Peritonitis due to gram-negative bacilli (GNB), particularly nonfermenting GNB (NF-GNB), is a serious complication of peritoneal dialysis with a low resolution rate. Beyond the patient’s condition, microbiological properties such as antimicrobial resistance, biofilm production and other virulence factors can explain the poor outcomes. This study aimed to evaluate the influence of patient condition, microbiological characteristics, including biofilm production, and treatment on peritonitis outcome. We reviewed the records of 62 index episodes caused by NF-GNB that occurred between 1997 and 2015 in our center. The etiologies were species of Pseudomonas (51.6%), Acinetobacter (32.2%), and other NF-GNB (16.1%). There was a high (72.9%) proportion of biofilm producer lineages. The in vitro susceptibility rate of Pseudomonas spp. to amikacin, ciprofloxacin, and ceftazidime was significantly greater than that of Acinetobacter spp. and other species; however, there was a similar low resolution rate (< 45%) among the episodes attributable to them. Preexisting exit-site infection was independently associated with nonresolution. No other factor, including biofilm production, was associated with the outcome. The higher in vitro susceptibility of Pseudomonas compared to other NF-GNB that presented a similar resolution rate suggests that bacterial virulence factors such as biofilms can act in concert, thereby worsening the outcome.
(1) Background: Peritonitis due to nonfermenting Gram-negative bacilli (NF-GNB) is a dramatic complication of peritoneal dialysis (PD) with bad outcomes. Previous studies of PD-related peritonitis due to Pseudomonas species have shown a low-resolution rate, without a high resistance rate to antipseudomonal antibiotics. This suggests that bacterial virulence factors can act and influence peritonitis evolution. This study aimed to describe the microbiological characteristics of NF-GNB causing PD-related peritonitis and analyze their influence on the outcome. (2) Methods: We analyze the 48 isolates from NF-GNB peritonitis, which were stored in our culture collection regarding bacterial resistance, biofilm, and other virulence factors’ production, and clonal profile. Additionally, we collected data on treatment and outcomes from patients’ clinical registers. (3) Results: The etiologies were species of Pseudomonas (50%), Acinetobacter (36%), and other NF-GNB (14%). There was a high (75%) proportion of biofilm producer lineages. The in vitro susceptibility rate of Pseudomonas spp. to amikacin, ciprofloxacin, and ceftazidime was significantly greater than that of Acinetobacter spp. and other species; however, there was a similar low-resolution rate (<45%) among the episodes attributable to them. Pseudomonas species have a polyclonal profile, while we found a clone of five multiresistant Acinetobacter baumannii over an 8-year interval (2000–2008), which suggest an origin from the healthcare environment. (4) Conclusions: We are not able to identify any predictor of outcome, but it is possible that biofilm and others virulence factors can act in concert and contribute to the bad outcome.
Background Peritonitis due to Gram-negative bacilli (GNB), particularly the non-fermenting GNB (NF-GNB) is a serious complication of peritoneal dialysis (PD) with a low-resolution rate. Beyond the patient’s conditions, microbiological properties as antimicrobial resistance, biofilm and other virulence factors production could explain the bad outcomes. This study aimed to evaluate the influence of the patient’s conditions, microbiological characteristics, including biofilm production, and treatment of peritonitis on the peritonitis resolution. Methods We reviewed the records of 68 peritonitis episodes that occurred between 1997 and 2015 at a single university center. The influence of microbiological and clinical factors on resolution chance was analyzed by logistic regression. Results The etiologies were species of Pseudomonas (51.5%), Acinetobacter (30.9%), and others (18.6%). There was a high (75%) proportion of biofilm producers’ lineages. The in vitro susceptibility rate of Pseudomonas spp. to amikacin, ciprofloxacin, and ceftazidime was significantly greater than that of Acinetobacter spp. and other species; however, there was a similar low-resolution rate (<40%) among the episodes due to these etiologies. Concomitant ESI and resistance to amikacin were independently associated with non-resolution. No other factor, including biofilm production were associated with the outcome Conclusions Peritonitis due to NF-GNB in PD are severe infections with reduced resolution rate; bacterial resistance and concomitant ESI negatively influence the chance of resolution. Even though biofilm production has not had influence the outcome, the found of higher in vitro susceptibility of Pseudomonas than other NF-GNB, with similar resolution rate, suggest bacterial virulence factors as biofilm or others can act in concert, worsening the outcome.
Background Peritonitis due to gram-negative bacilli (GNB), particularly nonfermenting GNB (NF-GNB), is a serious complication of peritoneal dialysis (PD) with a low resolution rate. Beyond the patient’s condition, microbiological properties such as antimicrobial resistance, biofilms and the production of other virulence factors can explain the bad outcomes. This study aimed to evaluate the influence of the patient’s condition, the microbiological characteristics, including biofilm production, and the treatment of peritonitis on peritonitis resolution.Methods We reviewed the records of 62 new peritonitis episodes caused by NF-GNB that occurred between 1997 and 2015 at a single university center. The influence of microbiological and clinical factors on resolution chance was analyzed by logistic regression.Results The etiologies were species of Pseudomonas (51.6%), Acinetobacter (32.2%), and others (16.1%). There was a high (72.9%) proportion of biofilm producers’ lineages. The in vitro susceptibility rate of Pseudomonas spp. to amikacin, ciprofloxacin, and ceftazidime was significantly greater than that of Acinetobacter spp. and other species; however, there was a similar low resolution rate (<45%) among the episodes attributable to Pseudomonas spp, Acinetobacter spp, and other NF-GNB. Pre-existent exit-site infection was independently associated with nonresolution. No other factor, including biofilm production, was associated with the outcome. Conclusions Peritonitis due to NF-GNB in PD is a severe infection with a reduced resolution rate, and pre-existent exit site infection negatively influences the chance of resolution. The higher in vitro susceptibility of Pseudomonas compared to that of other NF-GNB with a similar resolution rate, suggests bacterial virulence factors beyond biofilm and can act in concert, thereby worsening the outcome.
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