A QUARTER OF A CENTURY OF ADULT PERITONEAL DIALYSIS-RELATED PERITONITIS AT AN AUSTRALIAN MEDICAL CENTER

• Published in: Peritoneal dialysis international Vol. 27; no. 5; pp. 565 - 574
• Main Authors: Brown, Fiona, Liu, Wen Jiun, Kotsanas, Despina, Korman, Tony M, Atkins, Robert C
• Format: Journal Article
• Language: English
• Published: Milton, ON Multimed 01.09.2007
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Australia; Bacterial Infections - epidemiology; Biological and medical sciences; Emergency and intensive care: renal failure. Dialysis management; Female; Glomerulonephritis; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Mycoses - epidemiology; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Peritoneal Dialysis - adverse effects; Peritoneal Dialysis - instrumentation; Peritonitis - epidemiology; Peritonitis - microbiology; Prospective Studies; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Australia; Kidney disease; Human; Extrarenal dialysis; Urinary system disease; patient survival; microbiological analysis; Abdominal disease; Renal failure; technique survival; Survival; Peritoneal dialysis; Peritonitis
• ISSN: 0896-8608; 1718-4304
• DOI: 10.1177/089686080702700518

Departments of Nephrology 1 and Infectious Diseases, 2 Monash Medical Centre, Clayton, Victoria, Australia Correspondence to: D. Kotsanas, Department of Infectious Diseases, Monash Medical Centre, 246 Clayton Road, Clayton 3168, Victoria, Australia. despina.kotsanas{at}southernhealth.org.au Background: Peritonitis remains one of the major complications of peritoneal dialysis (PD) and results in reduced technique survival and increased patient morbidity and mortality. Methods: We prospectively recorded comprehensive data on all episodes of PD peritonitis over a 25-year period, including organisms isolated and antibiotic sensitivities. Data on 1588 PD patient-years with 2073 episodes of peritonitis were analyzed; 2089 organisms were isolated in 608 patients. Peritoneal dialysis technique and patient survival were also recorded. Results: There was a significant decline over the years in the incidence of peritonitis, from 6.5 to 0.35 episodes/patient-year, with the decline in the post twin-bag era from 2.3 to 0.47 ( p < 0.001) due primarily to a decrease in gram-positive organisms. The most common isolates (68.9%) were gram-positive organisms; gram-negative organisms comprised 26.8% and fungi 4.1%. Coagulase-negative staphylococci were the most common pathogen isolated (35.3%). Culture-negative peritonitis was seen in 13.4% of episodes. Conclusion: This is the largest series of PD peritonitis reported, demonstrating a dramatic reduction over a 25-year period and also detailing the changing trends of organisms isolated in association with improved technique and patient survival. Although rates have improved, peritonitis remains a major complication and further research needs to be done to improve both PD technique and patient survival. KEY WORDS: Peritonitis; microbiological analysis; technique survival; patient survival. Received 4 December 2006; accepted 8 May 2007.