POS-651 PERITONEAL DIALYSIS-RELATED PERITONITIS IN BRUNEI DARUSSALAM: A 10.5-YEARS NATIONWIDE EXPERIENCE

Abstract

Brunei Darussalam has one of the world’s highest incidence and prevalence of kidney failure. Since the implementation of peritoneal dialysis (PD) preference policy in 2014, there has been an increasing uptake of PD in Brunei. All the PD patients in the country are managed in a dedicated PD unit. Here we report for the first-time data on the peritonitis rates, microbiology, initial treatment patterns and outcomes of PD-related peritonitis in Brunei. This was a retrospective observational analysis of all peritonitis in Brunei from 1st January 2010 to 30th June 2020, identified from the monthly peritonitis database. Data collected include demographics, etiology of the kidney failure, microbiology of the peritonitis episodes, the initial antibiotics regimen and the outcomes of the peritonitis episodes. There were 229 peritonitis episodes detected in 110 patients (56 male and 54 female). The most common etiology of the kidney failure was diabetes (47.3%). 79% of the PD catheters were inserted laparoscopically and 21% were inserted peritoneoscopically. Majority (87%) of these patients were using automated PD. The mean age at peritonitis was 49 years old. The mean PD vintage at peritonitis was 3 years. 21 (9.2%) patients had peritonitis within 3 months of starting PD. The overall rate of peritonitis in these patients was 0.33 episodes per patient year, of which 35.3%, 33.3%, 22.1%, 7.4%, 1.5% and 0.5% were due to culture-negative, gram-positive, gram-negative, polymicrobial, fungi and mycobacterium respectively. Of these 229 peritonitis episodes, 179 (78%) recovered, 32 (14%) resulted in PD catheter removal and 18 (8%) resulted in death. Coagulase negative staphylococcus (20.8%) was the most frequently implicated organism followed by Staphylococcus aureus (17.4%) and Streptococcus species (11.4%). However, over the years, there were increasing proportions of gram-negative organisms isolated as shown in Figure 1. Of all the gram-negative organisms, 93% were sensitive to ceftazidime which was appropriately used together with cefazolin as the initial empirical antibiotics. Compared with culture-negative peritonitis, the relative risks of PD catheter removal were 3.4, 5.0, 13.8 and 13.8 in gram-negative, polymicrobial, fungal and mycobacterial peritonitis respectively. Compared with culture-negative peritonitis, the relative risks of death were 6.4 and 8.0 in polymicrobial and fungal peritonitis respectively. Focused experience from a dedicated PD unit for the whole country has translated into favorable peritonitis outcomes compared to many small units in other countries. Our overall peritonitis rate is lower than the standard set by the International Society of Peritoneal Dialysis (ISPD). Like many countries, the patterns of isolated organisms from the peritonitis have changed over the years, with an increasing proportion of gram-negative organisms, possibly related to more widespread use of mupirocin prophylaxis on exit sites. This trend is worrying as our data shows that gram-negative peritonitis portends a worse outcome with a higher PD technique failure.