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Perit Dial Int 29(3): 310-318
2009
© 2009 International Society for Peritoneal Dialysis
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Clinical

TREATMENT OF PERITONEAL DIALYSIS-RELATED PERITONITIS WITH CIPROFLOXACIN MONOTHERAPY: CLINICAL OUTCOMES AND BACTERIAL SUSCEPTIBILITY OVER TWO DECADES

Miguel Pérez Fontán1,2, Helena Díaz Cambre1, Ana Rodríguez-Carmona1, Andrés López Muñiz1 and Teresa García Falcón1

Division of Nephrology,1 University Hospital Juan Canalejo; Department of Medicine,2 Health Science Institute, University of A Coruña, A Coruña, Spain

Correspondence to: M. Pérez Fontán, Division of Nephrology, University Hospital Juan Canalejo, Xubias 84, 15006 A Coruña, Spain. mfontan{at}canalejo.org

{diamondsuit} Background: There is controversy about the preferred initial antibiotic therapy for peritoneal dialysis (PD)-related peritonitis. Quinolones have been used extensively in this setting, yet their long-term effectiveness is unknown.

{diamondsuit} Aim: To analyze the results of a protocol of treatment of PD-related peritonitis with ciprofloxacin, maintained over two decades.

{diamondsuit} Method: We analyzed the clinical outcome of 682 episodes of bacterial peritonitis treated with intraperitoneal ciprofloxacin monotherapy, and the time course of bacterial susceptibility to this antimicrobial, in a historical cohort of 641 PD patients (1988–2007). Main outcome variables included changes to initial therapy and rates of hospital admission, catheter removal, relapse, reinfection, PD dropout, and mortality. For comparisons we divided the study period into phases A (1988–1994), B (1995–2000), and C (2001–2007).

{diamondsuit} Results: The incidence of Staphylococcus aureus peritonitis decreased, while the incidences of polymicrobial and negative-culture peritonitis increased after phase A. In vitro susceptibility to ciprofloxacin decreased significantly only among coagulase-negative staphylococci (87.0% susceptible strains in phase A vs 70.0% in B and 70.1% in C, p = 0.006). Overall success rates (catheter not removed and ongoing PD after the episode) remained stable, at over 85%. However, the proportion of patients treated solely with ciprofloxacin declined from 75.7% (A) to 47.3% (B) to 32.4% (C) (p < 0.0005) and admission rates increased from 12.7% to 16.8% to 24.9% respectively (p = 0.001). These changes affected all the etiologic groups except culture-negative peritonitis. In vitro resistance to ciprofloxacin was a marker of multiresistance and correlated strongly with clinical outcome of peritonitis. Among isolates susceptible to ciprofloxacin, changing initial therapy for any reason also predicted a poor outcome.

{diamondsuit} Conclusions: Following satisfactory early results, the effectiveness of ciprofloxacin as monotherapy for PD-related peritonitis has declined markedly in the long term. This decline cannot be explained solely by a decrease of in vitro susceptibility to this antimicrobial, which was significant only among coagulase-negative staphylococci. Resistance to ciprofloxacin is a strong marker of in vitro multiresistance and poor clinical outcome of peritonitis.

KEY WORDS: Ciprofloxacin; peritonitis; susceptibility; resistance.

Received 13 April 2008; accepted 6 August 2008.






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