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Repeated peritoneal dialysis-associated peritonitis: a multicenter registry study
Thulasi Thirugnanasambathan1, Carmel M Hawley, Sunil V Badve
1Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia.
Background:
Determinants and outcomes of peritoneal dialysis (PD)-associated peritonitis occurring within 4 weeks of completion of therapy of a prior episode caused by the same (relapse) or different organism (recurrence) recently have been characterized. However, determinants and outcomes of peritonitis occurring more than 4 weeks after treatment of a prior episode caused by the same (repeated) or different organism (nonrepeated) are poorly understood.
Study Design:
Observational cohort study using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data.
Setting & Participants:
All Australian PD patients between October 1, 2003, and December 31, 2007, with first episodes of repeated or nonrepeated peritonitis.
Predictors:
Repeated versus nonrepeated peritonitis, according to International Society of PD (ISPD) criteria.
Outcomes & Measurements:
Relapse, hospitalization, catheter removal, hemodialysis transfer, and death.
Results:
After a peritonitis episode, the probability that a subsequent episode represented repeated rather than nonrepeated peritonitis was highest in the second month (41%), then progressively decreased to a stable level of 14% from 6 months onward. When first episodes of repeated (n = 245) or nonrepeated peritonitis (n = 824) were analyzed, repeated peritonitis was predicted independently by a shorter elapsed time from the prior episode (adjusted OR per day elapsed, 0.91; 95% CI, 0.88-0.94). Staphylococcus aureus and coagulase-negative staphylococcus were isolated more frequently in repeated peritonitis, whereas Gram-negative, streptococcal, and fungal organisms were recovered more frequently in nonrepeated peritonitis. Using multivariate logistic regression, repeated peritonitis was associated independently with higher relapse (OR, 5.41; 95% CI, 3.72-7.89) and lower hospitalization rates (OR, 0.63; 95% CI, 0.46-0.85), but catheter removal, hemodialysis transfer, and death rates similar to nonrepeated peritonitis.
Limitations:
Limited covariate adjustment. Residual confounding and coding bias could not be excluded.
Conclusions:
Repeated and nonrepeated peritonitis episodes are caused by different spectra of micro-organisms and have different outcomes. Study findings suggest that the ISPD definition for repeated peritonitis should be limited to 6 months.
Insights
Repeated peritonitis in peritoneal dialysis (PD) patients, defined as occurring more than 4 weeks after a prior episode, involves different microbes and outcomes. Findings suggest limiting the definition of repeated peritonitis to 6 months.
Area of Science:
- Nephrology
- Infectious Diseases
- Epidemiology
Background:
- Peritonitis is a common complication of peritoneal dialysis (PD).
- Understanding the characteristics of repeated peritonitis (occurring >4 weeks after prior episode) is crucial for patient management.
- Previous studies have focused on early recurrences, leaving a gap in knowledge regarding later episodes.
Purpose of the Study:
- To investigate the determinants and outcomes of repeated peritonitis compared to nonrepeated peritonitis in PD patients.
- To analyze the microbial spectrum and clinical consequences of peritonitis episodes occurring more than 4 weeks after a previous episode.
Main Methods:
- An observational cohort study utilized data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA).
- Patients with first episodes of repeated or nonrepeated peritonitis between October 2003 and December 2007 were analyzed.
- Repeated peritonitis was defined according to International Society of PD (ISPD) criteria.
Main Results:
- The probability of a subsequent episode being repeated peritonitis was highest at 2 months (41%) and stabilized at 14% from 6 months onward.
- Repeated peritonitis was independently predicted by shorter time elapsed since the prior episode (OR per day, 0.91).
- Staphylococcus aureus and coagulase-negative staphylococcus were more frequent in repeated peritonitis, while Gram-negative, streptococcal, and fungal organisms were more common in nonrepeated episodes. Repeated peritonitis was associated with higher relapse (OR, 5.41) and lower hospitalization rates (OR, 0.63).
Conclusions:
- Repeated and nonrepeated peritonitis episodes differ in their causative microorganisms and clinical outcomes.
- The findings support revising the ISPD definition of repeated peritonitis to a 6-month timeframe.
- Further research is needed to address potential confounding factors and coding biases.
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