Staphylococcus Aureus Prophylaxis and Trends in Gram-Negative Infections in Peritoneal Dialysis Patients

Abstract

Objective To examine gram-negative exit-site infection and peritonitis rates before and after the implementation of Staphylococcus aureus prophylaxis in peritoneal dialysis (PD) patients. Design Prospective data collection with periodic implementation of protocols to decrease infection rates in two PD programs. Patients 663 incident patients on PD. Interventions Implementation of S. aureus prophylaxis, beginning in 1990. Main Outcome Measures Rates of S. aureus, gram-negative, and Pseudomonas aeruginosa exit-site infections and peritonitis. Results Staphylococcus aureus exit-site infection and peritonitis rates fluctuated without significant trends during the first decade (without prophylaxis), then began to decline during the 1990s subsequent to implementation of prophylaxis, reaching levels of 0.02/year at risk and zero in the year 2000. Gram-negative infections fell toward the end of the 1980s, due probably to the implementation of better connectology. However, there have been no significant changes for the past 6 years. There was little change in P. aeruginosa infections over the entire time period. Pseudomonas aeruginosa is now the most common cause of catheter infection and catheter-related peritonitis. Conclusions Prophylaxis against S. aureus is highly effective in reducing the rate of S. aureus infections but has no effect on gram-negative infections. Pseudomonas aeruginosa is now the most serious cause of catheter-related peritonitis.

Culture-dependent and metagenomic analysis of lesser horseshoe bats’ gut microbiome revealing unique bacterial diversity and signatures of potential human pathogens

“…Similar findings were also observed by Banskar et al [19]. Two bacterial genera, Staphylococcus and Streptococcus, may cause pneumonia, meningitis, bacteremia, infectious lesions, neonatal infections, and septicemia [73,74]. We observed that the R. monceros gut microbiome also harbors known pathogenic microbes, but their pathogenicity has not been determined.…”

Peritonitis rates and common microorganisms in continuous ambulatory peritoneal dialysis and automated peritoneal dialysis

“…9,10,19 Recently, some authors found a shift from Gram-positive to an increased incidence of Gram-negative peritonitis episodes. 2,5,14 Piraino et al . showed that the decrease in S. aureus peritonitis and catheter infections was striking after the start of prophylaxis in 1990.…”

“…Moreover, they reported that infections due to Gram-negative bacilli trended gradually downward from 1983 to 1988, and fell slightly but insignificantly from 1988 to 1989 to subsequent years. 5 APD has less effect on children's education and lifestyle, and has been therefore the preferred peritoneal dialysis modality, especially in infants and young children. APD use has increased in recent years, perhaps this has caused the relative increase in Gram-negative peritonitis .…”

“…3,4 Piraino et al reported that prophylaxis against Staphylococcus aureus was highly effective in reducing the rate of S. aureus infections although it had no effect on Gram-negative infections over the entire time period. 5 Some authors described increased risk of peritonitis in young children on CPD. 1,6 A recent International Society of Peritoneal Dialysis (ISPD) guideline reported that more information is needed regarding risk factors for peritonitis.…”

Severe Peritonitis in Patients Treated With Peritoneal Dialysis: A Case Series Study

“…With the advent of mupirocin prophylaxis for catheter infections there has been a decline in Gram‐positive bacterial peritonitis; however, the incidence of Gram‐negative, polymicrobial and fungal peritonitis remained stable (10). The special case of “enteric peritonitis”, also called abdominal catastrophe, deserves a special focus, since its only known and non‐modifiable risk factor is old age; it is characterized by high mortality (up to 46%) and demands surgical exploration, correction of the abdominal pathology and, almost always, peritoneal catheter removal (4).…”