Repeat and Relapsing Peritonitis Microbiological Trends and Outcomes: A 21-Year Single-Center Experience.

Area of Science:

• Nephrology
• Infectious Diseases
• Peritoneal Dialysis

Background:

• Peritonitis is a significant complication of peritoneal dialysis (PD).
• Relapsing peritonitis often necessitates Tenckhoff catheter removal due to biofilm formation.
• Clear indications for catheter removal in repeat peritonitis are less defined, prompting investigation into management strategies.

Purpose of the Study:

• To evaluate the microbiology and clinical outcomes of repeat and relapsing peritonitis.
• To assess the impact of these recurrent infections on technique survival in PD patients.
• To analyze the effect of Tenckhoff catheter removal on the incidence of subsequent peritonitis episodes caused by the same microorganism.

Main Methods:

• A single-center retrospective study was conducted from 1998 to 2019.
• Repeat and relapsing peritonitis cases were compared to a control group.
• Data analyzed included causative microorganisms, cure rates, catheter removal status, and dialysis modality transfer.

Main Results:

• The repeat/relapsing peritonitis group showed a higher cure rate (80.4% vs. 74.5%) and lower hospitalization rates (10.9% vs. 27.7%) compared to controls.
• Technique survival was superior in the repeat/relapsing peritonitis group (log rank=4.5, p=0.03).
• Gram-positive bacteria, particularly *Streptococci viridans*, were more prevalent in repeat/relapsing cases (43.5% vs. 21.3%).

Conclusions:

• While repeat and relapsing peritonitis exhibit higher cure rates, they are associated with increased morbidity and further infectious episodes.
• The probability of a subsequent peritonitis episode by the same microorganism is similar whether the Tenckhoff catheter is removed or not in repeat peritonitis.
• Further research is needed to optimize management strategies for recurrent peritonitis to improve long-term PD outcomes.