POS-643 PERITONEAL DIALYSIS RELATED PERITONITIS: A SINGLE CENTRE EXPERIENCE IN BORNEO, MALAYSIA

Abstract

Peritoneal dialysis (PD) - related peritonitis is a common complication and a major cause of conversion to haemodialysis (HD). We aimed to determine the demographic characteristics of our patients, and to evaluate the microbiology and clinical outcomes among PD patients with peritonitis A retrospective observational cohort study enrolling all patients who had been treated with continuous ambulatory PD (CAPD) or automated PD (APD) for at least 90 days and developed peritonitis at Hospital Queen Elizabeth, Sabah, Malaysia from January 2014 until June 2020. Relevant demographic, biochemical and clinical data were collected. A total of 369 episodes of peritonitis were recorded in 194 patients. The median age of patients were 46.41± 16.2 years (range from 8 to 84 years); 85 (43.8%) were male. 71 (36.6%) had diabetes as the primary disease. The overall peritonitis rate was 0.384 episodes per patient-year. Gram-positive organism was the predominant organism from the cultures, 156 episodes (42.28%), followed by Gram-negative organism (88 episodes, 23.85%), fungal (19 episodes, 5.15%), mycobacterium (4 episodes, 1.08%), polymicrobial (5 episodes, 1.36%), and culture negative (97 episodes, 26.29%). Coagulase negative Staphylococcus (CONS) was the most common organism among the gram-positive peritonitis while Escherichia coli was the most common organism in gram-negative peritonitis. The PD catheter were removed in 109 episodes (29.54%). Mycobacterium and fungal had higher risk of catheter loss (100% and 89.5% respectively). The catheter loss rate was significantly higher in gram-negative peritonitis, as compared to gram-positive (38.6% VS 15.4%, p<0.001). Seven patients died due to PD peritonitis (2 from gram-positive, 3 gram-negative, 1 culture negative and 1 polymicrobial). The high rates of culture negative PD peritonitis needs further evaluation and improvement on identification of the organisms. Retraining, exit site care, improved microbiology sensitivity, appropriate antimicrobial treatment and response and early removal of the catheter are warranted to further improve the PD-related peritonitis technique failure and mortality.