title: Microbiology and outcomes of peritonitis in northern India.
abstract: BACKGROUND
  Peritoneal dialysis (PD) is an established treatment modality for end-stage renal disease (ESRD). Peritonitis remains a serious complication in PD patients and an important cause of drop-out from the program. Types of pathogens and their drug resistance patterns may determine the outcome of peritonitis. The present study was undertaken to determine the microbiology of peritonitis in PD patients, antibiotic resistance in commonly isolated bacterial pathogens and clinical outcomes.
  
  
  METHODS
  We enrolled 211 patients with ESRD undergoing PD who developed peritonitis during 2002 to 2011. PD fluids were cultured and antibiotic susceptibility test of the bacterial isolates was performed.
  
  
  RESULTS
  A total of 303 peritonitis episodes with an overall incidence of 0.41 episodes per patient-year were recorded. Gram-positive, gram-negative, fungi, Mycobacterium tuberculosis and ≥ 2 organisms were isolated from 102 (33.7%), 89 (29.4%), 41 (13.5%), 11 (3.6%) and five (1.6%) episodes respectively; 55 (18.2%) episodes were culture negative. Coagulase-negative Staphylococcus spp. (CONS) was the most common isolate. Catheter loss and hospital admission in gram-negative peritonitis were significantly higher than in gram-positive peritonitis (36/89 (40.4%) vs 20/102 (19.6%), p < 0.001; and 56/89 (62.9%) vs 42/102 (41.2%), p = 0.004 respectively). Antibiotic susceptibility tests showed 54.3% of Enterobacteriaceae isolates were extended spectrum β-lactamase (ESBL) producers, 23.5% of Acinetobacter species and 11.5% of Pseudomonas aeruginosa were metallo-β-lactamase (MBL) producers; 15.4% of enterococci and 28.6% of staphylococci were resistant to vancomycin and methicillin respectively. Mortality was significantly higher in patients having peritonitis due to vancomycin-resistant enterococci, ESBL- and MBL-producing bacteria.
  
  
  CONCLUSIONS
  Emerging antimicrobial resistance calls for prompt diagnosis and aggressive empiric therapy based on the local sensitivity data.
authors.affiliation: Department of Microbiology,1 Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India;
authors.forename: Kashi Nath
authors.initials: KN
authors.lastname: Prasad
authors.forename: Kamini
authors.initials: K
authors.lastname: Singh
authors.forename: Arshi
authors.initials: A
authors.lastname: Rizwan
authors.forename: Priyanka
authors.initials: P
authors.lastname: Mishra
authors.forename: Dinesh
authors.initials: D
authors.lastname: Tiwari
authors.forename: Narayan
authors.initials: N
authors.lastname: Prasad
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D007194:India; D007676:Kidney Failure, Chronic / Q000382:microbiology / Q000628:therapy*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010530:Peritoneal Dialysis; D010538:Peritonitis / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D015996:Survival Rate
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic resistance; etiology of peritonitis; mortality in peritonitis; outcome of peritonitis; peritoneal dialysis