Microbiology of Peritonitis in Peritoneal Dialysis Patients with Multiple Episodes

Author:

Nessim Sharon J.12,Nisenbaum Rosane34,Bargman Joanne M.5,Jassal Sarbjit V.5

Affiliation:

1. Division of Nephrology, Montreal, Quebec

2. Jewish General Hospital, and McGill University, Montreal, Quebec

3. Centre for Research in Inner City Health and Applied Health Research Centre in the Keenan Research Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada

4. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Dalla Lana School of Public Health, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada

5. University of Toronto, and Division of Nephrology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada

Abstract

Background Peritoneal dialysis (PD)–associated peritonitis clusters within patients. Patient factors contribute to peritonitis risk, but there is also entrapment of organisms within the biofilm that forms on PD catheters. It is hypothesized that this biofilm may prevent complete eradication of organisms, predisposing to multiple infections with the same organism. Methods Using data collected in the Canadian multi-center Baxter POET (Peritonitis, Organism, Exit sites, Tunnel infections) database from 1996 to 2005, we studied incident PD patients with 2 or more peritonitis episodes. We determined the proportion of patients with 2 or more episodes caused by the same organism. In addition, using a multivariate logistic regression model, we tested whether prior peritonitis with a given organism predicted the occurrence of a subsequent episode with the same organism. Results During their time on PD, 558 patients experienced 2 or more peritonitis episodes. Of those 558 patients, 181 (32%) had at least 2 episodes with the same organism. The organism most commonly causing repeat infection was coagulase-negative Staphylococcus (CNS), accounting for 65.7% of cases. Compared with peritonitis caused by other organisms, a first CNS peritonitis episode was associated with an increased risk of subsequent CNS peritonitis within 1 year (odds ratio: 2.1; 95% confidence interval: 1.5 to 2.8; p < 0.001). Among patients with repeat CNS peritonitis, 48% of repeat episodes occurred within 6 months of the earlier episode. Conclusions In contrast to previous data, we did not find a high proportion of patients with multiple peritonitis episodes caused by the same organism. Coagulase-negative Staphylococcus was the organism most likely to cause peritonitis more than once in a given patient, and a prior CNS peritonitis was associated with an increased risk of CNS peritonitis within the subsequent year.

Publisher

SAGE Publications

Subject

Nephrology,General Medicine

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1. Staphylococcus aureus small colony variants: A potentially underestimated microbiological challenge in peritoneal dialysis;International Journal of Antimicrobial Agents;2024-05

2. Persistent peritonitis in peritoneal dialysis: a comphrenesive review of recurrent, relapsing, refractory, and repeat peritonitis;International Urology and Nephrology;2023-08-10

3. A case of Neurospora sitophila causing PD peritonitis;Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis;2023-05-02

4. Peritonitis in CAPD: Microbiological Considerations in Diagnosis;Diagnosis and Management of Complications of Peritoneal Dialysis related Peritonitis;2023

5. Predictive Factors, Treatment, and Outcomes of Coagulase-Negative Staphylococcal Peritonitis in Malaysian Peritoneal Dialysis Patients: A Single-Center Study;International Journal of Nephrology;2022-04-11

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