Enterococcal peritonitis in Australian peritoneal dialysis patients: Predictors, treatment and outcomes in 116 cases

Edey, Matthew, Hawley, Carmel M., McDonald, Stephen P., Brown, Fiona G., Rosman, Johan B., Wiggins, Kathryn J., Bannister, Kym M. and Johnson, David W. (2010) Enterococcal peritonitis in Australian peritoneal dialysis patients: Predictors, treatment and outcomes in 116 cases. Nephrology Dialysis Transplantation, 25 4: 1272-1278. doi:10.1093/ndt/gfp641


Author Edey, Matthew
Hawley, Carmel M.
McDonald, Stephen P.
Brown, Fiona G.
Rosman, Johan B.
Wiggins, Kathryn J.
Bannister, Kym M.
Johnson, David W.
Title Enterococcal peritonitis in Australian peritoneal dialysis patients: Predictors, treatment and outcomes in 116 cases
Journal name Nephrology Dialysis Transplantation   Check publisher's open access policy
ISSN 0931-0509
1460-2385
Publication date 2010-04
Year available 2009
Sub-type Article (original research)
DOI 10.1093/ndt/gfp641
Volume 25
Issue 4
Start page 1272
End page 1278
Total pages 7
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Collection year 2011
Language eng
Formatted abstract
Background. Enterococcal peritonitis is a serious complication of peritoneal dialysis (PD), although reports of this condition in the literature are exceedingly limited.
Methods. The frequency, predictors, treatment and clinical outcomes of enterococcal peritonitis were investigated in all 4675 patients receiving PD in Australia between 1 October 2003 and 31 December 2006.
Results. One hundred and sixteen episodes of enterococcal peritonitis occurred in 103 individuals. Enterococcal peritonitis tended to be associated with older age, Maori and Pacific Islander racial origin, renovascular disease and coronary artery disease. Polymicrobial peritonitis, defined as recovery of two or more organisms from dialysate effluent, was significantly more common when an Enterococcus species was isolated than when it was not (45% vs 5%, respectively, P < 0.001, odds ratio 13.4, 95% CI 9.45-19.0). Although international guidelines recommend intraperitoneal ampicillin therapy, only 8% of patients with pure enterococcal peritonitis were treated with this agent, whilst the majority (78%) received vancomycin monotherapy. Overall, 59 (51%) patients with enterococcal peritonitis were successfully treated with antibiotics without experiencing relapse, catheter removal or death. The sole independent predictor of adverse clinical outcomes was recovery of additional (non-Enterococcus) organisms. Polymicrobial enterococcal peritonitis was associated with very high rates of hospitalization (83%), catheter removal (52%), permanent haemodialysis transfer (50%) and death (5.8%). In contrast, clinical outcomes were broadly comparable for pure enterococcal and non-enterococcal peritonitis (hospitalization 75% vs 69%, respectively; catheter removal 25% vs 21%; permanent haemodialysis transfer 17% vs 17%; death 1.6% vs 2.2%) although worse than non-enterococcal Gram-positive peritonitis (63%, 12%, 3% and 0.6%, respectively). Removal of the PD catheter within 1 week of enterococcal peritonitis onset was associated with a lower probability of permanent haemodialysis transfer than later removal (74% vs 100%, P = 0.03).
Conclusions. Enterococcal peritonitis is associated with an increased risk of catheter removal, permanent haemodialysis transfer and death, particularly when other organisms are isolated in the same episode.
© 2009 The Author.
Keyword Antibiotics
Bacteria
Enterococcus faecalis
Enterococcus faecium
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes First published online: November 30, 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: Wed, 14 Apr 2010, 11:37:39 EST by Maree Knight on behalf of Medicine - Princess Alexandra Hospital