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Peritoneal dialysis (PD) serves as a pivotal treatment modality for stage V chronic kidney disease (CKD) patients. Among the complications associated with PD, peritonitis emerges as a paramount concern due to its direct correlation with heightened morbidity and mortality rates. A comprehensive understanding of the bacteriological profile specific to each dialysis service is imperative, facilitating the prompt initiation of accurate empirical treatment and averting the progression to peritoneal failure, subsequently necessitating a transition to hemodialysis.
A retrospective and descriptive analysis was conducted, utilizing a sample comprising patients who experienced at least one episode of peritonitis associated with PD at the Nephrology Service of Hospital Ana Nery from January 2020 to December 2021.
Out of 73 PD patients, 39 individuals (53%) presented with at least one episode of peritonitis. Notably, there was a prevalence of females, and the age group of 40 to 49 years exhibited the highest incidence, with 23 cases (59%) and 14 cases (35.8%), respectively. The predominant cause of CKD remained indeterminate in the majority (51.2%), followed by Diabetes Mellitus (20.5%). Sixty-three peritonitis episodes were recorded during the study period, with 17 cases (29.3%) featuring negative cultures. Gram-positive bacteria, accounting for 46.5%, were identified as the most common etiological agents, while Gram-negative bacteria comprised 15.5% of cases. Fungal peritonitis was detected in 8.3%. Notably, eight episodes of peritonitis were attributed to Methicillin-Resistant Staphylococcus, and only two episodes involved extended-spectrum beta-lactamase-producing Enterobacteriaceae.
Within this exclusive SUS facility, the incidence of peritonitis was 0.8 episodes per patient-year in 2020 and rose to 1.17 episodes per patient-year in 2021, surpassing ISPD recommendations (0.4/year). Despite this, no significant antimicrobial resistance was observed, supporting the implementation of dual empirical therapy with first and third generation cephalosporins. This study paves the way for further investigations, both within and beyond our research center, pertaining to protocols for prevention, treatment, and fungal prophylaxis in peritoneal dialysis patients.