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Infectious peritonitis. The main complication of intermittent peritoneal dialysis
Abstract:
Infectious peritonitis was studied in 164 patients with renal failure receiving 24,282 peritoneal dialyses over a five-year period. One hundred and fifty nine episodes were registered in 93 patients. The overall incidence was 0.66 episodes per 100 dialyses. Two epidemics accounted for a higher incidence during the first half of the study, while the incidence of endemic peritonitis remained unchanged. Infectious peritonitis was the most common complication among out-patients and was the cause of drop out in 39 per cent of the patients transferred to haemodialysis. The calculated mortality from peritonitis was 0.08, corresponding to one fifth of all deaths. The case fatality rate was 0.14. The most common aetiological microorganisms were Staphylococcus aureus and micrococci, accounting for 50 per cent of the cases. Forty six per cent of the cases caused by Staphylococcus aureus were preceded by wound or catheter tunnel infections with the same strain. This points to the abdominal skin flora as the main source of endemic peritonitis. However, further epidemiological studies are needed to elucidate how the skin saprophytes reach the peritoneal cavity.
Insights
Infectious peritonitis is a significant complication in patients undergoing peritoneal dialysis, leading to high dropout rates and mortality. Staphylococcus aureus is a common cause, often linked to skin infections near the catheter site.
Area of Science:
- Nephrology
- Infectious Diseases
- Epidemiology
Background:
- Infectious peritonitis is a serious complication for patients with renal failure undergoing peritoneal dialysis.
- Understanding its incidence, causes, and outcomes is crucial for patient management and treatment strategies.
Purpose of the Study:
- To investigate the incidence, etiological agents, and clinical outcomes of infectious peritonitis in patients with renal failure undergoing peritoneal dialysis.
- To identify risk factors and sources of infection to inform preventative measures.
Main Methods:
- Retrospective analysis of 164 patients with renal failure undergoing 24,282 peritoneal dialysis procedures over five years.
- Epidemiological data collection on peritonitis episodes, causative microorganisms, and patient outcomes, including mortality and transfer to hemodialysis.
Main Results:
- An overall incidence of 0.66 episodes per 100 dialyses was observed, with two epidemics noted.
- Infectious peritonitis was the most frequent complication, causing 39% of patient dropouts from peritoneal dialysis.
- Staphylococcus aureus and micrococci were the most common pathogens (50% of cases), with 46% of S. aureus infections preceded by wound or catheter tunnel infections.
Conclusions:
- Infectious peritonitis significantly impacts patients on peritoneal dialysis, contributing to high morbidity and mortality.
- The abdominal skin flora, particularly Staphylococcus aureus, appears to be a primary source of endemic peritonitis.
- Further research is needed to clarify the transmission pathways of skin microorganisms to the peritoneal cavity.