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Peritoneal dialysis-related peritonitis caused by Pseudomonas species: Insight from a post-millennial case series
Wanhong Lu1, Bonnie Ching-Ha Kwan2, Kai Ming Chow2
1Nephrology Department, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Background:
Pseudomonas peritonitis is a serious complication of peritoneal dialysis (PD). However, the clinical course of Pseudomonas peritonitis following the adoption of international guidelines remains unclear.
Methods:
We reviewed the clinical course and treatment response of 153 consecutive episodes of PD peritonitis caused by Pseudomonas species from 2001 to 2015.
Results:
Pseudomonas peritonitis accounted for 8.3% of all peritonitis episodes. The bacteria isolated were resistant to ceftazidime in 32 cases (20.9%), and to gentamycin in 18 cases (11.8%). In 20 episodes (13.1%), there was a concomitant exit site infection (ESI); in another 24 episodes (15.7%), there was a history of Pseudomonas ESI in the past. The overall primary response rate was 53.6%, and complete cure rate 42.4%. There was no significant difference in the complete cure rate between patients who treated with regimens of 3 and 2 antibiotics. Amongst 76 episodes (46.4%) that failed to respond to antibiotics by day 4, 37 had immediate catheter removal; the other 24 received salvage antibiotics, but only 6 achieved complete cure.
Conclusions:
Antibiotic resistance is common amongst Pseudomonas species causing peritonitis. Adoption of the treatment guideline leads to a reasonable complete cure rate of Pseudomonas peritonitis. Treatment with three antibiotics is not superior than the conventional two antibiotics regimen. When there is no clinical response after 4 days of antibiotic treatment, early catheter removal should be preferred over an attempt of salvage antibiotic therapy.
Insights
Pseudomonas peritonitis in peritoneal dialysis (PD) patients shows common antibiotic resistance. Following guidelines yields a reasonable cure rate, with early catheter removal being superior to salvage antibiotics when treatment fails.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Pseudomonas peritonitis is a significant complication for patients undergoing peritoneal dialysis (PD).
- The clinical outcomes of Pseudomonas peritonitis after implementing international treatment guidelines were previously unclear.
Observation:
- A review of 153 PD peritonitis episodes caused by Pseudomonas species between 2001 and 2015 was conducted.
- Antibiotic resistance to ceftazidime (20.9%) and gentamycin (11.8%) was noted.
- Concomitant or prior exit site infections (ESI) were present in 28.8% of cases.
Findings:
- The overall primary response rate was 53.6%, with a complete cure rate of 42.4%.
- No significant difference in cure rates was observed between two- and three-antibiotic regimens.
- Early catheter removal after 4 days of non-response yielded better outcomes than salvage antibiotic therapy.
Implications:
- International guidelines result in a reasonable cure rate for Pseudomonas peritonitis.
- Early catheter removal is recommended over salvage antibiotics for non-responsive cases.
- This study informs clinical practice regarding the management of PD-related Pseudomonas infections.
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