Peritonitis before Peritoneal Dialysis Training: Analysis of Causative Organisms, Clinical Outcomes, Risk Factors, and Long-Term Consequences

Abstract

Background and objectives Peritonitis before peritoneal dialysis (PD) training (pretraining peritonitis [PTP]) is an uncommon event. The study aim was to examine the causative organisms, clinical outcomes, risk factors, and long-term consequences of PTP.Design, setting, participants, & measurements In this single-center, retrospective, observational study involving all incident patients on PD who developed PTP between 1998 and 2012, we examined the causative organisms, primary response rate, complete cure rate, risk factors, and associations of PTP with peritoneal equilibration test (PET) and patient survival. For each patient in the PTP group, the patients who underwent catheter insertion immediately before and after the index case were identified as controls.Results Among 1252 incident patients on PD, 52 (4.2%) patients developed PTP, and 104 patients were identified as controls. The two groups were similar in age, sex distribution, comorbidities, and residual renal function, but the PTP group had significantly lower hemoglobin and serum albumin. Patients were followed up for a median of 37.5 months (interquartile range [IQR], 16.3-62.2 months). The most common causative organisms of PTP were Staphylococcus aureus (30.8%) and polymicrobial (21.2%); 25% had negative growth. The primary response and complete cure rates were 82.7% and 78.8%, respectively. In the PTP group, 7.7% of patients died, 9.6% of patients required catheter removal, and PD training was significantly delayed (median =42.0; IQR, 26.0-65.8 days versus 27.5; IQR, 23.0-35.0 days; P=0.01). Multivariate logistic regression analysis showed that serum albumin was the only predictor of PTP (adjusted odds ratio, 0.89 per 1-g/dl increase; 95% confidence interval, 0.82 to 0.97). There were no differences in PET results and dialysis adequacy (measured around 1 month after PD training). The PTP group had significantly worse patient survival (median =41.2; IQR, 21.8-60.5 months versus 55.8; IQR, 40.4-71.2 months; P=0.02). Technique failure occurred in 11.5% and 10.6% of patients in the PTP and control groups, respectively.Conclusions S. aureus is the most common causative organism of PTP. Nutritional interventions in patients who are hypoalbuminemic before catheter insertion deserve additional study.

Peritoneal dialysis in Tunisia: complications, technique and patient´s survival (twenty-seven years of experience in a single center)

“…Over the years, there was a change in the causative microorganism profile: predominance of gram-negative bacilli between 1996 and 2000, then the emergence of gram-positive cocci with constant progressive rise from 2001 till 2017. Such findings of the predominance of gram-positive bacteria were similar to studies conducted in Scotland, Canada, United States of America and Hong Kong in which gram-positive microorganism comprised for up to 66% of causative pathogens of peritonitis [ 9 - 12 ].…”

Microbiology and Outcome of Peritoneal Dialysis-related Peritonitis in Elderly Patients: a Retrospective Study in Hunan Province, China

“…This bacterial ora distribution and high incidence of Staphylococcus were similar to previous reports [8][9][10][11] . And such results of the predominance of gram-positive bacteria were similar to the studies in America, Canada, Scotland, and Hong Kong [12][13][14][15] . The type of pathogenic microorganism usually indicates a possible cause of infection.…”

Peritoneal dialysis-associated peritonitis outcomes reported in trials and observational studies: A systematic review

“…8 It is also recommended by the ISPD to start counting peritonitis episodes from the first day of PD training, resulting in a small proportion of peritonitis episodes not being taken into account when occurring after catheter insertion but before PD training start. 14,15 It is important to monitor every single episode of peritonitis from the day of catheter insertion. In the present analysis, only 13 studies (17%) specified the start of time at risk for developing peritonitis.…”