Clinical Course and Outcomes of Single-Organism Enterococcus Peritonitis in Peritoneal Dialysis Patients

Abstract

♦ Background and Objectives: Enterococci are part of the normal flora of the gastrointestinal tract. They can cause enteric peritonitis, which is a serious complication of peritoneal dialysis (PD). However, the clinical course and outcome of PD-related Enterococcus peritonitis remains unclear. ♦ Methods: We reviewed all Enterococcus peritonitis episodes occurring in our dialysis unit from 1995 to 2009. ♦ Results: During the study period, 1421 episodes of peritonitis were recorded. Of 29 episodes (2.0%) that were attributable to single-organism Enterococcus, 12 episodes were caused by E. faecalis; 9, by E. faecium; and the remaining 8, by other Enterococcus species. The overall rate of ampicillin resistance was 41.4%. Recent use of antibiotics was associated with the development of ampicillin-resistant Enterococcus (ARE) peritonitis (hazard ratio: 12.53; p = 0.04). The primary response rate of Enterococcus peritonitis was significantly higher than that of Escherichia coli peritonitis (89.7% vs. 69.9%, p = 0.038), but the primary response rate was not significantly lower for ARE peritonitis than for ampicillin-susceptible Enterococcus (ASE) peritonitis (83.3% vs. 94.1%, p = 0.553). However, significantly more patients with ARE had received vancomycin (83.3% vs. 23.5%, p = 0.003), with a longer mean duration of vancomycin treatment (11.8 ± 6.9 days vs. 3.7 ± 6.8 days, p = 0.005). ♦ Conclusions: Recent use of antibiotics was a risk factor for the development of ARE peritonitis. Outcomes in ASE and ARE peritonitis were similar, but vancomycin was required during treatment for ARE peritonitis, in turn possibly predisposing the patients to infections caused by vancomycin-resistant organisms.

Treatment of Enterococcal Peritonitis in Peritoneal Dialysis Patients by Oral Amoxicillin or Intra-Peritoneal Vancomcyin: a Retrospective Study

“…Intra-abdominal pathology is generally considered to be the source of enterococcal peritonitis. Similar to previous reports [6, 7], we found that other pathogenic organisms are isolated in over half of the enterococcal peritonitis episodes, and the coexistence of other organisms was associated with high rates of catheter removal, permanent hemodialysis transfer, and death. Our result suggests that oral amoxicillin, together with effective intra-peritoneal antibiotics for other concomitant organisms, is effective for polymicrobial peritonitis with Enterococcus as one of the causative organisms.…”

“…Although clinical experience suggests that IP ampicillin is sometimes effective [7], there is always a concern that ampicillin has little in vitro activity when added to common PD solutions [11]. Routine treatment with IP vancomycin is currently recommended [10], but the possibility of provoking vancomycin-resistant strains is always a concern.…”

“…Enterococcal species account for less than 5% of PD-related peritonitis [4]. However, peritonitis episodes caused by Enterococcal species are associated with particularly high rates of catheter removal, permanent hemodialysis transfer, and death [6, 7]. The treatment of PD-related enterococcal peritonitis is, unfortunately, difficult and optimal regimen controversial.…”

Escherichia Coli Peritonitis in Peritoneal Dialysis: The Prevalence, Antibiotic Resistance and Clinical Outcomes in a South China Dialysis Center

“…As a result, it comprises a broad population of bacteria that exhibit an extremely high degree of genetic and phenotypic diversity, with only 20% of the genome common to all strains (28). However, to what extent this highly diverse pathotype contributes to the different outcomes of E. coli peritonitis in PD remains mainly unexplored in published literatures (11,12,21,24).…”

Peritonitis Caused by Veillonella Species and Eggerthella lenta in Peritoneal Dialysis

“…Infections with E. faecalis are most commonly the result of intra-abdominal pathology and are frequently polymicrobial in nature (2,3). The recommended treatment is usually IP ampicillin, but cases involving ampicillin-and vancomycin-resistant strains are increasingly common (4,5).…”