Bacteremia Complicating Peritonitis in Peritoneal Dialysis Patients

Abstract

Bacteremia is a rare complication of peritonitis in end-stage renal failure (ESRF) patients treated by peritoneal dialysis. Three of our ESRF patients on peritoneal dialysis developed bacteremia during a peritonitis episode (1/19 peritonitis episodes). In 2 cases, the responsible organism was Escherichia coli and peritonitis was most likely associated with infection of the biliary tract. The 3rd patient had a perforation of the colon and Klebsiella spp. was the infective organism. Only the last patient survived but had to be transferred to hemodialysis. Bacteremia during peritonitis is infrequent in peritoneal dialysis patients and it appears to be related to other intra-abdominal events.

A Review of Hemodialyzer Reuse

“…In October 1992, the results of a USRDS case‐mix study were made public bythe Food and Drug Administration (7, 44). This study retrospectively examined mortality rates in 3163ESRD patients with high‐flux or conventional hemodialysis in 291 free‐standingand hospital‐based hemodialysis units who had started dialysis during 1986 and1987.…”

Gram Negative Rod Peritonitis in Peritoneal Dialysis

“…Other diagnostic laboratory tests are seldom helpful. Blood cultures are notusually indicated, even in febrile patients; bacteremia is rare in patientswith PD peritonitis.Patients with GNRP may have a greater tendency for bacteremia, most likely afunction of the source of infection: while bacteremia was exclusively due toGNR organisms in oneseries of patients with PD peritonitis, all cases involved primarygastrointestinal or biliary disease with secondary contamination of theperitoneal cavity (44). A high peritoneal fluid amylase level may be seen with GNRPwhen associated with a primary intra‐abdominal process such as pancreatitis orbowel perforation (69).…”

“…This may occur with gross bowelperforation, in which case peritoneal fluid may be grossly feculent and contain food fibers. The presenceof multiple organisms, including anaerobes and enterococci in addition to gramnegative rods, is typical, but bowel perforation has been reported to present as peritonitis witha single GNR organism, either Escherichia coli, Proteus , or Klebsiella(42–44).…”

“…Escherichia coli peritonitis has also occurred in PD patients after colonoscopy (45) and colonoscopic polypectomy(46); in both of these cases there was no obvious bowel perforation. Escherichia coli peritonitis has also been reported following asplenic infarct with a subsequent splenic abscess (47), in conjunction with cholecystitis(44), and contamination of dialysis tubing by diarrheal stools(48). Citrobacter freundii peritonitis has followedperforation of the gall bladder (43), and Enterobacter peritonitis after an episode of pancreatitis (49).…”

Hospitalizations in Dialysis End-Stage Renal Failure Patients

“…For the 8 patients treated with PD and transferred to HD, their hospitalizations were recorded as PD or HD according to the treatment patients received at the time of hospitalization. Dialysis was performed as described previously [5,6]. Briefly, HD was performed using polysulfone dialyzers.…”