Pseudomonas peritonitis in Australia: predictors, treatment, and outcomes in 191 cases.
OBJECTIVE
Pseudomonas peritonitis is a serious complication of peritoneal dialysis. To date, there as been no comprehensive, multicenter study of this condition.


METHODS
The predictors, treatment, and clinical outcomes of Pseudomonas peritonitis were examined by binary logistic regression and multilevel, multivariate Poisson regression in all Australian PD patients in 66 centers between 2003 and 2006.


RESULTS
A total of 191 episodes of Pseudomonas peritonitis (5.3% of all peritonitis episodes) occurred in 171 individuals. Its occurrence was independently predicted by Maori/Pacific Islander race, Aboriginal/Torres Strait Islander race, and absence of baseline peritoneal equilibration test data. Compared with other organisms, Pseudomonas peritonitis was associated with greater frequencies of hospitalization (96 versus 79%; P = 0.006), catheter removal (44 versus 20%; P < 0.001), and permanent hemodialysis transfer (35 versus 17%; P < 0.001) but comparable death rates (3 versus 2%; P = 0.4). Initial empiric antibiotic choice did not influence outcomes, but subsequent use of dual anti-pseudomonal therapy was associated with a lower risk for permanent hemodialysis transfer (10 versus 38%, respectively; P = 0.03). Catheter removal was associated with a lower risk for death than treatment with antibiotics alone (0 versus 6%; P < 0.05).


CONCLUSIONS
Pseudomonas peritonitis is associated with high rates of catheter removal and permanent hemodialysis transfer. Prompt catheter removal and use of two anti-pseudomonal antibiotics are associated with better outcomes.
Siva
Brian
B
Australia and New Zealand Dialysis and Transplant Registry, University of Adelaide at Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
Hawley
Carmel M
CM
McDonald
Stephen P
SP
Brown
Fiona G
FG
Rosman
Johan B
JB
Wiggins
Kathryn J
KJ
Bannister
Kym M
KM
Johnson
David W
DW
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000706:statistics & numerical data*; D010538:Peritonitis / Q000188:drug therapy* / Q000208:ethnology*; D016012:Poisson Distribution; D011237:Predictive Value of Tests; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000208:ethnology*; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents