Introduction:
Peritonitis remains a serious complication in Continuous ambulatory peritoneal dialysis(CAPD) patients and an important cause of drop-out from the program. Peritoneal dialysis -associated peritonitis is associated with substantial morbidity, increases treatment costs and hospitalization events and is a primary reason for transition to hemodialysis
AIM
To determine the incidence of infective peritonitis including microbiological spectrum and assess clinical outcome following infective PD peritonitis.
Methods:
All patients (n=150) on CAPD followup between January 2020 and June 2024 were included in the study. It is a retrospective observational study. Clinical characteristics of patients, occurrence of peritonitis episodes, risk factors, microbiological spectrum of organisms involved and outcomes were analysed. Culture of peritoneal fluid was done by automated culture(BACTEC)
Results:
Overall 96 peritonitis episodes occurred during the study period (80 patients). PD peritonitis rate was 0.34 episodes per patient year. 62 % of patients were male, 38 % were female. Mean age was around 39.92 ±15.07 years. Mean duration of first peritonitis was 8 months. Cumulative culture positive was found in 90.5%. Mixed organisms in culture were common 28% (gram negative organism involvement in 80.9%, gram positive organism in 36.5%, Fungal 9.5%, Tubercular 4.8%). Predominant gram negative organisms were Acinetobacter(n=13), Pseudomonas(n=13), Alkaligenes faecalis 12. Most common gram positive organism was Coagulase negative staphylococcus aureus. In fungal spectrum, candida was common (n=5). Breach in technique was found to be associated with peritonitis (86%) leading to catheter removal in 32 patients (40%). Other common risk factors were change in caregiver (7%) and gastroenteritis/constipation (7%). Refractory peritonitis occurred in 22.5%(n=18). Mortality occurred in 11.25% patients (n=9)
Conclusions:
Proper training of caregiver in performing exchanges is prudent to prevention of peritonitis episodes as a breach in technique is the major predisposing factor in our patients. Microbiological spectrum of PD peritonitis in developing countries may be different from developed countries and there has been an increasing trend in the incidence of gram-negative peritonitis. A more detailed knowledge for culture negativity and resistant profiles of the causative organisms is needed to guide appropriate antibiotic therapy and improve peritonitis outcome.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.