TY - JOUR
T1 - Enterococcal peritonitis in Australian peritoneal dialysis patients
T2 - Predictors, treatment and outcomes in 116 cases
AU - Edey, Matthew
AU - Hawley, Carmel M.
AU - McDonald, Stephen
AU - Brown, Fiona G.
AU - Rosman, Johan B.
AU - Wiggins, Kathryn J.
AU - Bannister, Kym M.
AU - Johnson, David W.
N1 - Copyright:
Copyright 2010 Elsevier B.V., All rights reserved.
PY - 2010/4
Y1 - 2010/4
N2 - 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.
AB - 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.
KW - Antibiotics
KW - Bacteria
KW - Enterococcus faecalis
KW - Enterococcus faecium
KW - Outcomes
UR - http://www.scopus.com/inward/record.url?scp=77950291521&partnerID=8YFLogxK
U2 - 10.1093/ndt/gfp641
DO - 10.1093/ndt/gfp641
M3 - Article
C2 - 19948875
AN - SCOPUS:77950291521
SN - 0931-0509
VL - 25
SP - 1272
EP - 1278
JO - Nephrology Dialysis Transplantation
JF - Nephrology Dialysis Transplantation
IS - 4
ER -