Predictors of Outcome following Bacterial Peritonitis in Peritoneal Dialysis

Abstract

Objective No studies have been done to examine factors that predict the outcome of bacterial peritonitis during peritoneal dialysis (PD), beyond the contribution of the organism causing the peritonitis, concurrent exit-site or tunnel infection, and abdominal catastrophes. Design In this study we examined several clinical and laboratory parameters that might predict the outcome of an episode of bacterial peritonitis. Between March 1995 and July 2000, we identified 399 episodes of bacterial peritonitis in 191 patients on dialysis. Results There were 260 episodes of gram-positive peritonitis, 99 episodes of gram-negative peritonitis, and 40 episodes of polymicrobial peritonitis. Gram-positive peritonitis had a significantly higher resolution rate than either polymicrobial peritonitis or gram-negative peritonitis. Staphylococcus aureus episodes had poorer resolution than other gram-positive infections. Nonpseudomonal peritonitis had a better outcome than Pseudomonas aeruginosa episodes. Among all the gram-negative infections, Serratia marcescens had the worst outcome. Episodes associated with a purulent exit site had poor outcome only on univariate analysis. For those peritonitis episodes in which the PD fluid cell count was > 100/μL for more than 5 days, the nonresolution rate was 45.6%, compared to a 4.2% nonresolution rate when the cell count returned to 100/μL or less in less than 5 days. Those patients that had a successful outcome had been on continuous ambulatory PD for a significantly shorter period of time than those patients that had nonresolution. The nonresolution rate for those patients that had been on PD for more than 2.4 years was 24.4%, compared to 16.5% for those that had been on PD for less than 2.4 years ( p = 0.05). Conclusion The duration of PD and the number of days the PD effluent cell count remained > 100/μL were the only factors that independently predicted the outcome of an episode of peritonitis. Caucasians seem to have a higher nonresolution (failure) rate compared to Blacks. Other variables, such as the number of peritonitis episodes before the episode in question, vancomycin-based initial empiric treatment, serum albumin level, total lymphocyte count and initial dialysate white blood cell count, age, sex, diabetes, previous renal transplantation, and the use of steroids did not affect the outcome of peritonitis.

Severe Peritonitis in Patients Treated With Peritoneal Dialysis: A Case Series Study

“…The first important issue is awareness of the elevated risk for patients with long PD duration, age above 60 years, and low residual renal function, often combined with fast peritoneal transport and low nutritional indices. This is supported by our data and other reports (9,25–27). As the dialysis population grows older, and with increasing vascular and diabetic comorbidity, such patients will present increasingly more often with infectious complications (28).…”

RENAL RESEARCH INSTITUTE SYMPOSIUM: Continuous Peritoneal Dialysis‐Associated Peritonitis: A Review and Current Concepts

“…Fungi accounted for 2.6% of the episodes. These percentages are similar to other long-term outcome studies (2). Of note, the rate of gram-positive peritonitis decreased significantly during the study period, but the rate of gram-negative peritonitis remained the same.…”

“…Krishnan et al (2) identified 399 episodes of peritonitis in order to identify factors that might predict outcome.…”

Quality of life in chronic haemodialysis and peritoneal dialysis patients in Turkey and related factors

“…Peritonitis causes many problems such as abdominal pain, fatigue, loss of appetite and malnutrition. [33][34][35] The QOL of dialysis patients, whether they receive HD or PD, is affected negatively by these treatment modalities. Inconsistent results were obtained in studies regarding the QOL in HD and PD patients.…”