Enterococcal peritonitis in Australian peritoneal dialysis patients: Predictors, treatment and outcomes in 116 cases

Matthew Edey, Carmel M. Hawley, Stephen McDonald, Fiona G. Brown, Johan B. Rosman, Kathryn J. Wiggins, Kym M. Bannister, David W. Johnson

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background. Enterococcal peritonitis is a serious complication of peritoneal dialysis (PD), although reports of this condition in the literature are exceedingly limited.Methods. The frequency, predictors, treatment and clinical outcomes of enterococcal peritonitis were investigated in all 4675 patients receiving PD in Australia between 1 October 2003 and 31 December 2006.Results. One hundred and sixteen episodes of enterococcal peritonitis occurred in 103 individuals. Enterococcal peritonitis tended to be associated with older age, Maori and Pacific Islander racial origin, renovascular disease and coronary artery disease. Polymicrobial peritonitis, defined as recovery of two or more organisms from dialysate effluent, was significantly more common when an Enterococcus species was isolated than when it was not (45% vs 5%, respectively, P < 0.001, odds ratio 13.4, 95% CI 9.45-19.0). Although international guidelines recommend intraperitoneal ampicillin therapy, only 8% of patients with pure enterococcal peritonitis were treated with this agent, whilst the majority (78%) received vancomycin monotherapy. Overall, 59 (51%) patients with enterococcal peritonitis were successfully treated with antibiotics without experiencing relapse, catheter removal or death. The sole independent predictor of adverse clinical outcomes was recovery of additional (non-Enterococcus) organisms. Polymicrobial enterococcal peritonitis was associated with very high rates of hospitalization (83%), catheter removal (52%), permanent haemodialysis transfer (50%) and death (5.8%). In contrast, clinical outcomes were broadly comparable for pure enterococcal and non-enterococcal peritonitis (hospitalization 75% vs 69%, respectively; catheter removal 25% vs 21%; permanent haemodialysis transfer 17% vs 17%; death 1.6% vs 2.2%) although worse than non-enterococcal Gram-positive peritonitis (63%, 12%, 3% and 0.6%, respectively). Removal of the PD catheter within 1 week of enterococcal peritonitis onset was associated with a lower probability of permanent haemodialysis transfer than later removal (74% vs 100%, P = 0.03).Conclusions. Enterococcal peritonitis is associated with an increased risk of catheter removal, permanent haemodialysis transfer and death, particularly when other organisms are isolated in the same episode.

LanguageEnglish
Pages1272-1278
Number of pages7
JournalNephrology Dialysis Transplantation
Volume25
Issue number4
DOIs
Publication statusPublished - 1 Apr 2010

Keywords

  • Antibiotics
  • Bacteria
  • Enterococcus faecalis
  • Enterococcus faecium
  • Outcomes

