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Clinical |
UCL Centre for Nephrology, Royal Free & University College Medical School, London, United Kingdom
Correspondence to: A. Davenport, UCL Centre for Nephrology, Royal Free & University College Medical School, Rowland Hill Street, London NW3 2PF United Kingdom. andrew.davenport{at}royalfree.nhs.uk
Background: Over the past two decades, the rate of
peritonitis in patients treated by peritoneal dialysis (PD) has been
significantly reduced. However, peritonitis remains a major complication of
PD, accounting for considerable mortality and hospitalization among PD
patients. Objective: To compare the outcome of peritonitis in a
large unselected group of PD patients with that from single-center and
selected groups. Method: We audited the outcome of peritonitis in PD
patients attending the 12 PD units in the Thames area in 2002 and 2003. There
were 538 patients on continuous ambulatory PD (CAPD) and 325 patients on
automated PD (APD) and/or continuous cycling PD (CCPD) at the end of 2002, and
635 CAPD and 445 APD/CCPD patients at the end of 2003. Results: There were 1467 episodes of PD peritonitis
during the 2-year period, including 129 recurrent episodes, with the average
number of months between peritonitis episodes being 14.7 for CAPD and 18.1 for
APD/CCPD, p < 0.05. However there was considerable variation
between units. Coagulase-negative staphylococcus (CoNS) was the most common
cause, accounting for around 30% of all peritonitis episodes, including
recurrences, followed by non-pseudomonas gram negatives and Staphylococcus
aureus. Cure rates were 77.2% for CoNS, 46.6% for S. aureus, and
7.7% for methicillin-resistant S. aureus. The cure rate for
pseudomonas was 21.4%, and other gram negatives 56.7%. In total, there were
351 episodes of culture-negative peritonitis, with an average cure rate of
76.9%. Cure rates were higher for those centers that used a combination of
intraperitoneal gentamicin and cephalosporins than those centers that used
oral-based regimes. A total of 296 PD catheters were removed as a direct
consequence of PD peritonitis: 121 due to gram-positive and 123 due to
gram-negative organisms. Only 49 catheters were reinserted and the patients
returned to PD. 52 patients died during or subsequent to their episode of PD
peritonitis, with an overall mortality rate of 3.5%. Conclusion: This audit showed that, in a large
unselected population of PD patients, the incidence of peritonitis was
significantly greater than that reported in single-center short-term studies,
and varied from unit to unit. Similarly, the success of treating PD
peritonitis varied not only with the cause of the infection but also from unit
to unit. PD peritonitis remains a major cause of patients discontinuing PD and
switching to hemodialysis.
KEY WORDS: Peritonitis; audit; icodextrin; infection.
Received 15 May 2008; accepted 30 September 2008.
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