Pseudomonas peritonitis in peritoneal dialysis patients: The network #9 peritonitis study

Abstract

To determine risk factors for the development of Pseudomonas peritonitis (PsP) and outcomes of PsP, the authors compared peritoneal dialysis patients who developed PsP with peritoneal dialysis patients who developed non- Pseudomonas bacterial peritonitis (non-PsP). The authors also sought to determine if there were differences in patients who had resolution of PsP compared with those patients whose PsP did not resolve. The data were derived from the prospective Tristate Renal Network Peritonitis and Catheter Survival Study. Resolution in this study was defined as clearing of peritoneal dialysate on visual inspection, with up to three courses of antibiotic therapy allowed. Catheter removal, switch to hemodialysis, or death were outcomes that were considered separately from resolution because of the study design. There were 31 cases of PsP in 28 patients and 886 cases of non-PsP identified in 667 adult patients. There were no differences in race, gender, age, or incidence of diabetes between the groups. The PsP group had a 25% incidence of previous exposure to immunosuppressive agents, whereas it was 10.6% in the non-PsP group ( P = 0.028). PsP infections were more frequently associated with concomitant exit and tunnel infections, higher hospitalization rates, increased incidence of catheter loss, switch to hemodialysis, and a worse rate of resolution when compared with non-PsP (all, P < 0.05). Logistic regression could not identify patients at increased risk of PsP. PsP resolved with antibiotic therapy only in 10 of 31 episodes. The resolution group had a higher incidence of treatment with two anti-pseudomonal drugs and a lower incidence of prior peritonitis when compared with the nonresolution PsP group (both, P < 0.05). PsP episodes with concomitant exit site or tunnel infections had an increased catheter loss compared with those PsP episodes that did not have concomitant flesh infections ( P < 0.05). The authors conclude that PsP has an increased incidence of concomitant exit site and tunnel infections when compared with non-PsP. Resolution rate, catheter loss, and switch to hemodialysis are significantly worse with PsP compared with non-PsP. Episodes of PsP that resolved occurred in patients who did not have a concomitant tunnel or exit site infection, had a lower incidence of previous peritonitis, and were treated with at least two anti-pseudomonal drugs.