Continuous Ambulatory Peritoneal Dialysis Peritonitis Research Articles

#2361 The influence of glucose biocompatible solutions to the clinical outcomes of patients treated with continuous ambulatory peritoneal dialysis

Abstract Background and Aims The use of biocompatible glucose solutions is associated with longer preservation of residual renal function and less frequent occurrence of complications in patients on peritoneal dialysis. The aim of this study was to examine the influence of conventional and biocompatible glucose solutions to laboratory parameters and clinical outcomes of PD patients during a four-year period at Zvezdara University Medical Center. Method This retrospective study included 25 incident patients treated with continuous ambulatory peritoneal dialysis (CAPD) during the follow up period from 2018 to 2022. During 2018/2019 these patients used conventional solutions (Dianeal PD4) containing lactate as a buffer, while due to the change in solution production technology in 2020/2021, all patients were transferred to a biocompatible solution (Physioneal 40) with lactate and bicarbonate as a buffer. Clinical outcomes were compared in relation to the administered solution: pain during infusion (measured by a Visual Analogue Scale—VAS), correction of anaemia and bicarbonate, average annual 24h diuresis and 24h ultrafiltration, occurrence of CAPD peritonitis. The statistical significance of the differences between the two periods was checked using the SPSS. Results The average age of 25 patients was 61 ± 14 years, of which 59.1% were male and 40.9% female. The average BMI was 28.5 ± 5.30 kg/m2, and the most common comorbidities were HTA and DM. No statistically significant difference was found for the values of Le, albumin, Hb, PTH, bicarbonate, and K (p ˃ 0.05). During the use of biocompatible solutions, patients had statistically significantly lower Na values (138.84 ± 2.63 vs 137.17 ± 2.41 mmol/l, p = 0.0116, 95% CI 137.15– 138.84) and lower CRP values (15.3 ± 3.3 mg/l vs 7.7 ± 3.2, p = 0.0003, 95% CI 18.60-4.50). Although the dialysis exposure was longer, the rate of peritonitis was lower during the use of biocompatible solutions, but without a statistically significant difference (0.40 episodes per patient-year, vs 0.31 episodes per patient-year, p ˃ 0.05). No statistical significance was found in 24h diuresis value (900 ml vs 750 ml, p = 0.167.95% CI 686.90–1203.31) but the value is expected to be lower due to dialysis duration. Conclusion Our study showed that patients treated with the CAPD method while using a biocompatible solution have statistically significantly higher values of 24h ultrafiltration, lower Na and CRP values and less occurrence of pain during infusion, which significantly affects the quality of life. Although this may indicate better preservation of the peritoneal membrane, a prospective and randomized study is needed to clarify these potential differences.

Encapsulating Peritoneal Sclerosis in a hemodialysis patient: a case report

Background: Encapsulating peritoneal sclerosis is a rare manifestation nowadays. Case report: This was a case report of a young female with ESKD on hemodialysis for more than 6 months with a previous history of continuous ambulatory peritoneal dialysis (CAPD) and recurrent peritonitis which currently presented with painful abdominal distension. The CT scan of the abdomen showed a clumping of small bowel loops at the left side encased into a thin fibrocartilaginous membrane. Initially, she was treated for intrabdominal sepsis however after recurrent admission, IV Methylprednisolone was started followed by high dose steroids and tamoxifen as a treatment for EPS. Surprisingly she improved and had a good clinical response. She had readmitted again after a few months with abdominal pain due to an abrupt stop in steroid but improved again after the steroid was started. Conclusion: Abdominal pain in a patient with history of CAPD peritonitis needs to raise suspicion of EPS even though is rare Radiological Imaging is helpful in making early diagnosis. The most important thing is steroid as a mainstay of the treatment of EPS besides tamoxifen with a minimal one-year duration or lifelong as surgical intervention is very risky.

Rescue plan for CAPD peritonitis: Using ultrasonography as a guide on when to remove the catheter.

Ultrasound has been found to facilitate early identification of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). A retrospective analysis was carried out to evaluate the effectiveness of ultrasonography-guided removal of the Tenckhoff catheter in reducing complications like a shift to hemodialysis or death in CAPD patients. The "peritonitis rescue plan" supported timely decision-making for the removal of the infected catheter and resulted in a lower peritonitis episode per patient per month ratio (from 1:36 to 1:122) in 2021, a lower death rate (from 19% to 6.6%) and lower incidences of shifts to hemodialysis (from 2%-9% to 0%) as compared to that before the implementation of the plan in 2019. The implementation of the "peritonitis rescue plan" and the removal of the infected catheter within 3 days of peritonitis being detected was successful in improving the standard of care for patients undergoing CAPD.

#5992 PERITONEAL DIALYSIS-RELATED PERITONITIS: A SINGLE CENTER EXPERIENCE

Abstract Background and Aims Peritonitis is a common and severe complication in Continuous ambulatory peritoneal dialysis (CAPD). A high peritonitis rate affects PD patients’ technique survival and mortality. The aim of this retrospective study is to assess epidemiological aspects, microbiology presentation with antibiotic resistance and clinical outcomes for patients with acute CAPD peritonitis during 5-year period. Method The study included all patients treated by CAPD between the 1st of January 2017 and 1st of January 2022 in the Clinical Hospital Center Zvezdara. We included prevalent patients on CAPD, and analyzed demographic, clinical and microbiological data, and patient's outcomes during 5 year period. The data was collected from patient records, medical history and processed in SPSS. Results This study included 119 patients treated by PD of which 24 (8.13%) had one or more acute episodes of CAPD peritonitis in the designated period. The mean age of the population was 69±9 year, 54% were male, 20% had diabetes mellitus and 60% arterial hypertension as cause of end stage renal disease. During follow up it was diagnosed 41 episodes of CAPD peritonitis. The main characteristics of patients with peritonitis were turbid liquid (100 %), abdominal pain (73 %) and fever (43 %). Gram staining revealed that 53 % were gram-positive, and 10 % were gram-negative. The most frequent bacterial specimen was Staphylococcus epidermidis (11) followed by Streptococcus viridans (6), sterile culture (9), Staphylococcus aureus (3) and other organisms less than 2 episodes. The peritonitis rate was 1 episode per 27.36 patient-months, or 0.44 episodes per patient year. Resistance to Ampicillin and Penicillin occurred most often. In 2 patients, PD peritonitis was present once each, with multi-resistant bacteria: Klebsiella pneumoniae which was treated with parenteral administration of Tigacycline and Methicillin-resistant Staphylococcus aureus (MRSA) which was treated with parenteral administration of Moxifloxacin and Clindamycin. Out of 24 patients, 2 (8.33%) had 4 episodes of peritonitis, 3 (12.5%) had 3 episodes of peritonitis, 6 (25%) had 2 episodes of peritonitis, and the rest (54.16%) were had only one each. Only one patient had an episode of relapsing peritonitis. During 5-year period, 1 (4%) patient died of acute CAPD peritonitis caused by Proteus mirabilis, 7 (29%) died of other causes, 11 (46%) were transferred to hemodialysis and 5 (21%) are still receiving treatment by CAPD modality. CAPD peritonitis was the reason for technical failure in 20% patients. Conclusion PD-associated peritonitis is serious infective complication which could influence the outcome of PD patients, including technique survival. The rate and outcomes of peritonitis in our patients were slightly above of current recommendations.

#4850 20 YEARS' EXPERIENCE OF PERITONEAL DIALYSIS IN SARAWAK, MALAYSIA

Abstract Background and Aims Peritoneal dialysis is a modality of renal replacement therapy first introduced in the 1960s. In the event of the recent COVID 19 pandemic, peritoneal dialysis is gaining popularity due to the increased preference of home dialysis. Sarawak is the largest state in Malaysia with a population of more than 2 million. Unfortunately, 13% of households in the state are living in poverty. We present our experience with continuous ambulatory peritoneal dialysis (CAPD) for the past years in a geographically and socioeconomically challenging region. Method Sarawak General Hospital is the centre of referral for Tenckhoff catheter insertion from other districts in Sarawak. This is a retrospective record review of all CAPD patients who were under our clinic follow up from 2001 to 2022. Data examined included patient's demographic data, incidence of peritoneal dialysis related peritonitis and their outcome. Results All of the patients on CAPD were recorded by December of each year since we started our service in 2001 which shows a rising trend of patients on CAPD, with the highest in December 2022 at 399 patients. The number of patients with dialysis related peritonitis was also collected. Despite having more patients on CAPD, the number of peritonitis episodes per patient-year were in a decreasing trend. This was the result of the implementation of empirical first line intra-peritoneal antibiotics as part of the CAPD Peritonitis Management Protocol in 2015 and Decontamination Protocol in 2016. Conclusion Despite the headwinds of geographic and socioeconomic challenges, the number of patients on CAPD is on the rise. Over the years, peritonitis rate declined approaching to 0.2 episodes per patient-year. This was made possible with the introduction of local decontamination protocol and CAPD peritonitis management protocol, which helped improve the life expectancy and health of renal patients in the region.

