Peritonitis in peritoneal dialysis: comparative analysis of the follow-up indexes in two consecutive periods in a University Hospital

Abstract

Peritonitis (P) has been the most important and frequent cause of patient dropout from long-term peritoneal dialysis. In this study, we examined the followup indexes of two consecutive ten-year periods in a teaching hospital, following the advances in dialysis techniques and the application of a program of continuous medical and patient education. In period A (1989 to 1998), 26 patients treated during 451.6 months-patient, and in period B (1999 to 2008), 30 patients treated during 893 months-patient, were studied. The systems used were CAPD and APD. Peritonitis rates were 1.73 episodes / patient-year in A, and 0.65 episodes / patient-year in B. The difference in the proportion of patients with peritonitis between both groups was statistically significant (P = 0.004). In A, 38.5% of patients and 73.3% of patients in B were peritonitis-free during the first year of treatment (P = 0.01). The susceptibility of microbiological methods was 96.92% and 97.83%, which represents a high yield. A significant number of microorganism species was isolated from the dialysates in both periods. Interestingly, the following was observed: 1. a decrease in gram-positive cocci isolates (61.7% vs. 46.9%), and 2. the frequency of peritonitis with microorganisms from exogenous sources, basically avoidable, was about 1 episode / 9 months-patient during period A, but only 1 episode / 37.21 months-patient in B (P = 0.01). It is essential that all peritoneal dialysis-related peritonitis episodes be studied microbiologically, to determine the causative microorganisms as well as the source of infection. The first cloudy peritoneal dialysis effluent without antibiotics must be sent to the Microbiology Department at once, whereit must be cultured for aerobic and anaerobic bacteria and fungi. Susceptibility tests will allow to change the empiric therapy according to the susceptibility results. The results observed in the follow-up indexes between both time periods, showed the benefits of continuous medical and patients education.