title: Effects of a Statewide Protocol for the Management of Peritoneal Dialysis-Related Peritonitis on Microbial Profiles and Antimicrobial Susceptibilities: A Retrospective Five-Year Review.
abstract: ♦
  
  
  BACKGROUND
  Peritonitis is a major complication of peritoneal dialysis (PD) and is associated with significant morbidity and mortality. Early empirical antibiotic therapy is recommended, with the choice of agents guided by local resistance patterns. As routine use of specific antimicrobial agents can drive resistance, regular assessment of causative organisms and their susceptibility to empirical therapy is essential. ♦
  
  
  METHODS
  We conducted a retrospective review of all PD peritonitis cases and positive PD fluid cultures obtained over a 5-year period in Western Australia following the introduction of a statewide protocol for the initial management of PD peritonitis with intraperitoneal vancomycin and gentamicin. ♦
  
  
  RESULTS
  The incidence of PD peritonitis decreased from 1 in 16 patient months (0.75/year at risk) to 1 in 29 patient months (0.41/year at risk) over the 5 years. There were 1,319 culture-positive samples and 1,069 unique isolates identified. Gram-positive bacteria accounted for 69.9% of positive cultures, with vancomycin resistance averaging 2% over the study period. Gram-negative bacteria accounted for 25.4% of positive cultures, with gentamicin resistance identified in an average of 8% of organisms. No increase in antimicrobial resistance to vancomycin or gentamicin occurred over the 5 years and there was no change in the proportion of gram-positive (69.9%), gram-negative (25.4%) or fungal (4.4%) organisms causing PD peritonitis. ♦
  
  
  CONCLUSIONS
  Over time, the peritonitis rates have dramatically improved although the profile of causative organisms remains similar. Empirical treatment of PD peritonitis with intraperitoneal vancomycin and gentamicin remains efficacious, with high levels of susceptibility and no evidence that the introduction of this statewide empirical PD peritonitis treatment protocol is driving resistance to these agents.
authors.affiliation: Harry Perkins Institute of Medical Research, Nedlands, Western Australia School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: McGuire
authors.affiliation: Harry Perkins Institute of Medical Research, Nedlands, Western Australia School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia.
authors.forename: Christine F
authors.initials: CF
authors.lastname: Carson
authors.affiliation: Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, Western Australia School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia.
authors.forename: Timothy J J
authors.initials: TJ
authors.lastname: Inglis
authors.affiliation: Harry Perkins Institute of Medical Research, Nedlands, Western Australia School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia Renal Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia aron.chakera@uwa.edu.au.
authors.forename: Aron
authors.initials: A
authors.lastname: Chakera
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001315:Australia; D002985:Clinical Protocols; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000188:drug therapy* / Q000209:etiology*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: Peritonitis; empirical therapy; gentamicin; resistance patterns; vancomycin