2179. Clinical Characteristics And Outcomes of Peritoneal Dialysis-Related Peritonitis Infection by Ampc β-lactamase-producing Enterobacterales

Abstract

Abstract Background Peritonitis is one of the most significant complications in patients undergoing peritoneal dialysis (PD). Even when appropriately treated, approximately 20% of all episodes are refractory to treatment. Enterobacteriaceae represent about 10% of cases of peritonitis associated with PD, gram-negative organisms that have inducible beta-lactamase genes known as AmpC are usually more severe clinically and are associated with worse outcomes, including an increased risk of hospitalization and death. Methods A retrospective case series in Centro Médico Nacional 20 de Noviembre in Mexico from 2020-2022. We included hospitalized patients diagnosed with peritonitis who met the following criteria: Cloudy peritoneal effluent, Abdominal pain, white-cell counts higher than 100/μL with at least 50% polymorphonuclear cells and culture of peritoneal effluent with the isolation of AmpC β-lactamase-producing Enterobacterales Identified by Vitek 2 and corroborated by phenotypic tests. Results 30 episodes of peritonitis associated with PD by AmpC enterobacterales were identified. Clinical characteristics are summarized in Table1. Their resistance profiles are reported in Table2. Two patients had refractory peritonitis, 3 changed modality to hemodialysis, 2 had repeat peritonitis at 90 days due to Serratia marcescens and required removal. Four patients had a new episode of peritonitis due to another organism, and two died secondary to septic shock Table3. Notably, this infection may be related to poor hygiene conditions and poor techniques in replacing peritoneal fluid bags since we found that 71% of our patients acquired the infection at their homes. We found that 58% of patients treated with at least two antibiotics occupying 2 routes of administration (intravenous/intraperitoneal) had a good response. Table 2 Table3 Conclusion AmpC peritonitis can lead to refractoriness, loss of the catheter, change to hemodialysis and even death, which in our particular context, dual antibiotic therapy may be sufficient; however, removing the catheter improves the response to treatment and decreases refractory peritonitis. The relationship to complications by these agents are high (50% in this study), so aggressive management is necessary for better outcomes in case of isolation. Disclosures All Authors: No reported disclosures