title: Predictors, treatment, and outcomes of non-Pseudomonas Gram-negative peritonitis.
abstract: Non-Pseudomonas Gram-negative (NPGN) peritonitis is a frequent, serious complication of peritoneal dialysis; however, previous reports have been limited to small, single-center studies. To gain insight on the frequency, predictors, treatment, and outcomes of NPGN peritonitis, we analyzed data in the ANZDATA registry of all adult Australian peritoneal dialysis patients over a 39-month period using multivariate logistic and multilevel Poisson regressions. There were 837 episodes of NPGN peritonitis (23.3% of all peritonitis) that occurred in 256 patients. The most common organism isolated was Escherichia coli, but included Klebsiella, Enterobacter, Serratia, Acinetobacter, Proteus, and Citrobacter, with multiple organisms identified in a quarter of the patients. The principal risk factor was older age, with poorer clinical outcome predicted by older age and polymicrobial peritonitis. The overall antibiotic cure rate was 59%. NPGN peritonitis was associated with significantly higher risks of hospitalization, catheter removal, permanent transfer to hemodialysis, and death compared to other organisms contributing to peritonitis. Underlying bowel perforation requiring surgery was uncommon. Hence, we show that NPGN peritonitis is a frequent, serious complication of peritoneal dialysis, which is frequently associated with significant risks, including death. Its cure with antibiotics alone is less likely when multiple organisms are involved.
authors.affiliation: Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Jarvis
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hawley
authors.forename: Stephen P
authors.initials: SP
authors.lastname: McDonald
authors.forename: Fiona G
authors.initials: FG
authors.lastname: Brown
authors.forename: Johan B
authors.initials: JB
authors.lastname: Rosman
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Wiggins
authors.forename: Kym M
authors.initials: KM
authors.lastname: Bannister
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
mesh_terms: D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001315:Australia / Q000453:epidemiology; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D011379:Prognosis; D012042:Registries; D012074:Remission Induction; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents