Polymicrobial peritonitis in peritoneal dialysis patients in Australia: Predictors, treatment, and outcomes

Barraclough, Katherine, Hawley, Carmel M., McDonald, Stephen P., Brown, Fiona G., Rosman, Johan B., Wiggins, Kathryn J., Bannister, Kym M. and Johnson, David W. (2010) Polymicrobial peritonitis in peritoneal dialysis patients in Australia: Predictors, treatment, and outcomes. American Journal of Kidney Diseases, 55 1: 121-131. doi:10.1053/j.ajkd.2009.08.020


Author Barraclough, Katherine
Hawley, Carmel M.
McDonald, Stephen P.
Brown, Fiona G.
Rosman, Johan B.
Wiggins, Kathryn J.
Bannister, Kym M.
Johnson, David W.
Title Polymicrobial peritonitis in peritoneal dialysis patients in Australia: Predictors, treatment, and outcomes
Journal name American Journal of Kidney Diseases   Check publisher's open access policy
ISSN 0272-6386
1523-6838
Publication date 2010-01
Year available 2009
Sub-type Article (original research)
DOI 10.1053/j.ajkd.2009.08.020
Volume 55
Issue 1
Start page 121
End page 131
Total pages 11
Place of publication New York, NY, United States
Publisher W. B. Saunders & Co
Collection year 2011
Language eng
Subject C1
920109 Infectious Diseases
1108 Medical Microbiology
Formatted abstract
Background: The study aim was to examine the frequency, predictors, treatment, and clinical outcomes of peritoneal dialysis-associated polymicrobial peritonitis.
Study Design: Observational cohort study using ANZDATA (The Australia and New Zealand Dialysis and Transplant Registry) data.
Setting & Participants: All Australian peritoneal dialysis patients between October 2003 and December 2006.
Predictors: Age, sex, race, body mass index, baseline renal function, late referral, kidney disease, smoking status, comorbidity, peritoneal permeability, center, state, organisms, and antibiotic regimen.
Outcomes & Measurements: Polymicrobial peritonitis occurrence, relapse, hospitalization, catheter removal, hemodialysis transfer, and death.
Results: 359 episodes of polymicrobial peritonitis occurred in 324 individuals, representing 10% of all peritonitis episodes during 6,002 patient-years. The organisms isolated included mixed Gram-positive and Gram-negative organisms (41%), pure Gram-negative organisms (22%), pure Gram-positive organisms (25%), and mixed bacteria and fungi (13%). There were no significant independent predictors of polymicrobial peritonitis except for the presence of chronic lung disease. Compared with single-organism infections, polymicrobial peritonitis was associated with higher rates of hospitalization (83% vs 68%; P < 0.001), catheter removal (43% vs 19%; P < 0.001), permanent hemodialysis transfer (38% vs 15%; P < 0.001), and death (4% vs 2%; P = 0.03). Isolation of fungus or Gram-negative bacteria was the primary predictor of adverse clinical outcomes. Pure Gram-positive peritonitis had the best clinical outcomes. Patients who had their catheters removed >1 week after polymicrobial peritonitis onset were significantly more likely to be permanently transferred to hemodialysis therapy than those who had earlier catheter removal (92% vs 81%; P = 0.05).
Limitations: Limited covariate adjustment. Residual confounding and coding bias could not be excluded.
Conclusions: Polymicrobial peritonitis can be treated successfully using antibiotics alone without catheter removal in most cases, particularly when only Gram-positive organisms are isolated. Isolation of Gram-negative bacteria (with or without Gram-positive bacteria) or fungi carries a worse prognosis and generally should be treated with early catheter removal and appropriate antimicrobial therapy.
© 2009 National Kidney Foundation, Inc.
Keyword Antibiotics
Bacteria
Fungi
Microbiology
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online 22 November 2009

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2010 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Sun, 14 Feb 2010, 00:03:43 EST