Peritoneal dialysis-associated peritonitis: clinical features and predictors of outcome.
OBJECTIVE
The objective of this study was to identify the epidemiological, clinical, and microbiological factors affecting the outcome of peritoneal dialysis (PD)-associated peritonitis.


METHODS
All patients with PD-associated peritonitis, cared for at the University Hospital of Heraklion from 1990 to 2007, were retrospectively studied.


RESULTS
A total of 247 episodes of PD-associated peritonitis occurring in 82 patients were evaluated. The median age of patients was 68 years (range 10-92 years); 51 (62%) were males. There were 104 episodes (42%) of Gram-positive peritonitis, 46 (19%) of Gram-negative peritonitis, 13 (5%) of polymicrobial peritonitis, and 11 (4%) of fungal peritonitis. There were 64 (26%) complicated episodes. The latter included 22 (8.9%) relapses, 13 (5.3%) repeated episodes, 18 (7.3%) catheter removals, and 11 (4.5%) deaths. In multivariate analysis, the presence of a purulent exit-site infection (p<0.001), peritoneal dialysis effluent cell count >100 x 10(6)/l for more than 5 days (p<0.001), use of antimicrobials during the preceding 3 months (p<0.05), and low serum total protein level on admission (p<0.05) were independent predictors of a complicated course.


CONCLUSIONS
Exit-site infection, more than 5 days with a peritoneal dialysis effluent cell count >100 x 10(6)/l, prior use of antimicrobials, and low serum total protein level are potential predictors of complicated PD-associated peritonitis and may distinguish high-risk cases.
Kofteridis
Diamantis P
DP
Department of Internal Medicine-Infectious Disease Unit, University Hospital of Heraklion, 71 110, Heraklion, Crete, Greece. kofterid@med.uoc.gr
Valachis
Antonios
A
Perakis
Kostas
K
Maraki
Sofia
S
Daphnis
Eugenios
E
Samonis
George
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D005658:Fungi / Q000145:classification / Q000302:isolation & purification; D006090:Gram-Negative Bacteria / Q000145:classification / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000145:classification / Q000302:isolation & purification; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents