Continuous peritoneal dialysis-associated peritonitis of nosocomial origin.
OBJECTIVE
To describe our experience with nosocomial continuous peritoneal dialysis (CPD)-associated peritonitis focusing on the incidence, possible risk factors, spectrum of organisms, and outcome.


METHODS
Retrospective review of the medical records of our CPD patients admitted to an acute-care hospital between November, 1993 and December, 1994.


METHODS
University-associated acute-care hospitals in New Haven, Connecticut.


METHODS
One hundred and eighty-eight patients maintained on CPD therapy and admitted to an acute-care hospital.


RESULTS
Nineteen patients (5%) developing nosocomial peritonitis (NP) were identified from the 408 admissions occurring during the study period. Patients developing NP were older than the hospitalized CPD patients not developing NP (65.5 +/- 14.6 vs 58.4 +/- 14.7 years, p < 0.05). Comorbid diseases including diabetes, peripheral vascular disease, gastrointestinal disease, cardiovascular disease, and human immunodeficiency virus seropositivity were not more common in the patients developing NP. Patients developing NP were hospitalized significantly longer than the CPD patients not developing NP (39.5 +/- 46.5 days vs 12.7 +/- 12.4 days, p < 0.001). The mean serum albumin was lower in the NP patients than in the CPD patients not developing NP (2.35 +/- 0.52 g/dL vs 3.02 +/- 0.60 g/L, p < 0.001). Antecedent antibiotic use and performance of invasive procedures were noted in 89% and 68% of the patients developing NP, respectively. Staphylococcal species, enterococcal species, and gram-negative organisms accounted for 26%, 21%, and 53% of the episodes of NP, respectively. Furthermore, two strains of Enterococcus resistant to vancomycin were cultured. Eight patients developing NP expired, 8 patients continued CPD therapy, 2 patients transferred to hemodialysis, and one patient recovered renal function.


CONCLUSIONS
We conclude that NP is uncommon. Increased age, increased length of hospital stay, and hypoalbuminemia may predispose patients to the development of NP. Further studies with case controls should help to clarify whether antecedent antibiotics or prior performance of invasive procedures predispose patients to the development of nosocomial peritonitis. The spectrum of organisms accounting for NP is different than the spectrum of organisms causing community-acquired CPD-associated peritonitis. Some of these organisms may be resistant to standard antibiotic therapies. Patients developing NP do poorly, with 42% expiring while being treated for NP.
Troidle
L
L
New Haven CPD, Department of Internal Medicine, Hospital of St. Raphael, New Haven, Connecticut, USA.
Kliger
A S
AS
Goldie
S J
SJ
Gorban-Brennan
N
N
Brown
E
E
Fikrig
M
M
Finkelstein
F O
FO
D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D003237:Connecticut / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D004352:Drug Resistance, Microbial; D016983:Enterococcus / Q000187:drug effects; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology; D006679:HIV Seropositivity / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D010538:Peritonitis / Q000453:epidemiology / Q000382:microbiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D013203:Staphylococcal Infections / Q000453:epidemiology; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D012709:Serum Albumin; D014640:Vancomycin