Clinical Characteristics of Relapsing Peritonitis in CAPD Patients.
- Author:
Sang Hak LEE
1
;
Hyun Jin NOH
;
Sug Kyun SHIN
;
In Hee LEE
;
Shin Wook KANG
;
Kyu Hun CHOI
;
Sung Kyu HA
;
Dae Suk HAN
;
Ho Yung LEE
Author Information
1. Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
CAPD;
Recurrent peritonitis;
Treatment
- MeSH:
Amikacin;
Catheter-Related Infections;
Catheters;
Cefazolin;
Coagulase;
Enterococcus;
Follow-Up Studies;
Fungi;
Humans;
Klebsiella;
Peritoneal Dialysis, Continuous Ambulatory*;
Peritonitis*;
Pseudomonas;
Recurrence;
Serratia;
Staphylococcus aureus;
Tobramycin;
Vancomycin;
Xanthomonas
- From:Korean Journal of Nephrology
1997;16(4):738-746
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Relapsing peritonitis are major limitation of CAPD, a common reason for discontinuation of this form of therapy. Inappropriate treatment of previous peritonitis often leads to relapsing peritonitis, especially in patients with catheter-related infections. Although a multitude of therapeutic approaches have been tried, there is a controversy over the optimal antimicrobial treatment. The purposes of this study were: 1) to analyze the causative pathogen; 2) to determine the appropriate treatment regimen and duration; and 3) to evaluate the role of catheter replacement in recurrent peritonitis. Follow-up data were obtained in 43 CAPD patients who experienced 104 episodes of reucrrent peritonitis. 1) Among 104 episodes of recurrent peritonitis, 70 (67%) were culture-positive. The distribution of isolates was as follows : coagulase negative Staphylococci, 39 (38%); Enterococcus, 9 (9%); Staphylococcus aureus, 8 (8%); Pseudomonas, 4 (4%); Serratia, 4 (4%); Xanthomonas, 3 (3%); Klebsiella, 2 (2%); and fungus, 1 (1%). 2) Peritonitis recurred in 46 (50%) and did not recur in the other 46 (50%) of the 92 catheter- maintained peritonitis. After catheters were removed in 12 patients, new catheters were inserted in 3 patients without any more peritonitis. 3) There was no significant difference of recurrence between Gram-positive and Gram-negative peritonitis (56 vs. 50%). 4) Five (29%) of 17 peritonitis treated with vancomycin and amikacin, and 22 (73%) of 30 peritonitis treated with cefazolin and tobramycin experienced recurrence. Compared with cefazolin, initial therapy with vancomycin decreased the recurrence rate (P<0.05). 5) In Gram-positive and Gram-negative peritonitis, there was no reduction of recurrence in peritonitis treated for more than 2 weeks (63 vs. 51%, 40 vs. 60%). In coagulase negative Staphylococcal peritonitis, treatment for more than 2 weeks reduced the recurrence without statistical significance (59 vs. 30%, P=0.10). 6) In Gram-positive and Gram-negative peritonitis, there was no reduction of recurrence in peritonitis treated for more than 10 days after resolution (59 vs. 53%, 40 vs. 69%). In coagulase negative Staphylococcal peritonitis, treatment more than 10 days after resolution reduced the recurrence without statistical significance (50 vs. 26%, P=0.08). In conclusion, treatment with vancomycin and a longer treatment duration seem to be beneficial in relapsing CAPD peritonitis. Moreover, removal and replacement of catheter should be considered in cases unresponsive to antibiotic treatment.
