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

Abstract

♦ Introduction: Escherichia coli (E. coli) peritonitis is a frequent, serious complication of peritoneal dialysis (PD). The extended-spectrum β-lactamase (ESBL)-producing E. coli peritonitis is associated with poorer prognosis and its incidence has been on continuous increase during the last decades. However, the clinical course and outcomes of E. coli peritonitis remain largely unclear.

ESBL-Producing E. Coli in a Patient on Automated Peritoneal Dialysis

“…E. coli is the most common gram-negative causative pathogen, with a report prevalence of up to 59% of gram-negative PDP in some centers [2,6,8,9]. Despite the reduction in incidence of PDP through the use of prophylactic antibiotics, risk factors management and advances in PD techniques, the incidence of gram-negative PDP has not changed [6].…”

“…Despite the reduction in incidence of PDP through the use of prophylactic antibiotics, risk factors management and advances in PD techniques, the incidence of gram-negative PDP has not changed [6]. Moreover, an increased recognition of ESBL producing Enterobacteriaceae causing PDP has been reported [6,8].…”

“…Other risk factors include longer hospitalization and the admission to chronic care facilities [7]. Furthermore, Feng et al (2014) reported 68 cases of E. coli PDP, 35.5% of which were ESBL producing. They concluded that patients with a previous history of peritonitis were at a significantly higher risk of ESBL PDP compared to those with no prior history [odds ratio (OR): 5.286; 95% confidence interval (CI): 2.018 -13.843; p = 0.001] [8].…”

“…Furthermore, Feng et al (2014) reported 68 cases of E. coli PDP, 35.5% of which were ESBL producing. They concluded that patients with a previous history of peritonitis were at a significantly higher risk of ESBL PDP compared to those with no prior history [odds ratio (OR): 5.286; 95% confidence interval (CI): 2.018 -13.843; p = 0.001] [8]. In our case report, the patient had a previous history of peritonitis, multiple episodes of hospital admissions and a recent history of omeprazole use, all of which were risk factors for developing ESBL peritonitis.…”

“…This is mainly attributed to the late recognition and delay of appropriate antibiotics treatment [1,2,7,8,10,11]. A case control study of 31 ESBL-EC and K. pneumonia bacteremia found that less mortality occurred in those receiving appropriate treatment within 3 days from bacteremia [2].…”