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Analysis of continuous ambulatory peritoneal dialysis-related Pseudomonas aeruginosa infections
J Bernardini1, B Piraino, M Sorkin
1Department of Internal Medicine, University of Pittsburgh, Pennsylvania.
Abstract:
The outcomes of all continuous ambulatory peritoneal dialysis-related infections due to Pseudomonas aeruginosa (n = 33) were analyzed and compared with the outcomes of infections due to all other microorganisms (n = 663) over a seven-year period. There were 16 catheter infections (exit site or tunnel infection or both), seven episodes of peritonitis, and 10 episodes of catheter infections associated with peritonitis due to P. aeruginosa. Catheters were removed in 58 percent (19 of 33) of the infections due to P. aeruginosa, but in only 16 percent (104 of 663) of the infections due to other organisms (p less than 0.01). All P. aeruginosa catheter infections associated with P. aeruginosa peritonitis resulted in catheter loss. P. aeruginosa catheter infections not associated with peritonitis also often did not resolve with antibiotic therapy (nine of 16 or 56 percent of catheters removed compared with 42 of 317 or 13 percent of catheters removed for other organisms, p less than 0.01). However, P. aeruginosa peritonitis episodes that were not associated with a catheter infection were no more likely to result in catheter loss than were peritonitis episodes due to other organisms (one of seven compared with 37 of 256, 14 percent for both). It is concluded that catheter infections due to P. aeruginosa with or without associated peritonitis usually require catheter removal. Conversely, P. aeruginosa peritonitis without a catheter infection often does not require catheter removal.
Insights
Pseudomonas aeruginosa infections in continuous ambulatory peritoneal dialysis often require catheter removal, especially when associated with peritonitis. However, peritonitis alone caused by P. aeruginosa may not necessitate catheter removal.
Area of Science:
- Nephrology
- Infectious Diseases
- Medical Microbiology
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a vital treatment for end-stage renal disease.
- Infections, particularly those caused by Pseudomonas aeruginosa, pose a significant threat to the success of CAPD.
- Understanding the outcomes of P. aeruginosa infections is crucial for optimizing patient management.
Purpose of the Study:
- To compare the outcomes of CAPD-related infections caused by Pseudomonas aeruginosa with those caused by other microorganisms.
- To determine the factors influencing catheter removal in P. aeruginosa infections.
Main Methods:
- Retrospective analysis of 7-year data on CAPD-related infections.
- Comparison of infection outcomes between P. aeruginosa (n=33) and other microorganisms (n=663).
- Analysis of catheter infection, peritonitis, and combined infection outcomes.
Main Results:
- Catheter removal rates were significantly higher for P. aeruginosa infections (58%) compared to other organisms (16%).
- All P. aeruginosa catheter infections with peritonitis led to catheter loss.
- P. aeruginosa catheter infections without peritonitis also frequently required catheter removal (56%).
- P. aeruginosa peritonitis without catheter infection had similar catheter loss rates to other organisms (14%).
Conclusions:
- CAPD catheter infections due to P. aeruginosa, with or without peritonitis, typically necessitate catheter removal.
- P. aeruginosa peritonitis without concurrent catheter infection often does not require catheter removal, suggesting a more conservative management approach in such cases.