Repeat Peritonitis in Peritoneal Dialysis

Abstract

SummaryBackground and objectives The clinical behavior of repeat-peritonitis episodes, defined as peritonitis with the same organism occurring more than 4 weeks after completion of therapy for a prior episode, is poorly understood.Design, setting, participants, & measurements We compared outcomes of 181 episodes of repeat peritonitis from 1995 to 2009 (Repeat Group) with 91 episodes of relapsing peritonitis (Relapsing Group) and 125 episodes of peritonitis preceded 4 weeks or longer by another episode with a different organism (Control Group). ResultsIn Repeat Group, 24% were due to Staphylococcus aureus, as compared with 5.5% in Relapsing Group and 15% in Control Group. The majority of the organisms causing relapsing peritonitis were Gram negative (62%), whereas the majority of that in Repeat Group were Gram positive (56%). Repeat Group had a lower complete-cure rate (70.7% versus 54.9%) than Relapsing Group, but rates of primary response, catheter removal, and mortality were similar. Repeat Group had a higher primary response rate (89.0% versus 73.6%) and a lower rate of catheter removal (6.1% versus 15.2%) than Control Group, whereas the completecure rate and mortality were similar. Repeat Group had a higher risk of developing relapsing (14.3% versus 2.2%) and repeat peritonitis (26.1% versus 5.4%) than Control Group, whereas the risk of recurrent peritonitis was similar.Conclusions Repeat peritonitis is a distinct clinical entity. Although repeat-peritonitis episodes generally have a satisfactory response to antibiotic, they have a substantial risk of developing further relapsing or repeat peritonitis.

Difficult peritonitis cases in children undergoing chronic peritoneal dialysis: relapsing, repeat, recurrent and zoonotic episodes

“…However, more recently and in contrast to this experience in the pediatric patient population, Szeto et al described experience in the adult population in which the majority of organisms causing relapsing peritonitis were Gram-negative (62 %); S. aureus was isolated in only 5.5 % of relapsing peritonitis episodes [15]. The frequency of Gram-negative infections causing a relapsing infection in adult PD patients was also threefold higher than the frequency noted among pediatric PD patients [15].…”

“…The risk of having a repeat peritonitis episode appears to be much higher (25-30 %) in individuals with CNS and S. aureus peritonitis in series reported from China [23,33] and Australia [34,35]. A retrospective single-center observational cohort study of 181 consecutive cases of repeat peritonitis in 1995-2009 showed that Gram-positive organisms were responsible for more than half of the repeat peritonitis cases (56 %); 24 % of cases were caused by S. aureus and 18 % by CNS [15]. In the most recent Australian registry report, there was a similar frequency of S. aureus (24 %) infections, but CNS was isolated in a greater percentage of repeat peritonitis episodes (45 %) [31].…”

“…Adult data have also indicated that patients with repeated peritonitis had a higher risk of developing relapsing peritonitis than controls [15].…”

“…The cure rate of relapsing peritonitis following antibiotic therapy alone is similar in adult and pediatric relapsing peritonitis episodes (71 and 73 %, respectively) [15,20]. However, in the IPPR, relapsing infections-in comparison to sporadic peritonitis episodes-were associated with a lower rate of full functional recovery (73 vs. 91 %), a higher rate of ultrafiltration (UF) problems (14 vs. 2 %) and a higher rate of permanent PD discontinuation (17 vs. 7 %) [20].…”

“…It has often been assumed that a repeat peritonitis episode is merely a delayed form of a relapsing episode. However, a recent study comparing the outcomes of 181 episodes of repeat peritonitis (observed from 1995 to 2009) with 91 episodes of relapsing peritonitis showed that the two groups of peritonitis episodes have different patterns of causative organisms and therapeutic response, which implies that they are indeed two distinct entities [15]. Although there was a debate and confusion regarding the terminology and a correction was proposed [14], the definitions of relapsing, recurrent and repeat peritonitis were not changed and were fully endorsed in the 2010 update of the adult guidelines [11] and the 2012 update of the pediatric peritonitis guidelines [12].…”