Pseudomonal and candidal peritonitis as a complication of continuous ambulatory peritoneal dialysis in human immunodeficiency virus-infected patients.
OBJECTIVE
To our knowledge, there has been no report documenting the spectrum of peritonitis in human immunodeficiency virus (HIV)-infected persons. We therefore analyzed our records to confirm our previous observation of a higher incidence of pseudomonal and fungal peritonitis in a group of HIV antibody-positive (HIV+) patients undergoing continuous ambulatory peritoneal dialysis (CAPD).


METHODS
During a 22-month period, we retrospectively studied 71 patients with end-stage renal disease undergoing CAPD. Of these, seven were HIV+, five were at high risk for HIV infection but antibody-negative, and 59 were at low risk for HIV infection. Organisms isolated in episodes of peritonitis were classified microbiologically as one of the following: gram-positive, non-pseudomonal gram-negative, pseudomonal, fungal, or culture-negative.


RESULTS
The total peritonitis rate was higher in both the high-risk (p less than or equal to 0.01) and the HIV+ (p less than or equal to 0.02) groups when compared with that in the low-risk population. These differences were attributable to the following: (1) the high-risk group's two-fold increase in gram-positive infections (p less than or equal to 0.01), and (2) a 24-fold increase in pseudomonal (p less than 0.001) infections and seven-fold increase in fungal (p less than 0.005) infections in the HIV+ group. These infections were invariably associated with catheter loss and frequently resulted in conversion to hemodialysis.


CONCLUSIONS
We believe that the use of CAPD in HIV+ patients may be limited by this increased occurrence of pseudomonal and fungal peritonitis.
Dressler
R
R
Department of Medicine, Albert Einstein College of Medicine, Bronx, New York 10461.
Peters
A T
AT
Lynn
R I
RI
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000382:microbiology / Q000628:therapy; D002177:Candidiasis / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000382:microbiology / Q000628:therapy; D009894:Opportunistic Infections / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D010538:Peritonitis / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D011552:Pseudomonas Infections / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors