Peritonitis in peritoneal dialysis. Epidemiology, risk factors, inclusion of BACTEC™ in traditional culture systems, and long-term mortality
Abstract
Introduction: Peritonitis is the most common complication in peritoneal dialysis (PD), with an effect on morbidity and mortality. The aim of this study was to analyze epidemiology, risk factors, implementation of the BACTEC™ blood culture system and mortality of peritoneal dialysis-associated peritonitis. Methods: In this retrospective, cohort study, all the patients who started PD between 1992 and 2017 at Hospital Privado Universitario de Córdoba (Córdoba Private Medical College Hospital) were included. Results: The total number of patients was 159, 63 (39.62%) of which had suffered from peritonitis at least once and 96 (60.38%) had never had it. The global peritonitis rate was 0.37 episodes per patient-year. The risk factors for peritonitis were the following: a history of hemodialysis before PD (OR=3.18; CI 95%=1.41-7.14; p=0.0051) and hypoalbuminemia (OR=3.10; CI 95%=1.36-7.06; p=0.0071). The implementation of the BACTEC™ system increased the percentage of positive blood cultures (from 73.55% to 96.55%; p=0.0076). The most frequent isolates were MSSA (23.66 %) and GNB (20.61 %). Differences were found between the 1992-2006 and 2006-2017 periods in the Candida isolates (1.49 % and 9.38 %; p=0.0448) and the “other bacteria” group (1.49 % and 9.38 %; p=0.0448). Although peritonitis patients showed a higher mortality rate (55.56 % versus 38.58 %; p=0.0480), the multivariate analysis revealed that this condition was not a mortality independent risk factor. Conclusion: The risk factors for peritonitis were hemodialysis prior to PD and hypoalbuminemia. The use of the BACTEC™ system increased the percentage of positive blood cultures. After 2006 the number of isolates from the Candida and the “other bacteria” groups was higher. Peritonitis was not a long-term mortality independent risk factor.
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