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Kidney Week

Abstract: SA-PO719

Staphylococcal Peritonitis in Chronic Peritoneal Dialysis Patients: A Seven-Year Review

Session Information

  • Peritoneal Dialysis - II
    November 04, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Carvalho, Tiago J., Santa Cruz Hospital, Carnaxide, Portugal
  • Branco, Patricia Quadros, Santa Cruz Hospital, Carnaxide, Portugal
  • Martins, Ana Rita Mateus, Santa Cruz Hospital, Carnaxide, Portugal
  • Machado, Domingos Silveira, Santa Cruz Hospital, Carnaxide, Portugal
  • Gaspar, Maria augusta Cabrita silva, Santa Cruz Hospital, Carnaxide, Portugal
Background

Staphylococcal peritonitis (SP) is a serious complication of chronic peritoneal dialysis (CPD). The aim of this study was to examine the frequency, predictors and clinical outcomes of SP.

Methods

We reviewed all consecutive cases of SP in a CPD unit from 2010 to 2016. The mean number of patients treated per year was 87±14. There were 300 episodes of peritonitis, of which 109 (36.3%) were SP, affecting 59 patients, aged 52±15 years. Peritonitis rates varied from a minimum of 0.32 to a maximum of 0.52 episodes/patient/year. The unit’s empirical antibiotic protocol was intraperitoneal cefazolin and ceftazidime.

Results

Among SP affected patients, 30 had one episode, 17 had two episodes and 12 had three or more. There were 63 cases (57.8%) of coagulase-negative SP and 46 (42.2%) of Staphylococcus aureus peritonitis, 4 of which were methicillin-resistant. Caucasians had a higher risk of S. aureus peritonitis (Odds Ratio (OR) 22.71, 95% Confidence Interval (CI) 5.06-101.85, p<0.001). Overall primary response to treatment was 75.2%. When compared to coagulase-negative SP, S. aureus peritonitis were associated with a higher risk of catheter substitution/removal in a multivariate Cox regression adjusted for age, diabetes mellitus and previous exit-site infection (Hazard Ratio (HR) 2.81, 95% CI 1.08-7.29, p=0.033). There was also a trend towards increased hospitalization (OR 2.27, 95% CI 0.95-5.43, p=0.066). There were no differences in relapse rate (34.8% vs 33.3%) or permanent transfer to hemodialysis (0.02% vs 0.07%). No deaths occurred. Other factors associated with a higher risk of catheter substitution/removal were previous exit-site infection (OR 6.68, 95% IC 1.57-28.48, p=0.010) and relapse or repeat episode (OR 11.30, 95% IC 2.93-43.57, p<0.001).

Conclusion

SP remains an important clinical problem in CPD patients. Caucasian patients have a higher risk of S. aureus peritonitis. Previous exit-site infection, S. aureus peritonitis and relapse or repeat peritonitis episodes are associated with an increased risk of catheter substitution/removal. However, permanent transfer to hemodialysis remained low.