Related Experiment Video
Updated: Nov 2, 2025
A Retrograde Implantation Approach for Peritoneal Dialysis Catheter Placement in Mice
Published on: July 20, 2022
Clinical and microbiological factors predicting outcomes of nonfermenting gram-negative bacilli peritonitis in
Ana Claudia Moro Lima Dos Santos1, Rodrigo Tavanelli Hernandes1, Augusto Cezar Montelli1,2
1Biosciences Institute of Botucatu, Sao Paulo State University Julio de Mesquita Filho (UNESP), Botucatu, Brazil.
Abstract:
Peritonitis due to gram-negative bacilli (GNB), particularly nonfermenting GNB (NF-GNB), is a serious complication of peritoneal dialysis with a low resolution rate. Beyond the patient's condition, microbiological properties such as antimicrobial resistance, biofilm production and other virulence factors can explain the poor outcomes. This study aimed to evaluate the influence of patient condition, microbiological characteristics, including biofilm production, and treatment on peritonitis outcome. We reviewed the records of 62 index episodes caused by NF-GNB that occurred between 1997 and 2015 in our center. The etiologies were species of Pseudomonas (51.6%), Acinetobacter (32.2%), and other NF-GNB (16.1%). There was a high (72.9%) proportion of biofilm producer lineages. The in vitro susceptibility rate of Pseudomonas spp. to amikacin, ciprofloxacin, and ceftazidime was significantly greater than that of Acinetobacter spp. and other species; however, there was a similar low resolution rate (< 45%) among the episodes attributable to them. Preexisting exit-site infection was independently associated with nonresolution. No other factor, including biofilm production, was associated with the outcome. The higher in vitro susceptibility of Pseudomonas compared to other NF-GNB that presented a similar resolution rate suggests that bacterial virulence factors such as biofilms can act in concert, thereby worsening the outcome.
Insights
Peritonitis from nonfermenting gram-negative bacilli (NF-GNB) in peritoneal dialysis patients has poor outcomes. Preexisting exit-site infections, not biofilm production, were linked to nonresolution.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Peritonitis is a serious complication of peritoneal dialysis (PD).
- Nonfermenting gram-negative bacilli (NF-GNB) cause PD peritonitis with low resolution rates.
- Microbial virulence factors, including antimicrobial resistance and biofilm production, may impact outcomes.
Purpose of the Study:
- To evaluate patient condition, microbiological characteristics (including biofilm production), and treatment's influence on PD peritonitis outcomes caused by NF-GNB.
- To identify factors associated with peritonitis nonresolution in PD patients.
Main Methods:
- Retrospective review of 62 index peritonitis episodes caused by NF-GNB between 1997 and 2015.
- Analysis of etiologies (Pseudomonas, Acinetobacter, other NF-GNB), biofilm production, in vitro antimicrobial susceptibility, and clinical data.
- Statistical analysis to determine factors independently associated with peritonitis nonresolution.
Main Results:
- NF-GNB peritonitis was primarily caused by Pseudomonas (51.6%) and Acinetobacter (32.2%) species.
- A high proportion (72.9%) of causative NF-GNB strains were biofilm producers.
- Pseudomonas spp. showed higher in vitro susceptibility to amikacin, ciprofloxacin, and ceftazidime than Acinetobacter spp. and other NF-GNB.
- Peritonitis resolution rates were similarly low (<45%) across different NF-GNB etiologies.
- Preexisting exit-site infection was the only factor independently associated with nonresolution.
Conclusions:
- Despite higher in vitro susceptibility, Pseudomonas-related peritonitis had similar low resolution rates as Acinetobacter-related peritonitis.
- Biofilm production alone was not independently associated with peritonitis nonresolution.
- Bacterial virulence factors, potentially acting in concert with biofilms, may contribute to poor outcomes in NF-GNB peritonitis.
- Preexisting exit-site infection is a critical risk factor for peritonitis nonresolution in PD patients.
More Related Videos
Related Concept Videos
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:25Peritoneal Dialysis III: Nursing Management
01:26Urine Studies II: Urine Culture and Sensitivity Test
01:30Peritoneal Dialysis I: Introduction and Procedure
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention