1.Demographic characteristics and outcomes of continuous ambulatory peritoneal dialysis related peritonitis in Miri General Hospital, Malaysia
Andy Sing Ong Tang ; Carolisna Yanti Incham ; Sakura Doris ; Diplo Nurs ; Siaw Tze Yeo ; Keng Hee Koh
The Medical Journal of Malaysia 2019;74(4):270-274
Introduction: Sarawak has a population that is
geographically and characteristically widely varied. In this
study we aimed to determine the demographic
characteristics of our patient population who undergo
continuous ambulatory peritoneal dialysis (CAPD) and to
study the incidence, the microbiology and the outcome of
CAPD peritonitis.
Methods: A retrospective record review of all CAPD patients
on follow-up at the Miri Hospital, Sarawak, Malaysia from
2014 until 2017 was done.
Results and Discussion: During the 4-year period, the
overall peritonitis rate was 0.184 episodes per patient-year.
Gram-positive and gram-negative bacteria each constituted
one-third of the peritonitis; fungi (2.6%), Mycobacterium
tuberculosis (MTB) (5.3%), polymicrobial (2.6%) and sterile
culture (26.3%). The most commonly isolated gram-positive
bacteria were coagulase-negative Staphylococcus. Our
peritonitis rate is comparable to that of other centres i.e.,
Japan 0.195 and Indonesia 0.25. In comparison, countries
like India (0.41), Korea (0.40) and Singapore (0.59) had
relatively higher rate of PD-associated peritonitis. Two
tuberculosis peritonitis patients died. The rate of catheter
removal was approximately 20%. Gram-negative bacteria
and MTB have a higher risk of catheter loss. About one-fifth
used rainwater to clean their CAPD exit site. Out of this
group, 33% did not boil the rainwater prior to usage.
Conclusion: Patient’s characteristics and microbial
susceptibility vary in different places of practice. The high
rates of culture-negative peritonitis and high mortality risks
associated with TB peritonitis warrant special attention. In
patients with refractory peritonitis, early catheter removal is
warranted in order to reduce mortality and minimize damage
to peritoneal membrane.