Causative organisms and outcomes of peritoneal dialysis-related peritonitis in Sarawak General Hospital, Kuching, Malaysia: a 3-year analysis

Abstract

Background: Peritoneal dialysis peritonitis remains a significant cause of morbidity for peritoneal dialysis patients and the main reason for conversion from peritoneal dialysis to hemodialysis. As the characteristics of patients and microbial susceptibility vary from center to center, the aim of this study is to evaluate the microbiology and the clinical outcomes among continuous ambulatory peritoneal dialysis patients in Kuching, Malaysia. Methods: This is a retrospective record review of 82 continuous ambulatory peritoneal dialysis patients who developed peritonitis during 2013 to 2015. Data examined included patients' demographic data, causative organisms, and outcomes. Results: A total of 124 episodes of peritonitis were recorded, and the overall peritonitis rate was 0.40 episodes per patient-year. There was an increasing incidence in continuous ambulatory peritoneal dialysis peritonitis over the 3-year study period (0.35 to 0.47 episodes per patient-year). The gram-negative peritonitis rate increased over the period until towards the end of the study period, when gram-positive and gram-negative organisms accounted for almost equal proportions of peritonitis. Streptococcus sp. was the most common organism among the gram-positive peritonitis while Pseudomonas sp. was the most common organism in gram-negative peritonitis. The culture-negative peritonitis rate was 25.8%. The peritoneal dialysis catheter was removed in 32 episodes (26.6%). The catheter loss rate was significantly higher in gram-negative peritonitis, as compared to gram-positive peritonitis (38.9 vs 16.7%, p = 0.027). Conclusions: The increasing trend of peritonitis and high rates of culture negativity and peritoneal dialysis catheter removal are areas that need further evaluation and improvement in the future. Study on risk factors of continuous ambulatory peritoneal dialysis peritonitis, detailed microbiology, and antimicrobial treatment and response are warranted to further improve the outcomes of continuous ambulatory peritoneal dialysis patients.

Intraperitoneal antibiotic utilization among continuous ambulatory peritoneal dialysis (CAPD) patients with peritonitis at a tertiary hospital setting in Malaysia

“…In our setting, CNP accounted for 28.2% of the overall peritonitis cases, which was similarly reported in another center in Malaysia (28.2%)[ 12 ] and in the United Kingdom (>20%). [ 17 ] Whereas the other centers reported a lower incidence of CNP rates (<15%).…”

“…[ 2 11 ] Our prominent initial empiric combination (ceftazidime/cefazolin) was also reported to be the initial empirical antibiotic of choice in another center in Malaysia. [ 12 ] Both achieved a resolution rate of more than 70%. On the contrary, studies in other countries had reported the use of an aminoglycoside with vancomycin or cefazolin as their first-line initial empirical antibiotics.…”

Unusual cases of peritonitis: A case series of five patients

“…2,3 Most cases of PD-related peritonitis are due to gram-positive organisms, though there is a growing body of evidence to suggest that gram-negative infections are increasing in countries like China and Malaysia. 4,5 Upon review of our home dialysis program's causative organisms for peritonitis, we found that our peritonitis rates were consistent with other developed countries (see Figure 1 and Table 2).…”

Catheter-related infections and microbiological characteristics in coiled versus straight peritoneal dialysis catheters in Malaysia

“…Another retrospective study in Sarawak, Malaysia, reported similar occurrence of gram-negative and gram-positive organisms causing peritonitis, with trend of increasing gram-negative infection with time, causing higher rate of catheter loss. [ 22 ]…”