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Staphylococcal peritonitis in patients on continuous peritoneal dialysis
Abstract:
During 1984, 35 patients undergoing continuous peritoneal dialysis experienced 77 cases of peritonitis with 55 cases (71.4%) related to staphylococci. Coagulase-negative staphylococci were isolated in 41 cases, while Staphylococcus aureus was found in 14. A coexisting tunnel infection was more often associated with S. aureus (7/14) than with coagulase-negative staphylococci (2/41) (P less than 0.01). Likewise, eradication of the infection necessitated catheter removal more frequently with S. aureus (5/14) than with coagulase-negative staphylococci (2/41) (P less than 0.01). Of the 41 coagulase-negative staphylococci, 35 were characterized as to species, adherence, and production of two exopolysaccharides. Staphylococcus epidermidis was the most frequent coagulase-negative species (29/35). Peritonitis cases caused by coagulase-negative staphylococci that lacked adherence and exopolysaccharides were more frequently associated with complications (4/6) than were those organisms with either or both properties of adherence or exopolysaccharide production (5/29). There were no appreciable differences in antibiotic susceptibilities. Staphylococcal peritonitis remains a significant cause of morbidity in continuous peritoneal dialysis patients. The incidence of complications was not directly linked to staphylococcal properties of adherence or exopolysaccharide production.
Insights
Staphylococcal peritonitis is a major complication for patients on continuous peritoneal dialysis. Staphylococcus aureus infections led to more tunnel infections and catheter removal than coagulase-negative staphylococci.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Peritonitis is a serious complication in patients undergoing continuous peritoneal dialysis (CPD).
- Staphylococcal infections are a leading cause of peritonitis in CPD patients.
Purpose of the Study:
- To investigate the characteristics and clinical outcomes of staphylococcal peritonitis in CPD patients.
- To differentiate the roles of Staphylococcus aureus and coagulase-negative staphylococci in peritonitis and its complications.
Main Methods:
- Retrospective analysis of 77 peritonitis cases in 35 CPD patients during 1984.
- Identification and characterization of staphylococcal species, including coagulase-negative staphylococci (CoNS) species, adherence, and exopolysaccharide production.
- Comparison of complication rates (tunnel infection, catheter removal) between S. aureus and CoNS infections.
Main Results:
- Staphylococci accounted for 71.4% of peritonitis cases (55/77).
- Staphylococcus aureus infections were associated with significantly higher rates of tunnel infections (P<0.01) and catheter removal (P<0.01) compared to CoNS.
- Staphylococcus epidermidis was the most common CoNS species (29/35).
- Peritonitis cases caused by CoNS lacking adherence and exopolysaccharides showed a trend towards more complications, though not statistically significant.
- No significant differences in antibiotic susceptibilities were observed between S. aureus and CoNS.
Conclusions:
- Staphylococcal peritonitis remains a significant cause of morbidity in CPD patients.
- Staphylococcus aureus poses a greater risk for severe complications, including tunnel infections and the need for catheter removal, compared to coagulase-negative staphylococci.
- While certain microbial properties of CoNS were studied, they did not appear to directly correlate with the incidence of complications in this cohort.