Peritoneal Dialysis-related Peritonitis: Microbiological Profile and Outcome

Abstract

Objective: Peritonitis is a major complication of peritoneal dialysis (PD) and leads to significant mortality and technical failure. Understanding local peritonitis rates and microbiologic profiles are important for the prevention and appropriate management of PD-related peritonitis. We investigated the incidence rate, causative agents, and outcomes of PD-related peritonitis episodes. Methods: This retrospective study enrolled all patients who were receiving PD and have been treated for PD-related peritonitis between February 2005 and November 2021 in our PD unit. Data of the patients included demographic characteristics, causes of primary renal disease, microbiology, and outcomes (resolution, catheter loss, and death) of peritonitis episodes. Results: During the study period, 143 PD-related peritonitis episodes were identified in 69 patients. The peritonitis rate was 0.56 episodes per patient-year. Overall, 62.9% of the episodes were due to Gram-positive organisms, 32.1% were due to Gram-negative organisms, 3.4% were culture negative and 1.3% were candida. Coagulase-negative staphylococci were isolated in half of the Gram-positive episodes. Acinetobacter and Pseudomonas were the most frequently observed microorganisms among Gram-negative episodes. Overall, 81.1% of cases improved completely with medical treatment. The PD catheter was removed in 27 (18.8%) patients, and two patients died from sepsis. Gram-negative organisms resulted in a significantly higher rate of catheter removals and a lower rate of resolution than Gram-positive organisms (p<0.001). Conclusion: Reducing the incidence of PD-related peritonitis could be possible by knowledge of prevalent microbial agents in each center, adjusting empirical treatment accordingly, and taking the necessary measures to prevent peritonitis attacks.