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Outcome of polymicrobial peritonitis in continuous ambulatory peritoneal dialysis patients
L Kiernan1, F O Finkelstein, A S Kliger
1Department of Medicine, Hospital of St Raphael, New Haven, CT.
Abstract:
Polymicrobial peritonitis is a relatively uncommon, but potentially serious complication that develops in continuous ambulatory peritoneal dialysis (CAPD) patients. Its cause and optimal management remain controversial. The authors reviewed the frequency and natural history of polymicrobial peritonitis in 432 CAPD patients. Of 1,405 episodes of peritonitis, 80 were polymicrobial (6%). Patients with polymicrobial peritonitis were similar to all CAPD patients in age, gender, race, and underlying renal disease. Diabetes mellitus, human immunodeficiency virus (HIV) status, and clinically apparent gastrointestinal disease did not predisposes patients to polymicrobial peritonitis. Thirty days after the polymicrobial peritonitis, 64 patients remained on CAPD (80%), and at 180 days 48 patients continued CAPD. Prior exit-site infections were present in 12 patients (14%) with polymicrobial peritonitis. Only 22% of patients required catheter removal to treat the infection. We conclude that polymicrobial peritonitis accounts for 6% of the total episodes of peritonitis; diabetes, HIV infection, and underlying gastrointestinal disease are not more prevalent in patients with multiorganism infections. Most patients continue CAPD therapy at 30 and 180 days after the episode of polymicrobial peritonitis.
Insights
Polymicrobial peritonitis, a complication in continuous ambulatory peritoneal dialysis (CAPD), affects 6% of patients. Most patients successfully continue CAPD therapy after treatment for this infection.
Area of Science:
- Nephrology
- Infectious Diseases
- Internal Medicine
Background:
- Polymicrobial peritonitis is a serious complication in continuous ambulatory peritoneal dialysis (CAPD) patients.
- Its causes and optimal management are not well-established.
- This study investigates the frequency and outcomes of polymicrobial peritonitis in CAPD.
Purpose of the Study:
- To determine the incidence of polymicrobial peritonitis in CAPD patients.
- To analyze the natural history and outcomes of polymicrobial peritonitis.
- To identify risk factors associated with polymicrobial peritonitis.
Main Methods:
- Retrospective review of 432 CAPD patients.
- Analysis of 1,405 episodes of peritonitis, with a focus on 80 polymicrobial cases.
- Assessment of patient demographics, comorbidities, and treatment outcomes.
Main Results:
- Polymicrobial peritonitis accounted for 6% of all peritonitis episodes.
- Patients with polymicrobial peritonitis were similar to the general CAPD population in demographics and underlying renal disease.
- Diabetes, HIV, and gastrointestinal disease did not increase the risk of polymicrobial peritonitis.
- 80% of patients continued CAPD at 30 days and 48% at 180 days post-episode.
- Only 22% required catheter removal.
Conclusions:
- Polymicrobial peritonitis is an infrequent complication of CAPD.
- Specific comorbidities like diabetes or HIV do not predispose patients to polymicrobial infections.
- Most CAPD patients can continue therapy after experiencing polymicrobial peritonitis, with a low rate of catheter removal.