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Pathogens of peritoneal dialysis peritonitis: Trends from a single-center experience over 15 years
Tae Yeon Hwang1, Myung Gyu Kim1, Se Won Oh1
1Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea.
Background:
Concerns are increasing about the emergence of pathogens with antibiotic resistance in peritoneal dialysis (PD) peritonitis. We investigated the current pathogen trends and risk factors in PD peritonitis.
Methods:
We conducted a retrospective study analyzing data from 643 patients who maintained PD over 3 months between January 2001 and December 2015. The isolated pathogens from PD peritonitis were compared between period A (2001-2008) and period B (2009-2015).
Results:
Among 643 PD patients, 252 patients experienced one or more episodes of PD peritonitis (total 308 episodes) during the median follow-up of 66 months. In both periods, gram-positive bacteria were the dominant pathogens (22.2% vs. 53.8%, P < 0.01). Gram-negative bacteria showed an increasing tendency in period B, but without statistical significance (17.0% vs. 23.7%, P = 0.15). The culture-negative rate was improved from 57% in period A to 18% in period B (P < 0.01). There was no increase in the prevalence of resistant pathogens such as methicillin-resistant Staphylococcus epidermidis (MRSE), Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli between periods A and B. Preserved residual renal function was associated with a lower risk of PD peritonitis (odds ratio, 0.53; 95% confidence interval, 0.31-0.88; P = 0.01).
Conclusion:
Over the past two decades, the pathogens of PD peritonitis have not significantly changed in Korea. Gram-positive organisms remained dominant, with S. epidermidis being the most common pathogen. Resistant bacteria such as MRSE, MRSA, ESBL-producing Gram-negative bacilli did not increase, but should be monitored.
Insights
Antibiotic resistance in peritoneal dialysis (PD) peritonitis remains a concern, but pathogen trends in Korea have been stable over two decades. Gram-positive bacteria, particularly Staphylococcus epidermidis, are dominant, with no significant increase in resistant strains observed.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Rising concerns regarding antibiotic-resistant pathogens in peritoneal dialysis (PD) peritonitis.
- Need to investigate current pathogen trends and associated risk factors in PD peritonitis.
Purpose of the Study:
- To analyze pathogen trends and identify risk factors for PD peritonitis over a 15-year period.
- To assess changes in the prevalence of antibiotic-resistant bacteria in PD peritonitis.
Main Methods:
- Retrospective study of 643 patients undergoing PD from January 2001 to December 2015.
- Comparison of isolated pathogens from PD peritonitis between two periods: 2001-2008 (Period A) and 2009-2015 (Period B).
Main Results:
- Gram-positive bacteria were the dominant pathogens in both periods (53.8% in Period B).
- Culture-negative rates significantly improved from 57% to 18% (P < 0.01).
- No significant increase in resistant pathogens like MRSE, MRSA, or ESBL-producing E. coli was observed. Preserved residual renal function was a protective factor (OR, 0.53).
Conclusions:
- Pathogen profiles in Korean PD peritonitis have remained relatively stable over two decades.
- Gram-positive organisms, especially S. epidermidis, continue to be the primary cause.
- While resistant bacteria have not increased, ongoing monitoring is crucial.
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