MO707MICROBIOLOGY, CLINICAL SPECTRUM AND OUTCOME OF INFECTIOUS PERITONITIS IN PATIENTS ON AUTOMATED PERITONEAL DIALYSIS

Abstract

Abstract Background and Aims Automated peritoneal dialysis (APD) is a renal replacement therapy that offers patients various advantages such autonomy and comfort. Peritoneal dialysis-related infectious peritonitis (IP) is the most common and severe complication of APD. It is the main cause of technique failure and transfer to hemodialysis and can even be life-threatening. Given the seriousness of this complication, it is necessary to establish preventive strategies and adapt the therapeutic management.The aim of this study was to determine the microbiological and clinical profile of IP, to specify its causes its rate and outcome in patients treated by DPA at the unit of Charles Nicolle hospital in Tunis between January 2000 and December 2018. Method We conducted a single-center descriptive retrospective study in the peritoneal dialysis (PD) unit of Charles Nicolle Hospital in Tunis. We identified the episodes of IP occurring in patients treated with APD during the period from January 2000 to December 2018. We studied the clinical, biological and evolutionary aspects of IP. Results APD was used in 85% of patients treated at our PD unit during the study period. 322 episodes of IP occurred in 183 patients, that was an IP rate of 0.1 episodes/patient-year. 58% of patients treated with DPA have not presented IP. The mean age of the patients who presented PI was 43 years +/- 15(Extreme: 17-77) with a sex-ratio of 1.23. 74% of patients had a professional activity. 98% of patients had co-morbidities dominated by hypertension (88%), dyslipidemia(73%) and diabetes(16%) with a median Charlson score of 2[2-3] (Extremes: 2-9). Their average Body Mass Index was 24kg/m2+/-5. 33% of the patients were smokers. The average training duration before starting APD was 13days+/-5. The IP were evenly distributed according to seasons (27% occurred in autumn, 26% in spring, 25% in summer and 22% in winter). IP were: a 1st episode in 55% of cases, a new episode in 30% of cases, a relapse in 10% of cases, a recidivism in 3% of cases and a recurrence in 2% of cases. Fever was present in 34% of patients, abdominal pain in 75% of them. The dialysate was cloudy in 98% of cases. The median number of leukocytes in the PD fluid was 380/mm3(Range: 15-8000)with a mean% of neutrophils of 73%+/- 27. Dialysate culture was positive in 60% of cases, negative in 38% of cases and contaminated in 2% of cases. Among the positive cultures, only one was fungal (Candida albicans). Bacterial IP were distributed as follows: 64% Cocci Gram+ dominated by Staphylococcus aureus (48%), 34% Bacillus Gram- (mainly Klebsiella pneumoniae (21%) and Pseudomonas (21%)), 2 cases of Bacillus Gram+ (Corynebacterium afermentans and Lactobacillus) and 2 cases of polymicrobial culture (Cocci Gram+ and Bacillus Gram-).IP was of unknown cause in 48% of cases, related to an asepsis lack in 19% of cases, the orifice infection in 18% of cases and tunnelitis in 2% of cases. The other causes were essentially endogenous. Probabilistic antibiotic therapy was effective in 34% of cases. An adaptation according to the microbiological results was carried out in 19% of cases. Hospitalization was required in 10% of patients. 20% of peritonitis was refractory. Catheter ablation was performed in 14% of patients.IP caused the death of 8 patients and represented 37% of the causes of transfer to hemodialysis. Conclusion IPs are a turning point for the survival of the patient and the technique. Knowing the microbiological profile of these infections will make therapeutic interventions precocious and effective in order to preserve the prognosis of patients in APD at the short and long term.