relapsing peritonitis was linked to coagulase-negative staphylococci and Staphylococcus aureus, while recurrent peritonitis was more often associated with fungi.
- Both relapsed and recurrent peritonitis led to higher rates of catheter removal and hemodialysis transfer compared to uncomplicated peritonitis, with similar hospitalization and mortality rates.
Conclusions:
- Relapsed and recurrent PD peritonitis stem from different microorganisms but are clinically similar at presentation.
- Empirical broad-spectrum antibiotic treatment followed by susceptibility-guided adjustment results in comparable outcomes for both conditions.
- Despite similar outcomes, relapsed and recurrent peritonitis are associated with increased rates of catheter removal and transfer to hemodialysis.
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