Acinetobacter Peritoneal Dialysis Peritonitis: A Changing Landscape over Time

Abstract

Background Acinetobacter species are assuming an increasingly important role in modern medicine, with their persistent presence in health-care settings and antibiotic resistance. However, clinical reports addressing this issue in patients with peritoneal dialysis (PD) peritonitis are rare.MethodsAll PD peritonitis episodes caused by Acinetobacter that occurred between 1985 and 2012 at a single centre were retrospectively reviewed. Clinical features, microbiological data, and outcomes were analysed, with stratifications based upon temporal periods (before and after 2000).Results Acinetobacter species were responsible for 26 PD peritonitis episodes (3.5% of all episodes) in 25 patients. A. baumannii was the most common pathogen (54%), followed by A. iwoffii (35%), with the former being predominant after 2000. Significantly more episodes resulted from breaks in exchange sterility after 2000, while those from exit site infections decreased (P = 0.01). The interval between the last and current peritonitis episodes lengthened significantly after 2000 (5 vs. 13.6 months; P = 0.05). All the isolates were susceptible to cefepime, fluoroquinolone, and aminoglycosides, with a low ceftazidime resistance rate (16%). Nearly half of the patients (46%) required hospitalisation for their Acinetobacter PD-associated peritonitis, and 27% required an antibiotic switch. The overall outcome was fair, with no mortality and a 12% technique failure rate, without obvious interval differences.ConclusionsThe temporal change in the microbiology and origin of Acinetobacter PD-associated peritonitis in our cohort suggested an important evolutional trend. Appropriate measures, including technique re-education and sterility maintenance, should be taken to decrease the Acinetobacter peritonitis incidence in PD patients.

Acinetobacter lwoffii Peritonitis in a Patient on Automated Peritoneal Dialysis: A Case Report and Review of the Literature

“…Chao et al stated that DM and chronic glomerulonephritis are the most common causes of renal disease in the Acinetobacter peritonitis patients [9]. Similarly, our patient had comorbidity as DM, renal disease, and smoking.…”

Perirectal Abscess: Camouflaged as Culture Negative Peritonitis in a Continuous Ambulatory Peritoneal Dialysis Patient

“…Acinetobacter baumannii peritonitis was recently reviewed in PD patients, and the authors stated that infection with this bacterium generally results in serious peritonitis even after removal of the PD catheter (3). Acinetobacter ursingii peritonitis has been reported previously (4). However in this paper, detailed information, clinical findings, antibiotic sensitivity test and consequences of treatment were missed.…”

“…Etiology of acute pancreatitis after renal transplantation is unclear and includes immunosuppressive drugs, alcohol consumption, hyperlipidemia, bile duct stones, hyperparathyroidism and viral infections (2,3). Sirolimus is an mTOR inhibitor commonly used for post-transplant immunosuppression, with numerous adverse effects, most commonly proteinuria, hypertrigliceridemia and leukopenia (4). We present the first reported case of a renal transplant recipient with acute pancreatitis caused by sirolimus.…”

Exit-site Infections in Continuous Ambulatory Peritoneal Dialysis Patients, Taif, Saudi Arabia

“…Chia et al (2014), found that Acinetobacter baumannii after 2000, was 9 (64%)was the most common species identified from the effluent, and the leading causes of infection were sterility break and GI microflora translocation (33).…”