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Changing microbiology and outcomes of PD-associated peritonitis over four decades
Leonie Kraft1, Julia Oppold2, Daniel Kitterer3
1Department of General Internal Medicine and Nephrology, Robert Bosch Hospital Stuttgart, Stuttgart, Germany.
Background:
Peritoneal dialysis (PD)-associated peritonitis remains a major complication affecting patient outcomes and modality survival. This study aims to evaluate temporal trends in pathogen distribution and antibiotic susceptibility over four decades as well as clinical outcomes in PD-associated peritonitis.
Methods:
We retrospectively analyzed 832 peritonitis cultures of PD patients across four decades from 1979 to 2024 treated at Robert Bosch Hospital, Stuttgart (Germany). For longitudinal comparison of pathogen distribution and antibiotic susceptibility, the study period was divided into four time periods: P1 (1979-1992), P2 (1993-2003), P3 (2004-2014), and P4 (2015-2024). Clinical response and outcomes were assessed in P4.
Results:
Gram-positive bacteria was the most frequent causative organisms (56%), followed by Gram-negative bacteria (30%) and culture-negative peritonitis (CNP, 13%). Gram-negative peritonitis increased significantly in P4 compared to P1-P3, while coagulase-negative staphylococci (CNS) declined from 31% in P1 to 14% in P4 (P = .0446). Vancomycin susceptibility among Gram-positive organisms remained high, whereas cefazolin susceptibility changed over time. In P4, the overall cure rate was 63%, with the highest in gram-positive (72%) and lowest in polymicrobial peritonitis (43%).Regarding clinical outcomes, transition to permanent hemodialysis (HD) was significantly more frequent in Gram-negative than Gram-positive peritonitis (27% vs. 12%; P = .03). Both catheter removal and transition to permanent HD occurred significantly more often in polymicrobial peritonitis (54% and 40%) compared with Gram-positive (24% and 12%; P = .001 and P = .0008) and CNP (30% and 17%; P = .01 and P = .04). Regarding individual pathogens, Staphylococcus aureus (MSSA) was associated with a significantly higher catheter removal rate compared to other Gram-positive organisms.
Conclusion:
Our findings show temporal changes of microbiological spectrum of PD-associated peritonitis over four decades. Polymicrobial and Gram-negative peritonitis were associated with poorer outcomes, emphasizing the need for ongoing microbiological surveillance and antibiotic stewardship to optimize PD care.
Insights
Peritoneal dialysis peritonitis trends show increasing Gram-negative infections and declining coagulase-negative staphylococci over four decades. Polymicrobial and Gram-negative peritonitis are linked to worse outcomes, necessitating improved surveillance and antibiotic stewardship.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Peritoneal dialysis (PD)-associated peritonitis is a significant complication impacting patient outcomes and dialysis modality survival.
- Understanding temporal trends in causative pathogens and antibiotic susceptibility is crucial for effective management.
Purpose of the Study:
- To evaluate changes in pathogen distribution and antibiotic susceptibility in PD-associated peritonitis over four decades (1979-2024).
- To assess clinical outcomes, including cure rates, catheter removal, and transition to hemodialysis, in the most recent decade.
Main Methods:
- Retrospective analysis of 832 peritonitis cultures from PD patients treated between 1979 and 2024.
- Division of the study period into four distinct time intervals for longitudinal comparison.
- Assessment of clinical response and outcomes in the 2015-2024 period.
Main Results:
- Gram-positive bacteria were the most common cause (56%), followed by Gram-negative bacteria (30%).
- Gram-negative peritonitis significantly increased in the latest period (2015-2024), while coagulase-negative staphylococci decreased (P=.0446).
- Overall cure rate in the recent period was 63%; polymicrobial and Gram-negative peritonitis were associated with higher rates of catheter removal and transition to hemodialysis.
Conclusions:
- Significant temporal shifts in the microbiological landscape of PD-associated peritonitis have occurred over four decades.
- Polymicrobial and Gram-negative peritonitis are associated with poorer clinical outcomes, highlighting the need for vigilant microbiological surveillance.
- Optimizing PD care requires ongoing antibiotic stewardship and adaptation to evolving pathogen trends.
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