Risk factors and outcomes of extended-spectrum beta-lactamase-producing E. coli peritonitis in CAPD patients.
OBJECTIVE
To determine the risk factors and outcomes of peritonitis caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli in continuous ambulatory peritoneal dialysis (CAPD).


METHODS
Episodes of E. coli CAPD peritonitis in our unit from October 1994 to August 2003 were reviewed. Demographic data, underlying medical conditions, recent use of gastric acid inhibitors (including H2 antagonist and proton pump inhibitor), recent antibiotic therapy, antibiotic regimen for peritonitis episodes, sensitivity test results of the E. coli isolated, and clinical outcomes were examined.


RESULTS
Over a 10-year study period, 88 episodes of E. coli peritonitis were recorded; 11 of the 88 cases were caused by ESBL-producing E. coli. Recent use of cephalosporins and gastric acid inhibitor were associated with the development of ESBL-producing E. coil peritonitis. Compared with non-ESBL-producing E. coli peritonitis, more cases in the ESBL-producing E. coli group developed treatment failure (45.5% vs 13.0%, p = 0.02) and died of sepsis (27.3% vs 3.9%, p = 0.02). Peritoneal failure rate was higher in the ESBL-producing E. coli group, although the difference was not statistically significant (18.2% vs 3.9%, p = 0.12).


CONCLUSIONS
Peritonitis caused by ESBL-producing E. coli is associated with worse clinical outcomes. The use of cephalosporins and gastric acid inhibitors may contribute to its development. Further studies are warranted to investigate and determine the predisposing factors for ESBL-producing E. coli peritonitis.
Yip
Terence
T
Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong. terenceyip@netvigator.com
Tse
Kai-Chung
KC
Lam
Man-Fai
MF
Tang
Sydney
S
Li
Fu-Keung
FK
Choy
Bo-Ying
BY
Lui
Sing-Leung
SL
Chan
Tak-Mao
TM
Lai
Kar-Neng
KN
Lo
Wai-Kei
WK
D000368:Aged; D004926:Escherichia coli / Q000201:enzymology*; D004927:Escherichia coli Infections; D006801:Humans; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010538:Peritonitis / Q000382:microbiology*; D012307:Risk Factors; D001618:beta-Lactamases / Q000096:biosynthesis*
D001618:beta-Lactamases