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Outcomes of Acinetobacter Peritonitis in Peritoneal Dialysis Patients: A Multicenter Registry Analysis
Htay Htay1,2,3,4, Yeoungjee Cho1,2,3, Elaine M Pascoe3
1Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry.
Background:
Acinetobacter is a rare but important cause of peritonitis in peritoneal dialysis (PD) patients. As the complication has not been comprehensively evaluated previously, the present study examined the outcomes of Acinetobacter peritonitis in a large, national cohort of PD patients.
Methods:
The study included all episodes of peritonitis in Australia from January 2004 to December 2014 using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data. The primary outcome was peritonitis cure and secondary outcomes were catheter removal, hemodialysis transfer, recurrent/relapsing peritonitis, peritonitis-related hospitalization, and death. Outcomes were compared using multivariable logistic regression.
Results:
Overall, 5,367 patients experienced 11,122 episodes of peritonitis across 51 centers in Australia. Of these, 228 (4.2%) patients experienced 253 (2.3%) episodes of Acinetobacter peritonitis (176 episodes were due to Acinetobacter alone and 77 involved co-infection with other organisms). Of the 176 solitary Acinetobacter episodes, 131(74%) achieved cure with antibiotics alone. Compared with Acinetobacter, significantly lower odds of peritonitis cure were observed for Pseudomonas (adjusted odds ratio [AOR] 0.24, 95% confidence interval [CI]: 0.16 - 0.36), other gram-negative organisms (AOR 0.54, 95% CI 0.37 - 0.77), fungi (AOR 0.02, 95% CI 0.01 - 0.03), and polymicrobial organisms (AOR 0.36, 95% CI 0.25 - 0.51), whilst similar odds of cure were observed for Staphylococcus (AOR 0.73, 95% CI 0.50 - 1.06), other gram-positive organisms (AOR 1.32,95% CI 0.93 - 1.89), culture-negative (AOR 1.19, 95% CI 0.82 -1.71), and other organisms (AOR 0.72, 95% CI 0.49 - 1.07). The odds of catheter removal and hemodialysis transfer were higher with Pseudomonas, other gram-negative, fungal, and polymicrobial peritonitis than with Acinetobacter peritonitis. The odds of death were also higher with Pseudomonas and fungal peritonitis than with Acinetobacter peritonitis. Treatment of Acinetobacter peritonitis with gentamicin, ciprofloxacin, or ceftazidime achieved comparable outcomes.
Conclusions:
Outcomes of Acinetobacter peritonitis were favorable compared with most other forms of organism-specific peritonitis. Commonly used antibiotics covering gram-negative bacteria achieved comparable outcomes in Acinetobacter peritonitis.
Insights
Acinetobacter peritonitis in peritoneal dialysis (PD) patients shows favorable outcomes, with 74% cure rates using antibiotics alone. This rare complication had better results than most other infections, with common antibiotics proving effective.
Area of Science:
- Nephrology
- Infectious Diseases
- Clinical Epidemiology
Background:
- Acinetobacter is an uncommon but significant cause of peritonitis in patients undergoing peritoneal dialysis (PD).
- Previous evaluations of Acinetobacter peritonitis outcomes in PD patients have been limited.
- This study addresses this gap by examining outcomes in a large, national cohort.
Purpose of the Study:
- To comprehensively evaluate the outcomes of Acinetobacter peritonitis in Australian peritoneal dialysis patients.
- To compare the outcomes of Acinetobacter peritonitis with those of peritonitis caused by other organisms.
- To assess the effectiveness of common antibiotic treatments for Acinetobacter peritonitis.
Main Methods:
- Utilized data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) for peritonitis episodes between January 2004 and December 2014.
- Analyzed primary outcome (peritonitis cure) and secondary outcomes including catheter removal, hemodialysis transfer, recurrence, hospitalization, and death.
- Employed multivariable logistic regression to compare outcomes between different causative organisms and treatments.
Main Results:
- Acinetobacter peritonitis occurred in 2.3% of 11,122 peritonitis episodes, with 74% of solitary Acinetobacter infections achieving cure with antibiotics alone.
- Compared to Acinetobacter, significantly lower cure rates were observed for Pseudomonas, other gram-negative, fungal, and polymicrobial peritonitis.
- Catheter removal and hemodialysis transfer rates were higher for Pseudomonas, other gram-negative, fungal, and polymicrobial peritonitis than for Acinetobacter peritonitis. Death rates were also higher for Pseudomonas and fungal infections.
Conclusions:
- Acinetobacter peritonitis in PD patients demonstrates favorable outcomes relative to most other organism-specific peritonitis types.
- Standard antibiotic regimens effective against gram-negative bacteria yielded comparable outcomes for Acinetobacter peritonitis.
- The findings support the use of commonly prescribed antibiotics for treating Acinetobacter peritonitis in PD patients.
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