Relapsing and recurrent peritoneal dialysis-associated peritonitis: A multicenter registry study

Burke, Michael, Hawley, Carmel M., Badve, Sunil V., McDonald, Stephen P., Brown, Fiona G., Boudville, Neil, Wiggins, Kathryn J., Bannister, Kym M. and Johnson, David W. (2011) Relapsing and recurrent peritoneal dialysis-associated peritonitis: A multicenter registry study. American Journal of Kidney Diseases, 58 3: 429-436. doi:10.1053/j.ajkd.2011.03.022


Author Burke, Michael
Hawley, Carmel M.
Badve, Sunil V.
McDonald, Stephen P.
Brown, Fiona G.
Boudville, Neil
Wiggins, Kathryn J.
Bannister, Kym M.
Johnson, David W.
Title Relapsing and recurrent peritoneal dialysis-associated peritonitis: A multicenter registry study
Journal name American Journal of Kidney Diseases   Check publisher's open access policy
ISSN 0272-6386
1523-6838
Publication date 2011-09
Sub-type Article (original research)
DOI 10.1053/j.ajkd.2011.03.022
Volume 58
Issue 3
Start page 429
End page 436
Total pages 8
Place of publication New York, NY, U.S.A.
Publisher W.B. Saunders
Collection year 2012
Language eng
Formatted abstract
Background: The causes, predictors, treatment, and outcomes of relapsed and recurrent peritoneal dialysis (PD)-associated peritonitis are poorly understood.

Study Design: Observational cohort study using Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data.

Setting & Participants: All Australian PD patients between October 1, 2003, and December 31, 2007, with first episodes of peritonitis.

Predictors: Demographic, clinical, and facility variables and type of peritonitis; relapse (same organism or culture-negative episode occurring within 4 weeks of completion of therapy of a prior episode or 5 weeks if vancomycin used); recurrence (different organism occurring within 4 weeks of completion of therapy of a prior episode or 5 weeks if vancomycin used); control (first peritonitis episode without relapse or recurrence).

Outcomes & Measurements: Hospitalization, catheter removal, hemodialysis therapy transfer, death.

Results: Of 6,024 PD patients studied, first episodes of relapsed, recurrent, and control peritonitis occurred in 356, 165, and 2,021 patients, respectively. Coagulase-negative staphylococci and Staphylococcus aureus accounted for 48% of relapsing peritonitis (adjusted OR, 1.26 [95% CI, 0.94-1.70] and 1.54 [95% CI, 1.08-2.19], respectively), but were much less likely to be isolated in recurrent peritonitis. Recurrent peritonitis was associated more frequently with fungi (13%; OR, 2.16; 95% CI, 1.12-4.17). The empirical antimicrobial approaches to relapsing and recurrent peritonitis were similar and their subsequent clinical outcomes were comparable. Compared with uncomplicated peritonitis, relapsed and recurrent peritonitis were associated with higher rates of catheter removal (22% vs 30% vs 37%, respectively; P < 0.001) and permanent hemodialysis therapy transfer (20% vs 25% vs 32%; P < 0.001), but similar rates of hospitalization (73% vs 70% vs 70%) and death (2.8% vs 2.0% vs 1.2%).

Limitations: Limited covariate adjustment. Residual confounding and coding bias could not be excluded.

Conclusions: Relapsed and recurrent peritonitis are caused by different spectra of micro-organisms, but are not readily clinically distinguishable at presentation. Empirical treatment with broad-spectrum antibiotics and subsequent adjustment according to antimicrobial susceptibilities results in similar clinical outcomes, albeit with appreciably higher rates of catheter removal and hemodialysis therapy transfer than for uncomplicated peritonitis.
Keyword Antibiotics
Bacteria
Fungus
Microbiology
Peritoneal dialysis
Peritonitis
Outcomes
Recurrence
Relapse
Patients predictors
Infections recommendations
Negative peritonitis
Fungal peritonitis
Outcomes
Urokinase
Update
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Medicine Publications
 
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