Long-term trends in the incidence of peritoneal dialysis-related peritonitis disclose an increasing relevance of streptococcal infections: A longitudinal study

Abstract

Background The selective impact of strategies for prevention of PD-related peritonitis (PDrP) may have modified, in the long term, the causal spectrum, clinical presentation and outcomes of these infections. Objectives To compare trends in the incidence of PDrP by different microorganisms during a 30-year period, with a particular focus on streptococcal infections. To analyze the clinical presentation and outcomes of these infections. Secondarily, to investigate how the isolation of different species of streptococci can influence the clinical course of PDrP by this genus of bacteria. Method Following a retrospective, observational design we investigated 1061 PDrP (1990–2019). We used joinpoint regression analysis to explore trends in the incidence of PDrP by different microorganisms, and compared the risk profile (Cox), clinical presentation and outcomes (logistic regression) of these infections. Main results Our data showed a progressive decline in the incidence of PDrP by staphylococci and Gram negative bacteria, while the absolute rates of streptococcal (average annual percent change +1.6%, 95% CI -0.1/+3.2) and polymicrobial (+1.8%, +0.1/+3.5) infections tended to increase, during the same period. Remarkably, streptococci were isolated in 58.6% of polymicrobial infections, and patients who suffered a streptococcal PDrP had a 35.8% chance of presenting at least one other infection by the same genus. The risk profile for streptococcal infections was comparable to that observed for PDrP overall. Streptococcal PDrP were associated with a severe initial inflammatory response, but their clinical course was generally nonaggressive thereafter. We did not observe a differential effect of different groups of streptococci on the clinical presentation or outcome of PDrP. Conclusions Time trends in the incidence of PDrP by different microorganisms have granted streptococci an increasing relevance as causative agents of these infections, during the last three decades. This behaviour suggests that current measures of prevention of PDrP may not be sufficiently effective, in the case of this genus of microorganisms.

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

“…An increasing trend of streptococcal peritonitis has been observed in longitudinal studies, 321,322 mostly secondary to viridans groups (including oralis , sanguis and gordonii ). For viridans group streptococci , there is emerging evidence of mixed or polymicrobial strains with lower susceptibility to ampicillin, penicillin and ceftriaxone being encountered.…”

“…The reported cure rate of streptococcal peritonitis exceeds 85%, and most patients can continue PD. 320,321…”

Clinical features and risk factors of catheter removal among 1062 episodes of peritoneal dialysis‐associated peritonitis: A multicenter 7‐year study

“…The sources of these variations may be center-related factors, such as center size, topical antibiotic prophylaxis, and PD training [2]. To date, few articles describe the chronological changes in peritonitis rates, and most reports are from a single center [12,[14][15][16][17]. In our multicenter study, we demonstrated a significant decrease in the peritonitis rate during the study period, especially over the last 3 years, which could be attributable to the significant decrease in G+ PDAP, G-PDAP, and culture-negative PDAP rates.…”

Association of Peritonitis With Cardiovascular Mortality Over Time in the Peritoneal Dialysis Population: An Australia and New Zealand Dialysis and Transplant Registry Study

“… 32 , 33 , 34 , 35 Similar trends in the reduction of peritonitis rates have been observed worldwide. 4 , 36 , 37 , 38 , 39 …”