Hsin-Hui Wang1, Chung-Hao Huang2, Mei-Chuan Kuo3, Shang-Yi Lin2, Chin-Huei Hsu4, Chun-Yuan Lee2, Yi-Wen Chiu3, Yen-Hsu Chen5, Po-Liang Lu6. 1. Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan. 2. Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan. 3. Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan; Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan. 4. Department of Nursing, Kaohsiung Medical University Hospital, Taiwan. 5. College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsin Chu, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan. 6. Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsin Chu, Taiwan. Electronic address: idpaul@gmail.com.
Abstract
BACKGROUND: Peritoneal dialysis (PD)-related infection is a serious complication of patients with PD. Refractory peritonitis may lead to failure of PD, shift to hemodialysis (HD) or death. Besides, microbiologic resistance increased worldwide that might impact the treatment choice for such infections. Investigating the causative pathogens and risk factors of PD-related infections in Taiwan was warranted. METHODS: This is a retrospective study involving patients with PD from 2007 to 2016 in a southern Taiwan hospital. Patient characteristics, microbiological data, outcomes, and factors associated with refractory peritonitis were analyzed. RESULTS: There were 190 episodes of PD-related peritonitis in 110 patients from this cohort. Gram-positive organisms were the leading cause of PD-related peritonitis, but gram-negative organisms, esp. Pseudomonas aeruginosa, were predominant for exit site infection and tunnel infection. The incidence of peritonitis was 0.25 episode per patient-year (1 episode per 47.69 months). The refractory rate was 14.2% (27/190). Methicillin resistance was noted in 2 (13.3%) of 15 Staphylococcus aureus isolates. Of 114 isolates, 72.8% (83) were susceptible to either cefazolin or gentamicin. Staphylococcus spp. and Escherichia coli infections were significantly associated with refractory peritonitis. Baseline hyponatremia (<130 mmol/L) was independently associated with refractory peritonitis. CONCLUSION: Gram-positive organisms remained major cause of PD-related peritonitis. About three quarters of causative pathogens were susceptible to the recommended empirical treatment for PD-related peritonitis. Baseline hyponatremia (<130 mmol/L) was independently associated with refractory peritonitis. Staphylococcus spp. and E. coli infections had important roles for refractory peritonitis.
BACKGROUND: Peritoneal dialysis (PD)-related infection is a serious complication of patients with PD. Refractory peritonitis may lead to failure of PD, shift to hemodialysis (HD) or death. Besides, microbiologic resistance increased worldwide that might impact the treatment choice for such infections. Investigating the causative pathogens and risk factors of PD-related infections in Taiwan was warranted. METHODS: This is a retrospective study involving patients with PD from 2007 to 2016 in a southern Taiwan hospital. Patient characteristics, microbiological data, outcomes, and factors associated with refractory peritonitis were analyzed. RESULTS: There were 190 episodes of PD-related peritonitis in 110 patients from this cohort. Gram-positive organisms were the leading cause of PD-related peritonitis, but gram-negative organisms, esp. Pseudomonas aeruginosa, were predominant for exit site infection and tunnel infection. The incidence of peritonitis was 0.25 episode per patient-year (1 episode per 47.69 months). The refractory rate was 14.2% (27/190). Methicillin resistance was noted in 2 (13.3%) of 15 Staphylococcus aureus isolates. Of 114 isolates, 72.8% (83) were susceptible to either cefazolin or gentamicin. Staphylococcus spp. and Escherichia coli infections were significantly associated with refractory peritonitis. Baseline hyponatremia (<130 mmol/L) was independently associated with refractory peritonitis. CONCLUSION: Gram-positive organisms remained major cause of PD-related peritonitis. About three quarters of causative pathogens were susceptible to the recommended empirical treatment for PD-related peritonitis. Baseline hyponatremia (<130 mmol/L) was independently associated with refractory peritonitis. Staphylococcus spp. and E. coli infections had important roles for refractory peritonitis.
Authors: Anna L Królicka; Adrianna Kruczkowska; Magdalena Krajewska; Mariusz A Kusztal Journal: Int J Environ Res Public Health Date: 2020-07-23 Impact factor: 3.390