Peritonitis as the Cause of Death of CAPD Patients at RSUD Dr. Saiful Anwar Malang 2014-2020

Background: Continuous Ambulatory Peritoneal Dialysis (CAPD) is an effective modality of renal replacement therapy in patients with kidney failure. Peritonitis associated with peritoneal dialysis remains a significant challenge and complication to success long-term peritoneal dialysis. Aim: This study aims to report the peritonitis as a cause of death of CAPD patients for six years in end-stage renal failure (ESRD) patients at RSUD Dr. Saiful Anwar Malang. Methods: A descriptive study was conducted involving 40 patients with end-stage renal failure who underwent CAPD therapy with peritonitis as the cause of patient mortality by taking data from the CAPD Center medical record at RSUD Dr. Saiful Anwar from August 2014 to July 2020. Results: From 674 end-stage renal failure patients who underwent CAPD, 248 patients (36.8%) died, and 426 patients (63.2%) survived to 5 years. CAPD peritonitis is the second most common cause of 40 (16.1%) mortality cases after cardiovascular disease. The most common bacteria causing CAPD peritonitis was coagulate-negative Staphylococcus, with as many as 15 (37.5%) cases. Conclusion: the most common cause of mortality was Staphylococcus coagulase-negative (37.5 %,), a bacteria that come from touch contamination or infection at the exit site. So that patients and caregivers must be trained to carry out proper exit-site, and it is essential to maintain good hand hygiene before performing exit-site. Appropriate prevention and management of peritonitis are critical to patients' long-term success on peritoneal dialysis.

Comparison of Peritonitis Relapse Incidence in End-Stage Renal Disease Patients with Peritoneal Dialysis According to the Culture Results

Background: Peritoneal dialysis (PD) is one of the modalities of renal replacement therapy (RRT) in end-stage renal disease (ESRD). One of the complications that are often found in the use of PD is peritonitis. Presence of the culture from the peritoneal fluid was known to be associated with the incidence of peritonitis relapse among ESRD patients with PD. Aim: Comparing the incidence of relapse in patients with continuous ambulatory peritoneal dialysis (CAPD) with culture-negative and culture-positive in RSUD Dr. Saiful Anwar Malang. Methods: This study measured the incidence of relapse after administration of CAPD peritonitis therapy. Descriptive data are presented in percentages, and numerical data is presented in Mean ± SD. The analysis test was carried out using the Mann-Whitney with p<0.05, significant. Results: According to the culture results, it was found that 25.4% (18 of 71 PD peritonitis cultures) were culture-negative in patients with CAPD peritonitis. This result is slightly higher than the ISPD recommendation, with 20% culture-negative results. There were 3 out of 53 relapses in culture-positive subjects and 1 in 18 relapses in culture-negative subjects. There was no significant difference in the two groups, with an OR of 0.721 in the culture-positive group lead the culture-positive tended to experience no relapse by 0.721 times less than the patient with culture-negative. Conclusion: In peritoneal dialysis peritonitis, there was no significant difference in the incidence of relapse in the positive and culture-negatives.

POS-669 Clinical Characteristics and Outcomes of Continuous Ambulatory Peritoneal Dialysis (CAPD) Peritonitis After Colonoscopy

Peritonitis is an important complication in patients performing continuous ambulatory peritoneal dialysis (CAPD). Colonoscopy is known to be associated with CAPD peritonitis due to transmural migration of bacteria from gastrointestinal tract to peritoneal cavity. Previous study demonstrated peritonitis rate of 6.3% in patients without antibiotic prophylaxis before colonoscopy. Systematic review recommended intravenous ampicillin and aminoglycoside with or without metronidazole before the procedure for peritonitis prophylaxis.

Retracted : A case of chronic diarrhea due to <em>Strongyloides stercoralis</em> in an immunocompromised patient

Strongyloides stercoralis is a soil-transmitted nematode endemic throughout tropical and subtropical regions. Although most of the healthy infected individuals are asymptomatic, it can be life-threatening for immunocompromised patients and is responsible for a wide range of symptoms including chronic diarrhea. Hence, it is vital to have high suspicion and routine screening for immunosuppressed patients in these endemic regions. We report a case of chronic diarrhea due to Strongyloides stercoralis infection in a 55-year-old man who was on dialysis for end-stage Chronic Kidney Disease (CKD). The patient was initially managed as culture-negative continuous ambulatory peritoneal dialysis (CAPD) peritonitis. Later a thorough examination of his stools revealed Strongyloides stercoralis rhabditiform larvae, after which he was treated with albendazole. However, he eventually died of CKD. Therefore, we emphasize the need for a thorough examination of stools with a high degree of suspicion in chronic diarrheas, particularly in immunocompromised patients.

First Report of Tsukamurella conjunctivitidis CAPD-related Peritonitis

First Report of Tsukamurella conjunctivitidis CAPD-related Peritonitis

Low serum albumin a predictor sign of the incidence of peritoneal dialysis-associated peritonitis? A quasi-systematic review.

Peritonitis is associated with an increasing morbidity and mortality rate in peritoneal dialysis patients. A number of peritonitis cases result in hypoalbuminemia, and in other cases, peritonitis follows a decline in the serum albumin level. However, it is not clear whether the level of serum albumin can be utilized to predict and prevent the incidence of peritonitis. A quasi-systematic search of the literature was conducted in the following databases: Cochrane, EBSCO, ProQuest, AHMED, CINHAL, MEDLINE, and EMBASE, from January 2008 to January 2018. The data was reviewed and extracted from each study. The quality of the studies was assessed using the Critical Appraisal Skills Programme and the Newcastle-Ottawa Scale. Six articles met the stated inclusion criteria of the quasi-systematic review. The study found a significant correlation between a low serum albumin level at the start of continuous ambulatory peritoneal dialysis (CAPD) and the development of peritonitis. Thus, hypoalbuminemia can be utilized as a warning sign of the occurrence of peritonitis in CAPD. Consequently, immediate intervention is required when the level of serum albumin declines in order to prevent peritonitis.

Intraperitoneal Antibiotic Utilization among Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients with Peritonitis at a Tertiary Hospital Setting in Malaysia.

ABSTRACTIntroduction:Patients receiving continuous ambulatory peritoneal dialysis (CAPD) are commonly associated with peritonitis. However, little is known about the utilization of antibiotics for the treatment of peritonitis in these patients.Objectives:This study aimed to evaluate the patterns of intraperitoneal (IP) antibiotic utilization for the treatment of peritonitis in CAPD patients.Materials and Methods:This is a retrospective study conducted at a tertiary hospital setting in Malaysia. Medical records of CAPD patients who were diagnosed with peritonitis and registered with National Kidney Registry from 2013 to 2018 were reviewed. Types of antibiotics used and its dose and duration were recorded and reported using the anatomical therapeutic chemical/defined daily dose (ATC/DDD) system.Results:A total of 105 peritonitis episodes were recorded from 72 patients. The most common first-line empirical antibiotic combinations used were ceftazidime/cefazolin (40%, n = 42), followed by cefepime/cefazolin (30.5%, n = 32) and ceftazidime/cloxacillin (25.7%, n = 27). The definitive therapy for culture-proven CAPD-related peritonitis (CAPD-P) showed that vancomycin was the most frequently prescribed antibiotic (31.7%, n = 26/82), followed by amikacin (14.6%, n = 12/82), meropenem (11%, n = 9/82) and ampicillin (11%, n = 9/82). Ciprofloxacin was among the least prescribed definitive antibiotics for CAPD-P (2.4%, n = 2/82) but the DDD/100 patient-days estimates showed that it had the highest therapeutic intensity.Conclusion:There are various IP antibiotics used for CAPD-P and the most common empirical therapy was the combination of ceftazidime and cefazolin while vancomycin is predominantly used for definitive therapy. Future studies to evaluate the clinical outcomes of the antibiotic use should be conducted to have a better insight on the efficacy of the peritonitis treatment.

Unusual organisms causing continuous ambulatory peritoneal dialysis peritonitis

Peritonitis is an important cause for morbidity and mortality in Continuous Ambulatory Peritoneal Dialysis (CAPD) patients. There is an emerging trend towards unusual organism causing CAPD peritonitis. We report our experience with unusual organisms and its impact on survival. We had 43 CAPD peritonitis episodes, out of which, six were due to unusual organisms. Although five patients responded to antibiotic therapy, one lost her CAPD access (catheter). Clinically, peritonitis caused by unusual organism is similar to that caused by other pathogens. Adherence to diligent hygienic practices while handling catheter and bag is most important in avoiding such peritonitis episodes.

Continuous Ambulatory Peritoneal Dialysis Peritonitis: Microbiology and Outcomes

AbstractContext: Continuous ambulatory peritoneal dialysis (CAPD) is now a preferred mode of the treatment in patients with end-stage renal disease, but peritonitis remains to be a shortcoming of CAPD. High-culture negativity, emerging drug resistance and peritoneal dialysis (PD)-related morbidity and mortality have been a challenge to tackle. Aims: The present study was taken up to compare the the various culture methods and to identify the spectrum of organisms causing CAPD peritonitis and their outcome. Settings and Design: A prospective, observational, cross-sectional study was conducted at a tertiary care teaching hospital in Hyderabad over a period of 1 year. Subjects and Methods: Dialysate fluid from 100 episodes of clinically suspected peritonitis in 75 patients was processed by conventional centrifuging, water lysis, direct inoculation and addition of centrifuged pellet into brain–heart infusion broth and by automated blood culture system. Identification and antibiotic susceptibility of organisms was done, and the outcome of PD-related peritonitis was analysed. Statistical Analysis Used: The categorical data and continuous data were analysed using the Chi-square test and Student’s t-test, respectively. P < 0.05 was considered statistically significant. Results: Of the 100 PD fluids, 87 were culture positive. Automated blood culture systems detected 87 episodes, whereas conventional centrifuge method detected only 53 episodes (P = 0.00001). Peritonitis due to Gram-negative organisms (62.3%) was higher than that of Gram-positive peritonitis (31.1%) and fungi (6.4%). Nineteen per cent episodes were constituted by relapse (9), refractory (4), recurrent (4) and repeat (2) peritonitis. Outcomes were analysed as recovery (77%), catheter removal (15%) and death (2.6%). Conclusions: Direct inoculation of peritoneal fluid into automated blood culture bottles increases the positivity rate and also aids in the early detection of CAPD peritonitis, helping reduce morbidity and mortality of PD patients.

Application of 16S rRNA Gene-Targeted Next-Generation Sequencing for Bacterial Pathogen Detection in Continuous Ambulatory Peritoneal Dialysis Peritonitis

Application of 16S rRNA Gene-Targeted Next-Generation Sequencing for Bacterial Pathogen Detection in Continuous Ambulatory Peritoneal Dialysis Peritonitis

Micrococcus aloeverae - A Rare Cause of Peritoneal Dialysis-Related Peritonitis Confirmed by 16S rRNA Gene Sequencing.

The number of patients receiving peritoneal dialysis has increased worldwide. Herein, we report the first case to our knowledge of continuous ambulatory peritoneal dialysis (CAPD) peritonitis caused by Micrococcus aloeverae, which was initially reported to be caused by Micrococcus luteus in the dialysate culture report but later identified by 16S ribosomal ribonucleic acid (rRNA) gene sequencing as M. aloeverae. A 59-year-old woman visited the emergency room due to abdominal pain. She was hospitalized with CAPD peritonitis. The patient initially responded to empirical antibiotic treatment comprising intraperitoneal cefazolin (15 mg/kg/day) and ceftazidime (1 g/day); however, the leukocyte count of dialysate effluent increased again. M. luteus was isolated four times from peritoneal dialysate cultures. We treated the patient with intraperitoneal administration of vancomycin (2 g loading, followed by 1 g every 7 days) but needed to switch from CAPD to temporary hemodialysis. We analyzed the 16S rRNA sequence to confirm the exact causative organism, and the results revealed that the organism was M. aloeverae. Because M. aloeverae and M. luteus have sequence similarity, 16S rRNA sequencing is a useful method to distingush them.

Antimicrobial Susceptibility of Microorganisms Isolated from Patients with Intraabdominal Infection in Korea: a Multicenter Study.

