Introduction:
Peritoneal dialysis (PD)-associated peritonitis is a serious complication of PD and its prevention and treatment are important in reducing patient morbidity and mortality. It is associated with morbidity including pain, treatment costs, transfer to hemodialysis and death, as well as alterations of the peritoneal membrane and peritoneal adhesions. In resource limited rural areas many people choose PD over hemodialysis (HD) due to financial constrains owing to free availability of PD solution and consumables through government programme and also due to the cost and limited access to HD.
Methods:
This study is a hospital based cross sectional study to estimate the incidence of PD associated peritonitis a tertiary care centre in a rural area, associated risk factors and outcome of peritonitis episode. Data was collected from CKD patients undergoing continuous ambulatory peritoneal dialysis (CAPD) in Alappuzha district on follow up from our centre and who had a peritonitis episode in the past 2 years.
Results:
There were 44 new CAPD catheter insertions over the last 2 years in our centre and there are about 44 presently active CAPD patients. There was a total number of 21 peritonitis episodes among 18 patients over the last 2 years amounting to a peritonitis rate of 0.28 episode per patient per year in our institution.
The presenting symptoms were abdominal pain (93%), fever (66%), cloudy effluent (93%) and loose stools (26.6%). The mean PD fluid total leucocyte count at presentation was 3438 cells/mm3 of which 66% episodes were neutrophil predominant. 73.3% of episodes were culture negative and 26.7% of episodes yielded some organism on culture (20% bacterial and 6.7% fungal). Pseudomonas was the most common bacteria isolated.
Constipation was present in 53.3% of patients. There was a history of change in care giver in 40% of patients. History of wet contamination was obtained in 13.3% and there was associated exit site infection in 13.3%. History of poor hygiene with breach of aseptic precautions was obtained in 26% of patients.
66% of the patients were started on empirical intraperitoneal (IP) antibiotics cefazolin + ceftazidime while remaining received IP vancomycin + ceftazidime. 26.6 % of the peritonitis episodes were refractory requiring catheter removal. Peritonitis-associated haemodialysis transfer was 30%. Among refractory peritonitis one patient expired and remaining were transferred to maintenance HD. A seasonal variation was noted with clustering of cases during monsoon.
Conclusions:
Risk factors for PD associated peritonitis include constipation, change in care giver, breach of aseptic precautions and wet contamination.
Rural areas in our district mainly rely on paddy cultivation and farming is carried out below sea level. This leads to water logging especially during monsoon and interruption of safe water, increased infection risks probably causing a seasonal variation in peritonitis. Lack of availability of potable water, poor motivation to perform CAPD were found in our analysis as predisposing factors unique to patients in our area which need to be addressed prior to patient selection.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.