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Comprehensive Approach to Peritoneal Dialysis-Related Peritonitis by Enteric Microorganisms. Comparison Between
Roi Ribera-Sánchez1, Miguel Pérez-Fontán2,3, Antía López-Iglesias1
1Division of Nephrology, University Hospital A Coruña, Spain.
Background:
Peritoneal infections of enteric origin (EntP) have been classically investigated using partial strategies, focused on particular subgroups of microorganisms. A more comprehensive approach may facilitate the definition of the nomenclature and clinical presentation of these infections.
Objectives:
To investigate the clinical presentation and outcomes of a full spectrum of EntP, with a particular interest in the comparison between single-organism and polymicrobial infections.
Method:
Following an observational design, we investigated 165 single-organism and 83 polymicrobial peritonitis episodes with isolation of at least 1 enteric bacteria (Enterobacteriaceae, Enterococcus spp. and/or intestinal anaerobics). We compared the risk of treatment failure for these 2 types of infection and explored the significance of the isolation of specific microorganisms and of their antibacterial susceptibility patterns.
Results:
Polymicrobial EntP was associated with higher rates of hospitalization, more changes to initial antibiotic therapy, more surgical explorations, and higher mortality and treatment failure rates than monobacterial EntP. However, stratified and multivariate analyses revealed that the burden of these differences rested on the isolation of intestinal anaerobics (odds ratio [OR] 12.05, 95% confidence interval [CI] 2.53-31.09, p < 0.001) and/or Enterococcus faecium (OR 3.37, 95% CI 1.02-11.30, p = 0.046), while other polymicrobial infections were more comparable with single-organism peritonitis, except for even higher mortality rates in the former group. Lower antibiotic susceptibility of the isolations (OR 1.18, 95% CI 0.51-2.70, p = 0.70) did not perform as a predictor of treatment failure.
Conclusion:
A comprehensive approach to peritoneal infections by intestinal microorganisms may provide a focused perspective of the clinical presentation and outcomes of these complications of peritoneal dialysis.
Insights
Polymicrobial peritoneal infections originating from the gut are linked to worse outcomes, particularly when intestinal anaerobics or Enterococcus faecium are involved. Comprehensive analysis improves understanding of these complex infections.
Area of Science:
- Infectious Diseases
- Microbiology
- Nephrology
Background:
- Peritoneal infections of enteric origin (EntP) are often studied using fragmented approaches targeting specific microbes.
- A comprehensive strategy is needed to standardize nomenclature and understand clinical presentations of EntP.
Purpose of the Study:
- To comprehensively investigate the clinical presentation and outcomes of enteric origin peritoneal infections (EntP).
- To compare outcomes between single-organism and polymicrobial EntP.
Main Methods:
- An observational study included 165 single-organism and 83 polymicrobial peritonitis episodes involving enteric bacteria.
- Compared treatment failure risks between monobacterial and polymicrobial EntP.
- Explored the impact of specific microorganisms and their antibiotic susceptibility.
Main Results:
- Polymicrobial EntP showed higher hospitalization, antibiotic changes, surgical interventions, mortality, and treatment failure rates.
- Intestinal anaerobics (OR 12.05) and Enterococcus faecium (OR 3.37) significantly drove these adverse outcomes.
- Antibiotic susceptibility was not a predictor of treatment failure.
Conclusions:
- A holistic approach to peritoneal infections by intestinal microorganisms offers better insight into clinical outcomes.
- Specific microbial profiles, like anaerobics and E. faecium, are critical determinants of EntP severity in peritoneal dialysis patients.
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