Epidemiology and Clinical Characteristics ofAcinetobacterPeritoneal Dialysis-Related Peritonitis in Hong Kong-With a Perspective on Multi-Drug and Carbapenem Resistance.
♦ BACKGROUND:Acinetobacterspp. is an important cause of peritoneal dialysis (PD)-related peritonitis, but studies onAcinetobacterperitonitis have been scarce. In view of the rising concern of carbapenem-resistantAcinetobacter(CRA) and multidrug-resistantAcinetobacter(MDRA) infections, we conducted this study on the incidence ofAcinetobacterperitonitis and the impact of CRA and MDRA on its outcome. ♦ METHODS: We retrospectively evaluated the clinical characteristics, prevalence, antibiotic sensitivity patterns, outcomes, and factors associated with treatment failure over the past 16 years in our patients withAcinetobacterPD-related peritonitis. ♦ RESULTS: Out of 2,389 episodes of peritonitis, there were 66 episodes (3%) ofAcinetobacterperitonitis occurring in 59 patients. Twelve episodes were caused by MDRA (18%), of which 5 were CRA (8%). There was a progressive increase in the incidence of MDRA and CRA infections over the study period. Most isolates were sensitive to sulbactam combinations (ampicillin-sulbactam [95.4%] and cefoperazone-sulbactam [93.9%]), aminoglycosides (amikacin [92.4%], tobramycin [90.9%], and gentamicin [89.4%]), and carbapenems (imipenem [92.2%]). There was 1 case of relapse. Fifteen episodes resulted in catheter removal (23%), and 7 patients died (11%). Hypoalbuminemia (odds ratio [OR] = 0.85,p= 0.006) and carbapenem resistance (OR = 18.2,p= 0.049) were significantly associated with higher rates of treatment failure. ♦ CONCLUSION: Both carbapenem resistance and hypoalbuminemia were significantly associated with treatment failure. Up to 80% of peritonitis episodes by CRA resulted in catheter loss or mortality. Sulbactam combinations and/or aminoglycosides remained effective for the majority ofAcinetobacterisolates. There seemed to be an increasing relative incidence of MDRA and CRA infections over the past 16 years.
Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong phileh.li@gmail.com.
Philip Hei
PH
Li
Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
Vincent C C
VC
Cheng
Department of Medicine, Tung Wah Hospital, Hong Kong.
Terence
T
Yip
Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
Desmond Y H
DY
Yap
Department of Medicine, Tung Wah Hospital, Hong Kong.
Sing-Leung
SL
Lui
Department of Medicine, Tung Wah Hospital, Hong Kong.
Wai-Kei
WK
Lo
D000150:Acinetobacter / Q000187:drug effects* / Q000302:isolation & purification; D000151:Acinetobacter Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D000368:Aged; D015780:Carbapenems / Q000494:pharmacology; D015331:Cohort Studies; D016208:Databases, Factual; D024881:Drug Resistance, Bacterial; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods; D010538:Peritonitis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
D015780:Carbapenems
Acinetobacter; Hong Kong; carbapenem resistance; multidrug resistance; peritoneal dialysis; peritonitis