Microbiological aspects of peritonitis in patients on continuous ambulatory peritoneal dialysis

Abstract

The objective of the study was to identify the microbiological spectrum and drug-sensitivity pattern of peritonitis in patients on continuous ambulatory peritoneal dialysis. This was a prospective study done over a period of a year-and-a-half at a tertiary-care hospital in a hilly state of India. The effluent dialysate bags from 36 consecutive patients with peritonitis were studied. One hunderd ml dialysate fluid was processed under aseptic conditions by lysis centrifugation method. Microscopy and culture was done from the deposits for bacteriological, fungal, and mycobacterial isolates. They were identified by colony morphology and their biochemical reactions. Drug susceptibility testing was done by Kirby-Bauer disc diffusion method. In 36 dialysates, 33 (91.6%) dialysates were culture-positive and in 3 (8.4%), the culture was negative. A total of 36 microorganisms were isolated in 33 cultures. Among the 36 microorganisms, 19 (52.8%) isolates were gram-positive, 10 (27.8%) were gram-negative, 5 (13.9%) were fungi, and 2 (5.6%) were mycobacterial isolates. All gram-positive organisms were sensitive to ampicillin, amoxi-clavulanic acid, cefazolin, clindamycin, and vancomycin. Neither a methicillin-resistant Staphylococci aureus nor a vancomycin-resistant Enterococcus was isolated in gram-positive isolates. Gram-negative organisms were sensitive to ciprofloxacin, ceftriaxone, ceftazidime, cefepime, gentamicin, piperacillin–tazobactam and imipenem. One of the gram-negative isolate was an extended spectrum beta-lactamase producer. Gram-positive peritonitis was more frequent than gram-negative peritonitis in our continuous ambulatory peritoneal dialysis patients. Mycobacterial causes were responsible for peritonitis in patients with culture-negative peritonitis which was not responding to the conventional antimicrobial therapy.

Long-Term Clinical Outcomes of Peritoneal Dialysis Patients: 9-Year Experience of a Single Center from North India

“…Standard antituberculous chemotherapy is highly effective. Therefore, it is prudent to start empirical treatment with antituberculous chemotherapy in CAPD patients with peritonitits that is refractory to broad-spectrum antibiotics while awaiting the results of the mycobacterial cultures to improve the outcome and preserve peritoneal membrane integrity (30).…”

A Clinico-Microbiological Profile of Peritonitis in Continuous Ambulatory Peritoneal Dialysis Patients

“…About one-fifth of the cases of peritonitis were caused by CoNS in this study (Vikrant et al, 2013). Also, there are studies which have reported that the majority of CAPD peritonitis was caused by CoNS which may primarily be due to touch contamination or due to the formation of a biofilm.…”

Complications of continuous ambulatory peritoneal dialysis: An early experience in tertiary hospital of Western region of Nepal

“…Similar findings were observed in other studies. 3,14 Fungi are uncommonly implicated, being responsible for only 2-16% of all peritonitis episodes associated with CAPD. 15 Fungal peritonitis, if not detected early and treated appropriately, is associated with increased morbidity and mortality.…”