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Risk factors for multidrug-resistant organisms and their outcomes in peritoneal dialysis-related peritonitis: a
Yohan Park1, Jieun Shin2, Daun Song1
1Division of Nephrology, Department of Internal Medicine, Konyang University Hospital, College of Medicine, Konyang University, Daejeon, Republic of Korea.
Background:
Multidrug-resistant organisms (MDROs) present significant challenges in the treatment of peritoneal dialysis (PD)-related peritonitis. This study aimed to describe the incidence, risk factors, and outcomes of MDRO-peritonitis in a national cohort from the PDOPPS (Peritoneal Dialysis Outcomes and Practice Patterns Study)-Korea.
Methods:
Between July 2019 and December 2021, 147 of 292 peritonitis episodes had available data on organism sensitivity and resistance. Episodes were categorized as MDRO-defined as resistance to three or more classes of antibiotics-or non-MDRO. Multivariate logistic regression analysis identified factors associated with MDRO versus non-MDRO peritonitis and predictors of peritonitis cure.
Results:
Forty-one of the total 292 peritonitis episodes (14.0%) were identified as MDRO. Prior hospitalization (odds ratio [OR], 32.9; 95% confidence interval [CI], 3.5-313.1), diabetes mellitus (OR, 4.1; 95% CI, 1.2-14.2), and recurrent peritonitis (OR, 48.3; 95% CI, 3.2-735.8) were independent risk factors for MDRO-peritonitis. In the analysis of factors associated with peritonitis cure, longer PD vintage (OR, 0.8; 95% CI, 0.7-1.0) and Gram-negative organisms (OR, 0.1; 95% CI, 0.0-0.4) were associated with lower cure rates, while higher serum albumin level (OR, 1.2; 95% CI, 1.1-1.4) and management at a tertiary referral hospital (OR, 8.8; 95% CI, 1.6-48.0) were associated with higher cure rates. MDRO status itself was not significantly associated with peritonitis cure.
Conclusion:
Nearly one in seven peritonitis episodes (14.0%) was caused by MDROs. Prior hospitalization, diabetes mellitus, and recurrent peritonitis were independent risk factors for MDRO-peritonitis. Regarding peritonitis cure, characteristics of causative organisms tended to have a greater impact than did MDRO status itself.
Insights
Multidrug-resistant organism peritonitis (MDRO) affects 14% of peritoneal dialysis patients. Risk factors include prior hospitalization and diabetes, with organism type impacting cure more than MDRO status.
Area of Science:
- Nephrology
- Infectious Diseases
- Public Health
Background:
- Multidrug-resistant organisms (MDROs) pose significant treatment challenges for peritoneal dialysis (PD)-related peritonitis.
- Understanding MDRO-peritonitis is crucial for improving patient outcomes in PD.
Purpose of the Study:
- To determine the incidence, risk factors, and outcomes of MDRO-peritonitis in a national cohort.
- To identify predictors of peritonitis cure in PD patients.
Main Methods:
- Analysis of 292 peritonitis episodes from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS)-Korea (July 2019-December 2021).
- Categorization of episodes into MDRO (resistance to ≥3 antibiotic classes) or non-MDRO.
- Multivariate logistic regression to identify risk factors and predictors of cure.
Main Results:
- 14.0% of peritonitis episodes were caused by MDROs.
- Independent risk factors for MDRO-peritonitis included prior hospitalization, diabetes mellitus, and recurrent peritonitis.
- Peritonitis cure was associated with Gram-negative organisms and longer PD vintage (lower cure rates), and higher serum albumin and tertiary hospital management (higher cure rates). MDRO status was not significantly associated with cure.
Conclusions:
- MDROs account for a substantial proportion of peritonitis cases in PD patients.
- Specific patient factors and organism characteristics significantly influence peritonitis outcomes.
- Treatment strategies should consider organism type and patient comorbidities for effective peritonitis management.
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