Microbiological aspects of peritonitis in patients on continuous ambulatory peritoneal dialysis

Area of Science:

• Nephrology
• Infectious Diseases
• Microbiology

Background:

• Peritonitis is a serious complication for patients on continuous ambulatory peritoneal dialysis (CAPD).
• Understanding the microbiological spectrum and antimicrobial susceptibility is crucial for effective treatment and management of CAPD-related peritonitis.
• Previous studies have shown varying etiological patterns of peritonitis in different geographical regions.

Purpose of the Study:

• To determine the microbiological causes of peritonitis in patients on CAPD.
• To analyze the drug-sensitivity patterns of isolated microorganisms.
• To identify potential pathogens in culture-negative peritonitis cases.

Main Methods:

• A prospective study was conducted over 1.5 years at a tertiary-care hospital in India.
• Effluent dialysate from 36 CAPD patients with peritonitis was analyzed using microscopy and culture.
• Microorganisms were identified by morphology and biochemical tests; drug susceptibility was determined using the Kirby-Bauer disc diffusion method.

Main Results:

• Out of 36 dialysates, 33 (91.6%) were culture-positive, yielding 36 microorganisms.
• Gram-positive bacteria (52.8%) were the most common isolates, followed by gram-negative bacteria (27.8%), fungi (13.9%), and mycobacteria (5.6%).
• All gram-positive isolates were sensitive to ampicillin, amoxicillin-clavulanic acid, cefazolin, clindamycin, and vancomycin. Gram-negative isolates showed sensitivity to ciprofloxacin, ceftriaxone, ceftazidime, cefepime, gentamicin, piperacillin-tazobactam, and imipenem.

Conclusions:

• Gram-positive bacteria are the predominant cause of peritonitis in CAPD patients in this region.
• Mycobacterial infections should be considered in culture-negative peritonitis cases unresponsive to standard antimicrobial therapy.
• The identified drug-sensitivity patterns can guide empirical antibiotic choices for CAPD-associated peritonitis.