A Quarter of a Century of Adult Peritoneal Dialysis-Related Peritonitis at an Australian Medical Center

Abstract

Background Peritonitis remains one of the major complications of peritoneal dialysis (PD) and results in reduced technique survival and increased patient morbidity and mortality. Methods We prospectively recorded comprehensive data on all episodes of PD peritonitis over a 25-year period, including organisms isolated and antibiotic sensitivities. Data on 1588 PD patient-years with 2073 episodes of peritonitis were analyzed; 2089 organisms were isolated in 608 patients. Peritoneal dialysis technique and patient survival were also recorded. Results There was a significant decline over the years in the incidence of peritonitis, from 6.5 to 0.35 episodes/patient-year, with the decline in the post twin-bag era from 2.3 to 0.47 ( p < 0.001) due primarily to a decrease in gram-positive organisms. The most common isolates (68.9%) were gram-positive organisms; gram-negative organisms comprised 26.8% and fungi 4.1%. Coagulase-negative staphylococci were the most common pathogen isolated (35.3%). Culture-negative peritonitis was seen in 13.4% of episodes. Conclusion This is the largest series of PD peritonitis reported, demonstrating a dramatic reduction over a 25-year period and also detailing the changing trends of organisms isolated in association with improved technique and patient survival. Although rates have improved, peritonitis remains a major complication and further research needs to be done to improve both PD technique and patient survival.

Improving the Quality of a Peritoneal Dialysis Service: Learning From Experience

“…; Brown et al . ). As peritonitis episodes decrease, the clinical outcomes improve as demonstrated by The Aus/NZ Registry (Brown et al .…”

“…In addition, protocols including proper catheter placement, careful training of patients with periodic retraining, particularly after episodes of infection and/or at each home or clinic visit, thorough hand washing with complete drying, and aggressive treatment of exit-site infection can significantly reduce PD-related infections (Bender et al 2006;Brown et al 2007). As peritonitis episodes decrease, the clinical outcomes improve as demonstrated by The Aus/NZ Registry (Brown et al 2007).…”

Impact of early-onset peritonitis on mortality and technique survival in peritoneal dialysis patients

“…Due to improvements in connectology, peritonitis, a common and serious complication of PD, has decreased dramatically (Daly et al 2001 , 2014 ). Over the past several decades, the role of peritonitis as an independent risk factor for mortality and technique failure in PD patients has been well established (Brown et al 2007 ; Davenport 2009 ; Fried et al 1996 ; Kavanagh et al 2004 ; Mizuno et al 2011 ). However, recent studies on this topic have shown contradictory results (Fang et al 2008 ; Isla et al 2014 ).…”

Preclinical Assessment of Adjunctive tPA and DNase for Peritoneal Dialysis Associated Peritonitis

“…A major complication of PD is the development of PD-associated peritonitis, primarily caused by bacterial infections within the abdomen. The definition of PD peritonitis has been standardized and requires two or more of the following criteria: cloudy dialysate fluid and/or abdominal pain and/or fever, dialysate white cell count of >100/μL with >50% neutrophils, or positive culture of dialysate fluid [ 7 ]. PD peritonitis occurs approximately once in every 19–28 patient months on treatment [ 2 ], and is associated with reduced modality and patient survival [ 8 – 11 ].…”