BackgroundThis study evaluated the antimicrobial susceptibility of pathogens isolated from Korean patients with intraabdominal infections (IAIs).MethodsThis multicenter study was conducted at 6 university-affiliated hospitals in Korea between 2016 and 2018. All patients with microbiologically proven IAIs were retrospectively included, while patients with spontaneous bacterial peritonitis or continuous ambulatory peritoneal dialysis peritonitis were excluded. Identification and antimicrobial susceptibility testing were performed using automated microbiology systems.ResultsA total of 2,114 non-duplicated clinical isolates were collected from 1,571 patients. Among these pathogens, 510 (24.1%) were isolated from nosocomial infections, and 848 isolates (40.1%) were associated with complicated IAIs. The distribution of the microorganisms included aerobic gram-negative (62.6% of isolates), aerobic gram-positive (33.7%), anaerobic (0.9%), and fungal (2.8%) pathogens. The most common pathogens were Escherichia coli (23.8%), followed by Enterococcus spp. (23.1%) and Klebsiella spp. (19.8%). The susceptibility rates of E. coli and Klebsiella spp. to major antibiotics were as follows: amoxicillin/clavulanate (62.5%, 83.0%), cefotaxime (61.4%, 80.7%), ceftazidime (63.7%, 83.1%), cefepime (65.3%, 84.3%), ciprofloxacin (56.4%, 86.3%), piperacillin/tazobactam (99.0%, 84.8%), amikacin (97.4%, 98.3%), and imipenem (99.8%, 98.8%). The susceptibility rates of Enterococcus spp. to ampicillin were 61.0%, amoxicillin/clavulanate, 63.6%; ciprofloxacin, 49.7%; imipenem, 65.2%; and vancomycin, 78.2%. The susceptibility rates of Pseudomonas aeruginosa and Acinetobacter spp. to imipenem were 77.4% and 36.7%, respectively.ConclusionEnterococcus spp. with susceptibility to limited antibiotics was one of the main pathogens in Korean IAIs, along with E. coli and Klebsiella spp., which were highly susceptible to imipenem, amikacin, and piperacillin/tazobactam. Meanwhile, the low susceptibilities of E. coli or Klebsiella spp. to amoxicillin/clavulanate, advanced-generation cephalosporins, and ciprofloxacin should be considered when determining empirical antibiotic therapy in clinical practice.

A rare agent of continuous ambulatory peritoneal dialysis peritonitis: Rhizobium Radiobacter

Peritonitis is a common clinical problem in patients treated by continuous ambulatory peritoneal dialysis (CAPD). The most common microbiological factors causing peritonitis are Gram-positive (especially Staphylococcus spp.). Peritonitis with Rhizobium radiobacter (Agrobacterium radiobacter) is a rare infection in CAPD patients. Peritonitis due to R. radiobacter has been reported in our patient's dialysate culture who underwent CAPD for three years. We report the case of a 26-year-old female PD patient who had CAPD peritonitis due to R. radiobacter and successfully treated with intraperitoneal vancomycin and oral ciprofloxacin without relapses or removing the PD catheter.

A Retrospective Analysis of Etiology and Outcomes of Refractory CAPD Peritonitis in a Tertiary Care Center from North India.

Refractory peritonitis is defined as failure of clearance of peritoneal fluid despite 5 days of appropriate antibiotic therapy. Catheter removal decreases morbidity and mortality. Data on the outcomes of refractory peritonitis and of reinitiation of peritoneal dialysis (PD) in this group of patients are sparse. The present study analyzed etiology, outcomes, and prognostic factors of refractory peritonitis as well as survival of the reinitiation of the technique. This was a single-center retrospective study that included 90 patients of refractory continuous ambulatory PD (CAPD) peritonitis at a tertiary care center in North India. We collected information regarding symptomatology, causes, prognostic factors, and outcomes of refractory peritonitis. Ninety patients suffered 93 episodes of refractory peritonitis. Fungal peritonitis was the most common cause of refractory peritonitis. Twenty nine (31%) episodes were culture-negative. We observed no difference between culture-positive and culture-negative peritonitis. Out of 90 patients, 54 (60%) recovered while 36 (40%) died. Septic shock at presentation alone was significantly associated with mortality in our study. The immediate mortality of refractory peritonitis is high. Even in patients who were shifted to permanent hemodialysis, 33% died in the first 3 months. Mean duration of technique survival after reinitiation was 23 months (1 - 85 months). Among the 12 patients who were reinitiated on CAPD, 5 patients had technique failure due to refractory peritonitis or ultrafiltration (UF) failure. Refractory peritonitis is associated with significant morbidity and mortality despite catheter removal. Reinitiation is confounded by residual infection, which is a concern for poor technique survival, and high immediate mortality.

A case report on Kocuria kristinae continuous ambulatory peritoneal dialysis peritonitis

Kocuria kristinae is a gram-positive cocci bacteria of the family Micrococcaceae . Kocuria species are bacteria commonly found in the environment and human skin flora. They are usually regarded as non-pathogenic bacteria, thus rarely associated with human infections. We report a case of K. kristinae related continuous ambulatory peritoneal dialysis (CAPD) peritonitis. The clinical presentation resembles that of usual CAPD peritonitis and diagnosis was made via routine laboratory and microbiological investigation. However, mortality occurred in our case due to severe sepsis with multi-organ failure.