title: Acinetobacter peritoneal dialysis peritonitis: a changing landscape over time.
abstract: BACKGROUND
  Acinetobacter species are assuming an increasingly important role in modern medicine, with their persistent presence in health-care settings and antibiotic resistance. However, clinical reports addressing this issue in patients with peritoneal dialysis (PD) peritonitis are rare.
  
  
  METHODS
  All PD peritonitis episodes caused by Acinetobacter that occurred between 1985 and 2012 at a single centre were retrospectively reviewed. Clinical features, microbiological data, and outcomes were analysed, with stratifications based upon temporal periods (before and after 2000).
  
  
  RESULTS
  Acinetobacter species were responsible for 26 PD peritonitis episodes (3.5% of all episodes) in 25 patients. A. baumannii was the most common pathogen (54%), followed by A. iwoffii (35%), with the former being predominant after 2000. Significantly more episodes resulted from breaks in exchange sterility after 2000, while those from exit site infections decreased (P = 0.01). The interval between the last and current peritonitis episodes lengthened significantly after 2000 (5 vs. 13.6 months; P = 0.05). All the isolates were susceptible to cefepime, fluoroquinolone, and aminoglycosides, with a low ceftazidime resistance rate (16%). Nearly half of the patients (46%) required hospitalisation for their Acinetobacter PD-associated peritonitis, and 27% required an antibiotic switch. The overall outcome was fair, with no mortality and a 12% technique failure rate, without obvious interval differences.
  
  
  CONCLUSIONS
  The temporal change in the microbiology and origin of Acinetobacter PD-associated peritonitis in our cohort suggested an important evolutional trend. Appropriate measures, including technique re-education and sterility maintenance, should be taken to decrease the Acinetobacter peritonitis incidence in PD patients.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan; Graduate Institute of Toxicology, National Taiwan University, Taipei, Taiwan.
authors.forename: Chia-Ter
authors.initials: CT
authors.lastname: Chao
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan.
authors.forename: Szu-Ying
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu County, Taiwan.
authors.forename: Wei-Shun
authors.initials: WS
authors.lastname: Yang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Huei-Wen
authors.initials: HW
authors.lastname: Chen
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Cheng-Chung
authors.initials: CC
authors.lastname: Fang
authors.affiliation: Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chung-Jen
authors.initials: CJ
authors.lastname: Yen
authors.affiliation: Department of Integrative diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chih-Kang
authors.initials: CK
authors.lastname: Chiang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Kuan-Yu
authors.initials: KY
authors.lastname: Hung
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Jenq-Wen
authors.initials: JW
authors.lastname: Huang
mesh_terms: D000150:Acinetobacter; D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000209:etiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D063868:Patient Outcome Assessment; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000453:epidemiology* / Q000209:etiology*; D012189:Retrospective Studies; D055815:Young Adult