Peritonitis-Related Deaths in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients

Abstract

A total of 636 episodes of peritonitis occurred in 440 patients who entered our continuous ambulatory peritoneal dialysis (CAPD) program from September 1977 to February 1988. Sixteen patients (8 male and 8 female, aged 37–77 years) died during an episode of peritonitis (fatality rate 2.5%). They had been on CAPD for 3 to 105 (average 39) months. Six of them were diabetics. The peritonitis rate among these 16 patients were 1 episode per 12 patient months, while the corresponding figure for the whole (440) CAPD population was 14 patient months. Risk factors present in the 16 patients were: cardiovascular disease (12), cerebrovascular accident (2) peripheral artery disease (1) and pulmonary fibrosis (1). Fever and leukocytosis were present on admission in 11 patients, while total serum proteins and albumin were significantly lower (p < 0.001) than the corresponding values before peritonitis (56 ± 8 vs. 65 ± 5). Staph. aureus was isolated in 8 patients (50%), multiple organisms in 6, Pseudomonas and Candida albicans in 1 each. An abdominal abscess was found in 4 (25%) patients. The peritoneal catheter was removed between the 5th and 10th day in 6 and after the 10th day in 7 patients. Peritonitis with sepsis was the cause of death in 13 patients. Contributing factors were cardiovascular accident in 9, uremic coma in 2, extensive GI bleeding in 2, GI performation in 2, intestinal infarction in 1, and pneumonia in 2 patients. We conclude that the risk of peritonitis-related death in CAPD patients is increased with Staph. aureus or multibacterial peritonitis. Contributing factors are concomitant cardiovascular disease and delayed (>5 days) catheter removal.

Predictors of Peritonitis and the Impact of Peritonitis on Clinical Outcomes of Continuous Ambulatory Peritoneal Dialysis Patients in Taiwan—10 Years’ Experience in a Single Center

“…Local application of mupirocin ointment at the catheter exit site can prevent exit-site infection and peritonitis involving gram-positive organisms (14). In the present long-term Peritonitis is the most important complication of chronic PD, causing significant morbidity and mortality (23,24). Peritonitis associated with concurrent exit-site or tunnel infection is more likely to proceed to catheter loss (25).…”

Making Long-term Peritoneal Dialysis Possible

“…In severe peritonitis or that which persists despite appropriate antibiotic treatment, one should not hesitate to remove the catheter in order to prevent peritoneal membrane failure and death (9). In such cases, we should establish safe ways (catheters coated with antibiotics?)…”

Dialysate White Blood Cell Change after Initial Antibiotic Treatment Represented the Patterns of Response in Peritoneal Dialysis-Related Peritonitis

“…Numerous studies demonstrated that if dialysate WBC are more than 100 cells/mm 3 at day 5 after treatment, the chance of treatment failure is high [ 7 – 9 ]. Consequently, the International Society of Peritoneal Dialysis (ISPD) defined the term “refractory peritonitis” as failure of dialysate WBC clearance after five days of antibiotic treatment and recommended removing the peritoneal catheter and stopping dialysis therapy in order to prevent morbidity and mortality associated with treatment failure [ 10 , 11 ]. However, in some places where the hemodialysis resource is limited or the dialysis catheter is not readily removable, clinicians might choose to continue antibiotic treatment in selected patients who may have a delayed response to the treatment even though the target of dialysate WBC after the fifth day was not reached.…”