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Microbiology and outcomes of polymicrobial peritonitis associated with peritoneal dialysis: a register-based cohort
Valentine Forté1, Sophie Novelli2, Mohamad Zaidan3
1Sorbonne Université, Faculty of Medicine, Assistance Public des Hopitaux de Paris, Paris, France.
Background:
Previous studies have reported that polymicrobial peritonitis in peritoneal dialysis (PD) is associated with poor outcomes, but recent data from European cohorts are scarce.
Methods:
We included from the French Language Peritoneal Dialysis Registry all patients ≥18 years of age who started PD between January 2014 and November 2020. We compared microbiology and patient characteristics associated with mono- and polymicrobial peritonitis. We assessed patient outcomes after a first polymicrobial peritonitis using survival analysis with competing events. We differentiated microorganisms isolated from dialysis effluent as enteric or non-enteric pathogens.
Results:
A total of 8848 patients contributed 13 023 patient-years of follow-up and 3348 culture-positive peritonitis episodes, including 251 polymicrobial ones. This corresponded to rates of 0.32 and 0.02 episodes/patient-year, respectively. For most patients (72%) who experienced polymicrobial peritonitis, this was their first peritonitis episode. Enteric pathogens were more frequently isolated in polymicrobial than in monomicrobial peritonitis (57 versus 44%; P < .001). In both cases of peritonitis with and without enteric pathogens, the polymicrobial versus monomicrobial character of the peritonitis was not associated with mortality in patients who did not switch to haemodialysis {adjusted cause-specific hazard ratio [acsHR] 1.2 [95% confidence interval (CI) 0.3-5.0], P = .78 and 1.1 [95% CI 0.7-1.8], P = .73, respectively}. However, the risks of death and switch to haemodialysis were higher for monomicrobial peritonitis with enteric pathogens compared with those without [acsHR 1.3 (95% CI 1.1-1.7), P = .02 and 1.9 (95% CI 1.5-2.4), P < .0001, respectively].
Conclusion:
Isolation of enteric pathogens, rather than the polymicrobial character of the peritonitis, is associated with poorer outcomes.
Insights
Polymicrobial peritonitis in peritoneal dialysis (PD) is not linked to worse outcomes. Instead, the presence of enteric pathogens, regardless of whether the infection is polymicrobial or monomicrobial, is associated with poorer PD patient outcomes.
Area of Science:
- Nephrology
- Infectious Diseases
- Peritoneal Dialysis
Background:
- Polymicrobial peritonitis in peritoneal dialysis (PD) is historically linked to adverse patient outcomes.
- Recent European data on polymicrobial peritonitis in PD patients are limited.
Purpose of the Study:
- To investigate the association between polymicrobial peritonitis and patient outcomes in a contemporary European cohort.
- To compare the characteristics and microbiology of monomicrobial versus polymicrobial peritonitis in PD patients.
- To identify specific microbial factors influencing outcomes in PD peritonitis.
Main Methods:
- Analysis of data from the French Language Peritoneal Dialysis Registry (2014-2020).
- Inclusion of patients aged 18+ years initiating PD.
- Comparison of mono- and polymicrobial peritonitis microbiology and patient characteristics.
- Survival analysis with competing events to assess outcomes after the first polymicrobial peritonitis episode.
- Categorization of isolated microorganisms as enteric or non-enteric pathogens.
Main Results:
- A total of 8848 patients and 13,023 patient-years of follow-up were analyzed, with 3348 culture-positive peritonitis episodes, including 251 polymicrobial ones.
- Enteric pathogens were more prevalent in polymicrobial peritonitis (57%) compared to monomicrobial peritonitis (44%).
- Polymicrobial peritonitis was not associated with increased mortality compared to monomicrobial peritonitis, irrespective of enteric pathogen presence, in patients not switching to hemodialysis.
- Monomicrobial peritonitis with enteric pathogens showed significantly higher risks of death and transfer to hemodialysis compared to those without enteric pathogens.
Conclusions:
- The presence of enteric pathogens, not the polymicrobial nature of the infection, is the primary driver of poorer outcomes in peritoneal dialysis peritonitis.
- Clinical management and risk stratification should focus on identifying enteric pathogens in PD peritonitis.
- Further research into targeted therapies against enteric pathogens in PD peritonitis is warranted.
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