title: Risk factors and outcomes of extended-spectrum beta-lactamase-producing E. coli peritonitis in CAPD patients.
abstract: 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.
authors.affiliation: Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong. terenceyip@netvigator.com
authors.forename: Terence
authors.initials: T
authors.lastname: Yip
authors.forename: Kai-Chung
authors.initials: KC
authors.lastname: Tse
authors.forename: Man-Fai
authors.initials: MF
authors.lastname: Lam
authors.forename: Sydney
authors.initials: S
authors.lastname: Tang
authors.forename: Fu-Keung
authors.initials: FK
authors.lastname: Li
authors.forename: Bo-Ying
authors.initials: BY
authors.lastname: Choy
authors.forename: Sing-Leung
authors.initials: SL
authors.lastname: Lui
authors.forename: Tak-Mao
authors.initials: TM
authors.lastname: Chan
authors.forename: Kar-Neng
authors.initials: KN
authors.lastname: Lai
authors.forename: Wai-Kei
authors.initials: WK
authors.lastname: Lo
mesh_terms: 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*
chemical_list: D001618:beta-Lactamases