Corynebacterium peritonitis in Australian peritoneal dialysis patients: predictors, treatment and outcomes in 82 cases

Barraclough, K., Hawley, C. M., McDonald, SP, Brown, F. G, Rosman, J. B., Wiggins, K. J., Bannister, K. M. and Johnson, D. W. (2009) Corynebacterium peritonitis in Australian peritoneal dialysis patients: predictors, treatment and outcomes in 82 cases. Nephrology Dialysis Transplantation, 24 12: 3834-3839. doi:10.1093/ndt/gfp322


Author Barraclough, K.
Hawley, C. M.
McDonald, SP
Brown, F. G
Rosman, J. B.
Wiggins, K. J.
Bannister, K. M.
Johnson, D. W.
Title Corynebacterium peritonitis in Australian peritoneal dialysis patients: predictors, treatment and outcomes in 82 cases
Formatted title
Corynebacterium peritonitis in Australian peritoneal dialysis patients: predictors, treatment and outcomes in 82 cases
Journal name Nephrology Dialysis Transplantation   Check publisher's open access policy
ISSN 0931-0509
Publication date 2009
Year available 2009
Sub-type Article (original research)
DOI 10.1093/ndt/gfp322
Volume 24
Issue 12
Start page 3834
End page 3839
Total pages 6
Editor N Lameire
Place of publication United Kingdom
Publisher Oxford University Press
Collection year 2010
Language eng
Subject C1
920119 Urogenital System and Disorders
110312 Nephrology and Urology
Abstract Background. Infection due to Corynebacterium species has been reported with increasing frequency over recent decades. The impacts of enhanced laboratory detection together with widespread use of new peritoneal dialysis (PD) connection technology and antimicrobial prophylaxis strategies on Corynebacterium PD-associated peritonitis have not been well studied. Methods. We investigated the frequency, predictors, treatment and clinical outcomes of Corynebacterium peritonitis in all Australian adult patients involving 66 centres who were receiving PD between 1 October 2003 and 31 December 2006. Results. Eighty-two episodes of Corynebacterium peritonitis (2.3% of all peritonitis episodes) occurred in 65 (1.4%) PD patients. Ten (15%) patients experienced more than one episode of Corynebacterium peritonitis and additional organisms were isolated in 12 (15%) episodes of Corynebacterium peritonitis. The incidence of Corynebacterium peritonitis was significantly and independently predicted only by BMI: RR 2.72 (95% CI 1.38–5.36) for the highest tertile BMI compared with the lowest tertile. The overall cure rate with antibiotics alone was 67%, which was similar to that of peritonitis due to other organisms. Vancomycin was the most common antimicrobial agent administered in the initial empiric and subsequent antibiotic regimens, although outcomes were similar regardless of antimicrobial schedule. Corynebacterium peritonitis not infrequently resulted in relapse (18%), repeat peritonitis (15%), hospitalization (70%), catheter removal (21%), permanent haemodialysis transfer (15%) and death (2%). The individuals who had their catheters removed more than 1 week after the onset of Corynebacterium peritonitis had a significantly higher risk of permanent haemodialysis transfer than those who had their catheters removed within 1 week (90% versus 43%, P < 0.05). Conclusions. Corynebacterium is an uncommon but significant cause of PD-associated peritonitis. Complete cure with antibiotics alone is possible in the majority of patients, and rates of adverse outcomes are comparable to those seen with peritonitis due to other organisms. Use of vancomycin rather than cephazolin as empiric therapy does not impact outcomes, and a 2-week course of antibiotic therapy appears sufficient. If catheter removal is required, outcomes are improved by removing the catheter within 1 week of peritonitis onset.
Keyword antibiotics
corynebacteria
diphtheroids
peritonitis
renal failure
CORYNEFORM BACTERIA
JK
INFECTION
Q-Index Code C1
Q-Index Status Confirmed Code

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2010 Higher Education Research Data Collection
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 24 times in Thomson Reuters Web of Science Article | Citations
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Created: Sun, 13 Dec 2009, 00:02:33 EST