Repeated Peritoneal Dialysis–Associated Peritonitis: A Multicenter Registry Study

• Published in: American journal of kidney diseases Vol. 59; no. 1; pp. 84 - 91
• Main Authors: Thirugnanasambathan, Thulasi, MD, Hawley, Carmel M., MMed Sci, Badve, Sunil V, McDonald, Stephen P., PhD, Brown, Fiona G., PhD, Boudville, Neil, MMed Sci, Wiggins, Kathryn J., MD, Bannister, Kym M., MD, Clayton, Philip, MD, Johnson, David W., PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.01.2012; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antibiotics; Australia; bacteria; Biological and medical sciences; Cohort Studies; Emergency and intensive care: renal failure. Dialysis management; Female; fungus; Humans; Intensive care medicine; Male; Medical sciences; microbiology; Middle Aged; Nephrology; Nephrology. Urinary tract diseases; outcomes; peritoneal dialysis; Peritoneal Dialysis - adverse effects; peritonitis; Peritonitis - epidemiology; Peritonitis - microbiology; Recurrence; Registries; relapse; Australia; recurrence; Antibiotics; bacteria; fungus; peritonitis; outcomes; relapse; microbiology; peritoneal dialysis; Nephrology; Relapse; Prognosis; Microbiology; Multicenter study; Peritoneal dialysis; Urology; Extrarenal dialysis; Antibiotic; Register; Abdominal disease; Bacteria; Antibacterial agent; Peritonitis; Repetition
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2011.06.018

Background Determinants and outcomes of peritoneal dialysis (PD)-associated peritonitis occurring within 4 weeks of completion of therapy of a prior episode caused by the same (relapse) or different organism (recurrence) recently have been characterized. However, determinants and outcomes of peritonitis occurring more than 4 weeks after treatment of a prior episode caused by the same (repeated) or different organism (nonrepeated) are poorly understood. Study Design Observational cohort study using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data. Setting & Participants All Australian PD patients between October 1, 2003, and December 31, 2007, with first episodes of repeated or nonrepeated peritonitis. Predictors Repeated versus nonrepeated peritonitis, according to International Society of PD (ISPD) criteria. Outcomes & Measurements Relapse, hospitalization, catheter removal, hemodialysis transfer, and death. Results After a peritonitis episode, the probability that a subsequent episode represented repeated rather than nonrepeated peritonitis was highest in the second month (41%), then progressively decreased to a stable level of 14% from 6 months onward. When first episodes of repeated (n = 245) or nonrepeated peritonitis (n = 824) were analyzed, repeated peritonitis was predicted independently by a shorter elapsed time from the prior episode (adjusted OR per day elapsed, 0.91; 95% CI, 0.88-0.94). Staphylococcus aureus and coagulase-negative staphylococcus were isolated more frequently in repeated peritonitis, whereas Gram-negative, streptococcal, and fungal organisms were recovered more frequently in nonrepeated peritonitis. Using multivariate logistic regression, repeated peritonitis was associated independently with higher relapse (OR, 5.41; 95% CI, 3.72-7.89) and lower hospitalization rates (OR, 0.63; 95% CI, 0.46-0.85), but catheter removal, hemodialysis transfer, and death rates similar to nonrepeated peritonitis. Limitations Limited covariate adjustment. Residual confounding and coding bias could not be excluded. Conclusions Repeated and nonrepeated peritonitis episodes are caused by different spectra of micro-organisms and have different outcomes. Study findings suggest that the ISPD definition for repeated peritonitis should be limited to 6 months.