Causative bacteria and risk factors for peritoneal dialysis-related peritonitis: A retrospective study

摘要

Background: Although peritoneal dialysis (PD) is beneficial for patients with end-stage renal diseases (ESRD), there are some critical complications. PD-related peritonitis accounts for about 30% of all cases of catheter removal and transition to hemodialysis. We investigated the incidence, causative bacteria, and risk factors of PD-related peritonitis and peritonitis-related withdrawal in patients treated in the Nagasaki University Hospital. Methods: Subjects were 43 PD patients in the Nagasaki University Hospital observed between January 1, 2008 and December 31, 2012. We established the incidence of PD-related peritonitis, investigated causative bacteria and culture-negative peritonitis rates, and examined potential risk factors, including laboratory data obtained at the commencement of PD. Results: 20 episodes of peritonitis occurred in 12 patients during the observation period, and the incidence of PD-related peritonitis was one episode per 62 patient-months. The culture-negative peritonitis rate was 10%. In the isolated causative bacteria, 55% were Gram-positive cocci and 25% were Gram-negative rods. Two episodes were associated with methicillin-resistant Staphylococcus aureus (MRSA), and each episode was accompanied with an exit-site infection. PD catheter removal caused by PD-related peritonitis occurred in 4 patients. As a result of investigation for association between PD-related peritonitis and patient’s factors including laboratory data, sex, age, and cause of ESRD, the patients who experienced PD-related peritonitis had significantly lower hemoglobin levels at the initiation of PD.Conclusions: PD-related peritonitis remains an important complication of PD. We found that low hemoglobin level at the commencementof PD was a risk factor of PD-related peritonitis. In addition, MRSA peritonitis was a risk factor of peritonitis-relatedwithdrawal. Thus, improvement in anemia might be important to prevent PD-related peritonitis. It is also important to preventMRSA-associated peritonitis to avoid technical failure of PD.