Endogenous peritonitis and related outcome in peritoneal dialysis patients

Our objective was to study endogenous peritonitis and related catheter outcome in peritoneal dialysis (PD) patients. The study was designed to investigate endogenous peritonitis and related catheter loss in all end-stage renal disease (ESRD) patients who started peritoneal dialysis from January, 1989 to September, 1995. In a tertiary-referral university hospital, 192 ESRD patients (117 male, 75 female) who entered the home program from 1/89 to 9/95 were studied. Sixteen episodes of endogenous peritonitis occurred in 15 PD patients (7 male, 8 female) with a mean age of 63 years (range 33-81 years). Five patients were diabetic. Two hundred and seventeen episodes of peritonitis in 192 patients occurred over 4149 patient-months, resulting in one episode/19.1 patient-months. Sixteen episodes of endogenous peritonitis were encountered in 15 patients, accounting for 7% of all episodes of peritonitis. The mean duration of PD before contracting endogenous peritonitis was 24.2 months (range 7-52 months). Eleven episodes were related to diverticular leak/perforation, three to sigmoidoscopy/colonoscopy/PEG procedures, one to unknown etiology, and one to cholecystitis. During 11 episodes, severe constipation preceded. All the patients were initially treated conservatively with antibiotics. Five episodes (31%) responded to antibiotic therapy alongside antifungal prophylaxis and continued PD. One episode (6%) required cholecystectomy without catheter removal and resumed PD. Six episodes (38%) required catheter removal due to subsequent fungal peritonitis in a mean of 11 days (range 3-24 days): 4 patients transferred to hemodialysis and 2 patients resumed PD. Three patients underwent catheter removal along with colectomy and colostomy: 2 patients transferred to hemodialysis and 1 patient died in ten days. One patient refused surgery and died in 16 days. Endogenous peritonitis resulted in a high incidence of catheter loss and dropout from PD. Peritonitis due to bowel leak without frank bowel perforation can be managed with antibiotic therapy and antifungal prophylaxis. Aggressive management of constipation may decrease endogenous peritonitis.