Microbiology and outcomes of peritonitis in North America
2006; Elsevier BV; Volume: 70; Linguagem: Inglês
10.1038/sj.ki.5001916
ISSN1523-1755
Autores Tópico(s)Health Systems, Economic Evaluations, Quality of Life
ResumoA proper understanding of the patterns of occurrence of infectious complications in patients on peritoneal dialysis (PD) is crucial to lay the foundation for interventions directed at the major causes and predisposing factors. The present work is an initial report of a survey based on a large representative database of the infectious complications of PD. Gram-positive organisms accounted for 62% of peritonitis episodes in the US and 61% of these episodes in Canada. Gram-negative organisms accounted for 20.5% of episodes in the US and 23.6% of episodes in Canada. The peritoneal catheter was removed in 18% of the episodes in the US and 16% in Canada. Less than 4% of the episodes resulted in death. Gram-positive organisms accounted for the majority of exit-site infections in the US (69%) and Canada (76%). Gram-negative organisms accounted for a third of exit-site infections and among Gram-negative organisms Pseudomonas was the overwhelmingly dominant organism. The microbiology of exit-site infections revealed the expected representation of Gram-positive organisms. An important finding, however, is the significantly high contribution of Gram-negative organisms. Our findings can inform future guideline development and suggest that similar endeavors be undertaken in other parts of the world. A proper understanding of the patterns of occurrence of infectious complications in patients on peritoneal dialysis (PD) is crucial to lay the foundation for interventions directed at the major causes and predisposing factors. The present work is an initial report of a survey based on a large representative database of the infectious complications of PD. Gram-positive organisms accounted for 62% of peritonitis episodes in the US and 61% of these episodes in Canada. Gram-negative organisms accounted for 20.5% of episodes in the US and 23.6% of episodes in Canada. The peritoneal catheter was removed in 18% of the episodes in the US and 16% in Canada. Less than 4% of the episodes resulted in death. Gram-positive organisms accounted for the majority of exit-site infections in the US (69%) and Canada (76%). Gram-negative organisms accounted for a third of exit-site infections and among Gram-negative organisms Pseudomonas was the overwhelmingly dominant organism. The microbiology of exit-site infections revealed the expected representation of Gram-positive organisms. An important finding, however, is the significantly high contribution of Gram-negative organisms. Our findings can inform future guideline development and suggest that similar endeavors be undertaken in other parts of the world. A proper understanding of the patterns of occurrence of infectious complications in patients on peritoneal dialysis (PD), their natural history in the course of therapy, and the various predisposing factors that identify patients at risk is crucial to lay the foundation for therapeutic and prophylactic interventions. With few exceptions,1.Bunke M. 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Johnston J.R. et al.An analysis of ten-year trends in infections in adults on continuous ambulatory peritoneal dialysis (CAPD).Clin Nephrol. 1991; 36: 29-34PubMed Google Scholar, 9.Caravaca F. Ruiz-Calero R. Dominguez C. Risk factors for developing peritonitis caused by micro-organisms of enteral origin in peritoneal dialysis patients.Perit Dial Int. 1998; 18: 41-45PubMed Google Scholar, 10.Brown A.L. Stephenson J.R. Baker L.R. Tabaqchali S. Epidemiology of CAPD-associated peritonitis caused by coagulase-negative staphylococci: comparison of strains isolated from hands, abdominal Tenckhoff catheter exit site and peritoneal fluid.Nephrol Dial Transplant. 1991; 6: 643-648Crossref PubMed Scopus (14) Google Scholar, 11.Chow K.M. Szeto C.C. Leung C.B. et al.A risk analysis of continuous ambulatory peritoneal dialysis-related peritonitis.Perit Dial Int. 2005; 25: 374-379PubMed Google Scholar, 12.Gucek A. Benedik M. 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Bacterial peritonitis associated with peritoneal dialysis.J Med Assoc Thai. 1995; 78: S105-S107PubMed Google Scholar, 22.Szeto C.C. Leung C.B. Chow K.M. et al.Change in bacterial aetiology of peritoneal dialysis-related peritonitis over 10 years: experience from a centre in South-East Asia.Clin Microbiol Infect. 2005; 11: 837-839Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar, 23.Van Biesen W. Vanholder R. Vogelaers D. et al.The need for a center-tailored treatment protocol for peritonitis.Perit Dial Int. 1998; 18: 274-281PubMed Google Scholar, 24.Zelenitsky S. Barns L. Findlay I. et al.Analysis of microbiological trends in peritoneal dialysis-related peritonitis from 1991 to 1998.Am J Kidney Dis. 2000; 36: 1009-1013Abstract Full Text Full Text PDF PubMed Scopus (159) Google Scholar, 25.Troidle L. Gorban-Brennan N. Finkelstein F.O. Outcome of patients on chronic peritoneal dialysis undergoing peritoneal catheter removal because of peritonitis.Adv Perit Dial. 2005; 21: 98-101PubMed Google Scholar that are limited because of small numbers,9.Caravaca F. Ruiz-Calero R. Dominguez C. Risk factors for developing peritonitis caused by micro-organisms of enteral origin in peritoneal dialysis patients.Perit Dial Int. 1998; 18: 41-45PubMed Google Scholar, 10.Brown A.L. Stephenson J.R. Baker L.R. Tabaqchali S. Epidemiology of CAPD-associated peritonitis caused by coagulase-negative staphylococci: comparison of strains isolated from hands, abdominal Tenckhoff catheter exit site and peritoneal fluid.Nephrol Dial Transplant. 1991; 6: 643-648Crossref PubMed Scopus (14) Google Scholar, 12.Gucek A. Benedik M. Zakelj B. et al.Frequency of various types of peritoneal catheter infections and therapeutic outcome of treatment.Adv Perit Dial. 1995; 11: 149-151PubMed Google Scholar, 14.Kim M.J. Song J.H. Park Y.J. et al.The influence of seasonal factors on the incidence of peritonitis in continuous ambulatory peritoneal dialysis in the temperate zone.Adv Perit Dial. 2000; 16: 243-247PubMed Google Scholar, 17.Nakamoto H. Hashikita Y. Itabashi A. et al.Changes in the organisms of resistant peritonitis in patients on continuous ambulatory peritoneal dialysis.Adv Perit Dial. 2004; 20: 52-57PubMed Google Scholar, 18.Oxton L.L. Zimmerman S.W. Roecker E.B. Wakeen M. Risk factors for peritoneal dialysis-related infections.Perit Dial Int. 1994; 14: 137-144PubMed Google Scholar, 23.Van Biesen W. Vanholder R. Vogelaers D. et al.The need for a center-tailored treatment protocol for peritonitis.Perit Dial Int. 1998; 18: 274-281PubMed Google Scholar telescoping of several years of experience to obtain a sizeable sample,8.Bernardini J. Holley J.L. Johnston J.R. et al.An analysis of ten-year trends in infections in adults on continuous ambulatory peritoneal dialysis (CAPD).Clin Nephrol. 1991; 36: 29-34PubMed Google Scholar, 9.Caravaca F. Ruiz-Calero R. Dominguez C. Risk factors for developing peritonitis caused by micro-organisms of enteral origin in peritoneal dialysis patients.Perit Dial Int. 1998; 18: 41-45PubMed Google Scholar, 11.Chow K.M. Szeto C.C. Leung C.B. et al.A risk analysis of continuous ambulatory peritoneal dialysis-related peritonitis.Perit Dial Int. 2005; 25: 374-379PubMed Google Scholar, 12.Gucek A. Benedik M. Zakelj B. et al.Frequency of various types of peritoneal catheter infections and therapeutic outcome of treatment.Adv Perit Dial. 1995; 11: 149-151PubMed Google Scholar, 13.Kim D.K. Yoo T.H. Ryu D.R. et al.Changes in causative organisms and their antimicrobial susceptibilities in CAPD peritonitis: a single center's experience over one decade.Perit Dial Int. 2004; 24: 424-432PubMed Google Scholar, 15.Korbet S.M. Vonesh E.F. Firanek C.A. Peritonitis in an urban peritoneal dialysis program: an analysis of infecting pathogens.Am J Kidney Dis. 1995; 26: 47-53Abstract Full Text PDF PubMed Scopus (39) Google Scholar, 16.Krishnan M. Thodis E. Ikonomopoulos D. et al.Predictors of outcome following bacterial peritonitis in peritoneal dialysis.Perit Dial Int. 2002; 22: 573-581PubMed Google Scholar, 17.Nakamoto H. Hashikita Y. Itabashi A. et al.Changes in the organisms of resistant peritonitis in patients on continuous ambulatory peritoneal dialysis.Adv Perit Dial. 2004; 20: 52-57PubMed Google Scholar, 19.Perez Fontan M. Rodriguez-Carmona A. Garcia-Naveiro R. et al.Peritonitis-related mortality in patients undergoing chronic peritoneal dialysis.Perit Dial Int. 2005; 25: 274-284Crossref PubMed Scopus (226) Google Scholar, 20.Rotellar C. Black J. Winchester J.F. et al.Ten years' experience with continuous ambulatory peritoneal dialysis.Am J Kidney Dis. 1991; 17: 158-164Abstract Full Text PDF PubMed Scopus (59) Google Scholar, 22.Szeto C.C. Leung C.B. Chow K.M. et al.Change in bacterial aetiology of peritoneal dialysis-related peritonitis over 10 years: experience from a centre in South-East Asia.Clin Microbiol Infect. 2005; 11: 837-839Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar, 24.Zelenitsky S. Barns L. Findlay I. et al.Analysis of microbiological trends in peritoneal dialysis-related peritonitis from 1991 to 1998.Am J Kidney Dis. 2000; 36: 1009-1013Abstract Full Text Full Text PDF PubMed Scopus (159) Google Scholar, 25.Troidle L. Gorban-Brennan N. Finkelstein F.O. Outcome of patients on chronic peritoneal dialysis undergoing peritoneal catheter removal because of peritonitis.Adv Perit Dial. 2005; 21: 98-101PubMed Google Scholar variations in connectology,20.Rotellar C. Black J. Winchester J.F. et al.Ten years' experience with continuous ambulatory peritoneal dialysis.Am J Kidney Dis. 1991; 17: 158-164Abstract Full Text PDF PubMed Scopus (59) Google Scholar, 26.Holley J.L. Bernardini J. Piraino B. Infecting organisms in continuous ambulatory peritoneal dialysis patients on the Y-set.Am J Kidney Dis. 1994; 23: 569-573Abstract Full Text PDF PubMed Scopus (77) Google Scholar, 27.Honkanen E. Kala A.R. Gronhagen-Riska C. Divergent etiologies of CAPD peritonitis in integrated double bag and traditional systems?.Adv Perit Dial. 1991; 7: 129-132PubMed Google Scholar, 28.Lewis J. Abbott J. Crompton K. et al.CAPD disconnect systems: UK peritonitis experience.Adv Perit Dial. 1992; 8: 306-312PubMed Google Scholar, 29.Valeri A. Radhakrishnan J. Vernocchi L. et al.The epidemiology of peritonitis in acute peritoneal dialysis: a comparison between open- and closed-drainage systems.Am J Kidney Dis. 1993; 21: 300-309Abstract Full Text PDF PubMed Scopus (24) Google Scholar and in patient populations,21.Sutcharitchan N. Yawinchan S. Bacterial peritonitis associated with peritoneal dialysis.J Med Assoc Thai. 1995; 78: S105-S107PubMed Google Scholar, 30.Lewis M. Gorban-Brennan N.L. Kliger A. et al.Incidence and spectrum of organisms causing peritonitis in HIV positive patients on CAPD.Adv Perit Dial. 1990; 6: 136-138PubMed Google Scholar, 31.Pandya B.K. Friede T. Williams J.D. A comparison of peritonitis in polycystic and non-polycystic patients on peritoneal dialysis.Perit Dial Int. 2004; 24: 79-81PubMed Google Scholar, 32.Prasad N. Gupta A. Sharma R.K. et al.The spectrum of bacterial peritonitis in CAPD patients in a developing country: is it different?.Perit Dial Int. 2003; 23: 400-402PubMed Google Scholar as well as differences in methods of data collection and analysis. Data on the prevalence and incidence of infectious complications are important for several reasons, highest among them is a clarification of where we are with these complications and what needs to be done to improve patient outcomes. Knowledge of the status of infectious complications and some insight into predictive factors and identification of patients at risk are necessary for the planning of peritonitis reduction initiatives. Therapeutic interventions would also benefit from evaluations of outcomes, as measures of severity may impact the nature of these interventions. Although some have called for center-specific regimens,23.Van Biesen W. Vanholder R. Vogelaers D. et al.The need for a center-tailored treatment protocol for peritonitis.Perit Dial Int. 1998; 18: 274-281PubMed Google Scholar,33.Piraino B. Bailie G.R. Bernardini J. et al.Peritoneal dialysis-related infections recommendations: 2005 update.Perit Dial Int. 2005; 25: 107-131PubMed Google Scholar it is apparent to us that very few centers have the requisite size to gain enough expertise in presentations or outcomes to make the suggestion viable. To achieve these goals, there is a need for a large multicenter database that bypasses the limitations of sample size, center bias, and disparate data collection methods. The present work is an initial report of such a survey based on a large representative database that will allow exploration of clinical aspects of the infectious complications of PD. The general characteristics of the patient populations are shown in Table 1. The profile of patients in this study corresponded closely to the observed profiles for their respective countries.34.Fenton S.S. Schaubel D.E. Desmeules M. et al.Hemodialysis versus peritoneal dialysis: a comparison of adjusted mortality rates.Am J Kidney Dis. 1997; 30: 334-342Abstract Full Text PDF PubMed Scopus (538) Google Scholar, 35.Guo A. Mujais S. Patient and technique survival on peritoneal dialysis in the United States: evaluation in large incident cohorts.Kidney Int Suppl. 2003; 64: S3-S12Abstract Full Text Full Text PDF Scopus (168) Google Scholar, 36.Schaubel D.E. Blake P.G. Fenton S.S. Effect of renal center characteristics on mortality and technique failure on peritoneal dialysis.Kidney Int. 2001; 60: 1517-1524Abstract Full Text Full Text PDF PubMed Scopus (127) Google Scholar, 37.Schaubel D.E. Fenton S.S. Trends in mortality on peritoneal dialysis: Canada, 1981–1997.J Am Soc Nephrol. 2000; 11: 126-133PubMed Google Scholar, 38.Vonesh E.F. Snyder J.J. Foley R.N. Collins A.J. The differential impact of risk factors on mortality in hemodialysis and peritoneal dialysis.Kidney Int. 2004; 66: 2389-2401Abstract Full Text Full Text PDF PubMed Scopus (285) Google Scholar, 39.Xue J.L. Chen S.C. Ebben J.P. et al.Peritoneal and hemodialysis: I. Differences in patient characteristics at initiation.Kidney Int. 2002; 61: 734-740Abstract Full Text Full Text PDF PubMed Scopus (34) Google ScholarTable 1Characteristics of patient populationsUSACanadaParameterN%N%Total31116544Age (years), mean55.4±0.358.4±0.2 18–4055117.7194214.39 40–5058418.7796814.79 50–6066021.22121918.63 60–7063920.54153023.38 ≥7067721.76188528.81Gender Male161952.04357054.55 Female149247.96297445.45Race White/Caucasian201164.64545083.28 White of Hispanic descent1785.72310.47 Black70222.571151.76 Asian1304.184136.31 Other902.895358.18Primary cause of ESRD Diabetes113136.35218333.36 Hypertension90829.19103915.88 Glomerular disease2899.29103415.80 Cystic kidney disease1223.923405.20 Other66121.25194829.77 Open table in a new tab The two populations were distinct in their ethnic compositions in that the US population had a higher proportion of African-Americans and a lower proportion of Caucasians (Table 1). This may also explain the differences in etiology of end-stage renal disease, with a larger proportion of US patients having hypertension as a primary cause of end-stage renal disease whereas Canadians had a higher proportion of glomerular diseases (Table 1). Co-morbid conditions were similar in the two populations (Table 2).Table 2Co-morbid conditionsUSACanadaParameterN%N%Cardiovascular (all)113836.6282643.2Ischemic heart disease35011.2590113.77Congestive heart failure33810.865207.95Hypertension214468.92418864.00Cerebral vascular disease1986.364456.80Peripheral vascular disease2638.4576311.66Diabetes mellitus–type I38612.4177811.89Diabetes mellitus – type II55417.81152123.24Respiratory disease993.184146.33Gastrointestinal disease1193.835207.95Hepatobiliary disease381.221482.26Malignancy1434.604416.74HIV/AIDS311.0030.05None2628.424566.97 Open table in a new tab The US group had a higher proportion of patients coming to PD from hemodialysis and consequently a lower proportion of patients new to dialysis than the Canadian group; both had similar proportions of patients from failed transplant (Table 3). A larger proportion of US patients were on automated PD than continuous ambulatory PD at initiation of dialysis than Canadian patients. In both groups, there was an increase in the proportion of patients who subsequently went on automated PD, but the differential between the US and Canadian groups was maintained (Table 3).Table 3Renal historyUSACanadaParameterN%N%Patient source New to dialysis149548.05375357.35 Transfer from hemodialysis110735.58144722.11 Failed kidney transplant60919.58134420.54Dialysis modality (first) APD150748.44159124.31 CAPD160451.56495375.69Dialysis modality (most recent) APD205866.15296445.29 CAPD105333.85358054.71APD, automated peritoneal dialysis; CAPD, continuous ambulatory peritoneal dialysis. Open table in a new tab APD, automated peritoneal dialysis; CAPD, continuous ambulatory peritoneal dialysis. The methods of insertion of peritoneal catheters are illustrated in Figure 1. A larger proportion of Canadian patients had their catheters inserted with a blind method or with the use of a peritoneoscope. The higher proportion of blind insertion method use in Canada was due to the contribution of a specific small number of centers. In the US, only 1142 of 3111 (37%) patients developed peritonitis, at an annual rate of 0.367 infections per patient-year at risk (or one infection every 32.7 patient-months at risk). In Canada, only 2886 of 6544 (44%) patients developed peritonitis at an annual rate of 0.434 infections per patient-year at risk (or one infection every 27.6 patient-months at risk). In total, 2272 episodes of peritonitis were contributed by the US database and 6263 episodes by the Canadian database. The microbiology and organism-specific peritonitis rates for both US and Canada are shown in Table 4. Overall, the two groups had similar microbiologic profiles with little discordance. Gram-positive organisms accounted for 62% of peritonitis episodes in the US and 61% of episodes in Canada. Among Gram-positive organisms, coagulase-negative Staphylococcus was the most common accounting for 31% of all peritonitis episodes in both countries and 50.6% of Gram-positive episodes in the US and 52% in Canada.Table 4Microbiology of peritonitisUSACanadaParameterNumber of infectionsPercent of infectionsRate (infections/patient-years at risk)Number of infectionsPercent of infectionsRate (infections/patient-years at risk)Gram positiveCoNS71331.380.1152198731.730.1378 S. aureus26111.490.04225729.130.0397 Streptococcus2008.800.032369811.140.0484 Enterococcus773.390.01242834.520.0196 Corynebacteria542.380.00871211.930.0084 Other Gram positive1034.530.01661602.550.0111Gram negative Acinetobacter281.230.00451412.250.0098 Citrobacter200.880.0032671.070.0046 Escherichia coli873.830.01413996.370.0277 Enterobacter431.890.00691262.010.0087 Klebsiella773.390.01242493.980.0173 Neisseria70.310.0011370.590.0026 Other60.260.0010250.400.0017Enterobacteria Proteus110.480.0018290.460.0020 Pseudomonas833.650.01342063.290.0143 Serratia251.100.0040851.360.0059 Other Gram negative793.480.01281141.820.0079Fungi Candida492.160.00791542.460.0107 Other401.760.0065751.200.0052Culture negative36215.930.0585116118.540.0805CoNS, coagulase negative staph. Open table in a new tab CoNS, coagulase negative staph. Gram-negative organisms accounted for 20.5% of episodes in the US and 23.6% of episodes in Canada. Among Gram-negative organisms, Escherichia coli, Klebsiella, and Pseudomonas contributed equally in the US, whereas E. coli was the most common Gram-negative organism in Canada followed by Klebsiella and Pseudomonas. Fungal infections were observed in 3.92% of episodes in the US and 3.66% in Canada. Mycobacterial infections and anaerobic infections were rare. Culture negative peritonitis was seen in 15.9% of episodes in the US and 18.5% in Canada. Overall outcomes of the peritonitis episodes for the two databases and analysis by diabetic status subsets are shown in Table 5. Data on outcome were available on 867 episodes in the US database and 3532 in the Canadian database. In general, the outcomes were similar between the two countries. The peritoneal catheter was removed in 18% of the episodes in the US and 16% in Canada. Fewer than 4% of the episodes resulted in death. These outcomes were not different between diabetic and non-diabetic patients.Table 5Outcome of peritonitis by diabetic statusUSACanadaAll N=867DM N=365Non-DM N=502All N=3532DM N=1424Non-DM N=2108Resolved78.277.2678.8880.6683.578.72Catheter removed18.3418.3618.3315.9413.4117.67Death3.464.382.793.403.093.61DM, diabetes mellitus. Open table in a new tab DM, diabetes mellitus. Culture-negative peritonitis episodes had an outcome profile similar to that of Gram-positive infections with low mortality and low rate of catheter removal. Organism-specific outcomes are shown in Table 6. Overall, Gram-positive infections were characterized by greater resolution with therapy, lesser need for catheter removal, and lower mortality than Gram-negative infections. Among Gram-positive organisms, coagulase-negative infections had the best outcomes and Enterococcus infections the worst. Among Gram-negative organisms, Pseudomonas infections resulted in the highest rate of catheter removal and E. coli and Proteus infections were associated with the worst mortality. In the US, fungal infections resulted almost always in catheter removal. A lower rate of catheter removal and a higher rate of mortality from fungal infections were observed in Canada.Table 6Outcomes of peritonitis by specific organismsUSACanadaParameterResolvedCatheter removedDeathResolvedCatheter removedDeathGram positiveCoNS92.66.70.792.16.51.4S. aureus78.418.23.471.624.83.6 Streptococcus95.53.01.588.28.13.7 Enterococcus55.234.510.365.028.66.5 Corynebacteria79.116.74.282.413.24.4 Other Gram positive84.412.53.178.019.12.9Gram negative Acinetobacter83.48.38.386.012.81.2 Citrobacter66.733.3—68.723.57.8 Escherichia coli50.034.415.654.733.511.8 Enterobacter81.813.64.560.331.58.2 Klebsiella59.431.29.464.627.77.7 Neisseria———86.44.59.1 Other———58.841.2—Enterobacteria Proteus———52.328.619.1 Pseudomonas53.537.29.351.045.53.45 