title: Clinical course and outcomes of single-organism Enterococcus peritonitis in peritoneal dialysis patients.
abstract: OBJECTIVE
  Enterococci are part of the normal flora of the gastrointestinal tract. They can cause enteric peritonitis, which is a serious complication of peritoneal dialysis (PD). However, the clinical course and outcome of PD-related Enterococcus peritonitis remains unclear.
  
  
  METHODS
  We reviewed all Enterococcus peritonitis episodes occurring in our dialysis unit from 1995 to 2009.
  
  
  RESULTS
  During the study period, 1421 episodes of peritonitis were recorded. Of 29 episodes (2.0%) that were attributable to single-organism Enterococcus, 12 episodes were caused by E. faecalis; 9, by E. faecium; and the remaining 8, by other Enterococcus species. The overall rate of ampicillin resistance was 41.4%. Recent use of antibiotics was associated with the development of ampicillin-resistant Enterococcus (ARE) peritonitis (hazard ratio: 12.53; p = 0.04). The primary response rate of Enterococcus peritonitis was significantly higher than that of Escherichia coli peritonitis (89.7% vs. 69.9%, p = 0.038), but the primary response rate was not significantly lower for ARE peritonitis than for ampicillin-susceptible Enterococcus (ASE) peritonitis (83.3% vs. 94.1%, p = 0.553). However, significantly more patients with ARE had received vancomycin (83.3% vs. 23.5%, p = 0.003), with a longer mean duration of vancomycin treatment (11.8 ± 6.9 days vs. 3.7 ± 6.8 days, p = 0.005).
  
  
  CONCLUSIONS
  Recent use of antibiotics was a risk factor for the development of ARE peritonitis. Outcomes in ASE and ARE peritonitis were similar, but vancomycin was required during treatment for ARE peritonitis, in turn possibly predisposing the patients to infections caused by vancomycin-resistant organisms.
authors.affiliation: Dr. Lee Iu Cheung Memorial Renal Research Centre, Tung Wah Hospital, The University Department of Medicine, The University of Hong Kong, Hong Kong SAR, PR China. terenceyip@netvigator.com
authors.forename: Terence
authors.initials: T
authors.lastname: Yip
authors.forename: Kai-Chung
authors.initials: KC
authors.lastname: Tse
authors.forename: Flora
authors.initials: F
authors.lastname: Ng
authors.forename: Ivan
authors.initials: I
authors.lastname: Hung
authors.forename: Man-Fai
authors.initials: MF
authors.lastname: Lam
authors.forename: Sydney
authors.initials: S
authors.lastname: Tang
authors.forename: Sing-Leung
authors.initials: SL
authors.lastname: Lui
authors.forename: Kar-Neng
authors.initials: KN
authors.lastname: Lai
authors.forename: Tak-Mao
authors.initials: TM
authors.lastname: Chan
authors.forename: Wai-Kei
authors.initials: WK
authors.lastname: Lo
mesh_terms: D015746:Abdominal Pain / Q000382:microbiology; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004927:Escherichia coli Infections; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000188:drug therapy / Q000382:microbiology*; D012189:Retrospective Studies; D013203:Staphylococcal Infections; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin