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Predictive Factors, Treatment, and Outcomes of Coagulase-Negative Staphylococcal Peritonitis in Malaysian Peritoneal
Siew Yan Lau1, Boon Cheak Bee2, Hin-Seng Wong2,3
1Department of Pharmacy, Selayang Hospital, Selayang, Malaysia.
Aims:
Coagulase-negative Staphylococci (CoNS) are frequently isolated in peritoneal dialysis (PD)-related peritonitis with a high rate of relapse and repeat peritonitis after initial response to antimicrobials. The optimal treatment regimen for CoNS peritonitis remains debatable. Hence, this study aimed to describe the clinical and microbiologic characteristics of CoNS peritonitis in a PD center and determine predictive factors influencing the outcomes.
Methods:
All cases of CoNS peritonitis in Selayang Hospital between 2011 and 2019 were reviewed retrospectively.
Results:
A total of 906 episodes of peritonitis were recorded; 140 episodes (15%) in 98 patients were caused by CoNS. The oxacillin and gentamicin resistance rates were 47% and 46%, respectively. The overall primary response rate was 90%, and the complete cure rate was 79%. Patients with concomitant exit-site infection (odds ratio (OR) 0.06, 95% confidence interval (CI) 0.01 to 0.40, P < 0.01) and history of recent systemic antibiotic use (OR 0.04, 95% CI 0.01 to 0.82, P=0.04) were less likely to achieve primary response. CoNS episodes that were treated with beta-lactam-based or vancomycin-based therapy had a similar primary response rate and complete cure rate. The rates of relapse and repeat were 12% and 16%, respectively. Relapsed episodes (OR 0.35, 95% CI 0.13 to 0.97, P=0.04) had a significantly lower complete cure rate than the first episodes.
Conclusion:
Relapsed CoNS peritonitis was common and was associated with worse outcomes than the first episode of CoNS peritonitis. Oxacillin resistance was common, but the treatment outcome remained favourable when a beta-lactam-based regimen was used as empirical therapy.
Insights
Coagulase-negative Staphylococci (CoNS) peritonitis in peritoneal dialysis (PD) patients frequently relapses, leading to worse outcomes. Beta-lactam empirical therapy shows favorable results despite high oxacillin resistance.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Coagulase-negative Staphylococci (CoNS) are a common cause of peritonitis in patients undergoing peritoneal dialysis (PD).
- CoNS peritonitis is associated with high rates of relapse and repeat infections, complicating treatment.
- Optimal therapeutic strategies for CoNS peritonitis remain a subject of debate.
Purpose of the Study:
- To characterize the clinical and microbiological features of CoNS peritonitis in a PD setting.
- To identify factors that predict treatment outcomes in CoNS peritonitis.
- To evaluate the effectiveness of different empirical antibiotic regimens.
Main Methods:
- Retrospective review of all CoNS peritonitis cases at Selayang Hospital from 2011 to 2019.
- Analysis of 140 CoNS peritonitis episodes in 98 PD patients.
- Assessment of resistance patterns, treatment responses, relapse rates, and repeat peritonitis.
Main Results:
- CoNS caused 15% of 906 peritonitis episodes; oxacillin and gentamicin resistance rates were 47% and 46%.
- Overall primary response was 90%, with a 79% complete cure rate.
- Concomitant exit-site infection and recent systemic antibiotic use predicted poorer primary response. Relapsed episodes had lower cure rates.
Conclusions:
- Relapsed CoNS peritonitis is common and associated with significantly worse outcomes.
- Despite high oxacillin resistance, beta-lactam-based empirical therapy demonstrated favorable treatment outcomes.
- Effective management strategies are crucial to improve cure rates and reduce recurrence.
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