Serratia54.536.49.160.829.49.8 Other Gram negative56.136.67.3263.221.07.9Fungi Candida—95.84.2675.218.8 Other—94.75.31375.911.1Culture negative87.89.92.389.68.51.9CoNS, coagulase negative staph.Organisms for which there were less than 10 patients with reported outcomes are left blank. Open table in a new tab CoNS, coagulase negative staph. Organisms for which there were less than 10 patients with reported outcomes are left blank. In the US, only 668 of 3111 (21%) patients developed an exit-site infection at an annual rate of 0.184 infections per patient-year at risk (or one infection every 65.2 patient-months at risk). In Canada, only 1464 of 6544 (22%) of patients developed an exit-site infection at an annual rate of 0.193 infections per patient-year at risk (or one infection every 62.2 patient-months at risk). In total, 1140 episodes of exit-site infection were contributed by the US database and 2794 episodes by the Canadian database. The microbiology and organism-specific exit-site infection rates for both US and Canada are shown in Table 7. Gram-positive organisms accounted for the majority of exit-site infections in the US (69%) and Canada (76%). S. aureus was the predominant Gram positive organism. Gram-negative organisms accounted for a third of exit-site infections and among Gram-negative organisms Pseudomonas was the overwhelmingly dominant organism. A higher rate of Pseudomonas infections was observed in US than in Canadian patients.Table 7Microbiology of exit-site infectionsUSACanadaParameterNumber of infectionsPercent of infectionsRate (infections/patient-years at risk)Number of infectionsPercent of infectionsRate (infections/patient-years at risk)Gram positiveCoNS20618.070.033345716.360.0317 S. aureus35431.050.0572118742.480.0823 Streptococcus302.630.00481023.650.0071 Enterococcus272.370.0044210.750.0015 Corynebacteria14112.370.022829210.450.0202 Other Gram positive312.720.0050712.540.0049Gram negative Escherichia coli161.400.0026471.680.0033 Enterobacter121.050.0019200.720.0014 Klebsiella70.610.0011391.400.0027 Proteus141.230.0023220.790.0015 Pseudomonas20818.250.033636913.210.0256 Serratia342.980.0055752.680.0052 Other Gram negative605.260.00972127.590.0147CoNS, coagulase negative staph.Organisms with less than 1% contribution in both groups are not listed. Open table in a new tab CoNS, coagulase negative staph. Organisms with less than 1% contribution in both groups are not listed. Catheter removal rates for exit-site infection episodes for the two databases and analysis by diabetic status subsets are shown in Figure 2. Outcome information was available on 218 episodes in the US and 1648 in Canada. Although no difference in rate of catheter removal was observed between diabetic and non-diabetic patients, a much lower rate of catheter removal as a consequence of exit-site infection was seen in Canada. Organism-specific catheter removal outcomes are shown in Table 8. For each organism evaluated, a higher rate of catheter removal was seen in the US than in Canada. These differences need to be interpreted with caution because of the lower rate of outcomes documentation for exit sites in the US database.Table 8Catheter removal rates (%) for exit-site infections by specific organismUSACanadaGram positiveCoNS7.41.6 S. aureus11.55.3 Streptococcus—5.3 Enterococcus15.4— Corynebacteria12.53.2 Other Gram positive—3.4Gram negative Escherichia coli—6.4 Enterobacter—18.2 Pseudomonas16.28.3 Serratia—5.1 Other Gram negative—12.0CoNS, coagulase negative staph.Organisms for which there were less than 10 patients with reported outcomes are left blank. If the previous condition occurred for both populations then the organism was not listed. Open table
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