Microbiology and outcomes of polymicrobial peritonitis associated with peritoneal dialysis: a register-based cohort study from the French Language Peritoneal Dialysis Registry

Abstract

Background Previous studies have reported that polymicrobial peritonitis in peritoneal dialysis (PD) is associated with poor outcomes, but recent data from European cohorts are scarce. Methods We included from the French Language Peritoneal Dialysis Registryall patients ≥ 18 years who started PD between January 2014 and November 2020. We compared microbiology and patient characteristics associated with mono- and polymicrobial peritonitis. We assessed patient outcomes after a first polymicrobial peritonitis using survival analysis with competing events. We differentiated microorganisms isolated from dialysis effluent as enteric or non-enteric pathogens. Results 8848 patients contributed 13 023 patient-years of follow-up and 3348 culture-positive peritonitis, including 251 polymicrobial ones. This corresponded to rates of 0.32 and 0.02 episodes/patient-year, respectively. For most patients (72%) who experienced polymicrobial peritonitis, this was their first peritonitis episode. Enteric pathogens were more frequently isolated in poly- than in monomicrobial peritonitis (57 vs 44%, P < 0.001). In both cases of peritonitis with or without enteric pathogens, the poly- versus monomicrobial character of the peritonitis was not associated with mortality in patients who did not switch to hemodialysis (adjusted cause-specific hazard ratio, a.cs-HR, 1.2 [95% CI, 0.3–5.0], P = 0.78 and 1.1 [0.7–1.8], P = 0.73, respectively). However, the risks of death and switch to hemodialysis were higher for monomicrobial peritonitis with enteric pathogens, compared to those without (a.cs-HR, 1.3 [1.1–1.7], P = 0.02 and 1.9 [1.5–2.4], P < 0.0001, respectively). Conclusion Isolation of enteric pathogens, rather than the polymicrobial character of the peritonitis, is associated with poorer outcomes.

Peritoneal Dialysis–Related Infections

“…8 On the other hand, polymicrobial peritonitis episodes due to multiple Gram-positive organisms have a better prognosis and are expected to respond to antibiotic therapy alone. [65][66][67][68] Alternatively, hospital-acquired PD-related peritonitis 69 is associated with a worse prognosis, including lower primary medical cure rate and higher mortality. A review of 371 episodes of peritonitis that occurred during the hospital stay (admitted for another reason) showed a higher rate of ceftazidime-resistant bacterial isolates and worse outcomes.…”

“…8 On the other hand, polymicrobial peritonitis episodes due to multiple Gram-positive organisms have a better prognosis and are expected to respond to antibiotic therapy alone. 65–68…”

Evolution de la dialyse péritonéale en France depuis 2018 et durant les « années COVID » Rapport RDPLF

“…Le tableau V résume la répartition des germes cultivés en 2021. Les péritonites à germes multiples ne sont pas détaillées mais font l'objet d'un travail accepté dans le journal Nephrology Dialysis and Transplantation (sous presse) [6]. Le pourcentage de péritonites aseptiques était de 15,1%, conforme aux recommandations internationales.…”