[Peritonitis in continuous ambulatory peritoneal dialysis. An evaluation of the empiric initial antibiotic treatment]

Retrospectively, the clinical outcome and the initial empiric antibiotic treatment of peritonitis in 106 patients on continuous ambulatory peritoneal dialysis (CAPD) were evaluated during a two-year period. A mean frequency of 0.89 episodes of peritonitis per year of dialysis was found. There was a tendency towards an increased frequency of peritonitis in older patients. Diabetic patients constituted a younger age group and had a tendency towards having a lower risk of peritonitis. Patients with polycystic renal disease had a significantly increased risk. The risk of episodes with coagulase-negative staphylococci increased significantly with age. Repeated peritonitis episodes with coagulase-negative staphylococci was associated with a significant increase in the appearance of methicillin drug resistance. Carriers of Staphylococcus aureus had a significantly increased risk of Staphylococcus aureus peritonitis. Microorganisms were cultured in 94% of the episodes. The initial antibiotic therapy was only sufficient in 66% due to antimicrobial drug resistance. The initial antibiotic treatment was changed in 58% of the episodes. The treatment could have been changed to antibiotics with a narrower antimicrobial spectrum in 51% of the episodes. Relapse was seen in 11% of culture positive episodes. In 16% of the episodes (29% of patients with peritonitis) it was necessary to remove the dialysis catheter and transfer the patient to haemodialysis to clear the infection. Only 15% of these patients returned to CAPD again. We found that an initial empiric antibiotic regime of vancomycin combined with an aminoglycoside is to be recommended as achieving an antibiotic coverage of 88%, and this is now the standard regime in the department.