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Edey, Matthew ; Hawley, Carmel M. ; McDonald, Stephen ; Brown, Fiona G. ; Rosman, Johan B. ; Wiggins, Kathryn J. ; Bannister, Kym M. ; Johnson, David W. / Enterococcal peritonitis in Australian peritoneal dialysis patients : Predictors, treatment and outcomes in 116 cases. In: Nephrology Dialysis Transplantation. 2010 ; Vol. 25, No. 4. pp. 1272-1278.
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title = "Enterococcal peritonitis in Australian peritoneal dialysis patients: Predictors, treatment and outcomes in 116 cases",
abstract = "Background. Enterococcal peritonitis is a serious complication of peritoneal dialysis (PD), although reports of this condition in the literature are exceedingly limited.Methods. The frequency, predictors, treatment and clinical outcomes of enterococcal peritonitis were investigated in all 4675 patients receiving PD in Australia between 1 October 2003 and 31 December 2006.Results. One hundred and sixteen episodes of enterococcal peritonitis occurred in 103 individuals. Enterococcal peritonitis tended to be associated with older age, Maori and Pacific Islander racial origin, renovascular disease and coronary artery disease. Polymicrobial peritonitis, defined as recovery of two or more organisms from dialysate effluent, was significantly more common when an Enterococcus species was isolated than when it was not (45{\%} vs 5{\%}, respectively, P < 0.001, odds ratio 13.4, 95{\%} CI 9.45-19.0). Although international guidelines recommend intraperitoneal ampicillin therapy, only 8{\%} of patients with pure enterococcal peritonitis were treated with this agent, whilst the majority (78{\%}) received vancomycin monotherapy. Overall, 59 (51{\%}) patients with enterococcal peritonitis were successfully treated with antibiotics without experiencing relapse, catheter removal or death. The sole independent predictor of adverse clinical outcomes was recovery of additional (non-Enterococcus) organisms. Polymicrobial enterococcal peritonitis was associated with very high rates of hospitalization (83{\%}), catheter removal (52{\%}), permanent haemodialysis transfer (50{\%}) and death (5.8{\%}). In contrast, clinical outcomes were broadly comparable for pure enterococcal and non-enterococcal peritonitis (hospitalization 75{\%} vs 69{\%}, respectively; catheter removal 25{\%} vs 21{\%}; permanent haemodialysis transfer 17{\%} vs 17{\%}; death 1.6{\%} vs 2.2{\%}) although worse than non-enterococcal Gram-positive peritonitis (63{\%}, 12{\%}, 3{\%} and 0.6{\%}, respectively). Removal of the PD catheter within 1 week of enterococcal peritonitis onset was associated with a lower probability of permanent haemodialysis transfer than later removal (74{\%} vs 100{\%}, P = 0.03).Conclusions. Enterococcal peritonitis is associated with an increased risk of catheter removal, permanent haemodialysis transfer and death, particularly when other organisms are isolated in the same episode.",
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Enterococcal peritonitis in Australian peritoneal dialysis patients : Predictors, treatment and outcomes in 116 cases. / Edey, Matthew; Hawley, Carmel M.; McDonald, Stephen; Brown, Fiona G.; Rosman, Johan B.; Wiggins, Kathryn J.; Bannister, Kym M.; Johnson, David W.

In: Nephrology Dialysis Transplantation, Vol. 25, No. 4, 01.04.2010, p. 1272-1278.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Enterococcal peritonitis in Australian peritoneal dialysis patients

T2 - Nephrology Dialysis Transplantation

AU - Edey, Matthew

AU - Hawley, Carmel M.

AU - McDonald, Stephen

AU - Brown, Fiona G.

AU - Rosman, Johan B.

AU - Wiggins, Kathryn J.

AU - Bannister, Kym M.

AU - Johnson, David W.

PY - 2010/4/1

Y1 - 2010/4/1

N2 - Background. Enterococcal peritonitis is a serious complication of peritoneal dialysis (PD), although reports of this condition in the literature are exceedingly limited.Methods. The frequency, predictors, treatment and clinical outcomes of enterococcal peritonitis were investigated in all 4675 patients receiving PD in Australia between 1 October 2003 and 31 December 2006.Results. One hundred and sixteen episodes of enterococcal peritonitis occurred in 103 individuals. Enterococcal peritonitis tended to be associated with older age, Maori and Pacific Islander racial origin, renovascular disease and coronary artery disease. Polymicrobial peritonitis, defined as recovery of two or more organisms from dialysate effluent, was significantly more common when an Enterococcus species was isolated than when it was not (45% vs 5%, respectively, P < 0.001, odds ratio 13.4, 95% CI 9.45-19.0). Although international guidelines recommend intraperitoneal ampicillin therapy, only 8% of patients with pure enterococcal peritonitis were treated with this agent, whilst the majority (78%) received vancomycin monotherapy. Overall, 59 (51%) patients with enterococcal peritonitis were successfully treated with antibiotics without experiencing relapse, catheter removal or death. The sole independent predictor of adverse clinical outcomes was recovery of additional (non-Enterococcus) organisms. Polymicrobial enterococcal peritonitis was associated with very high rates of hospitalization (83%), catheter removal (52%), permanent haemodialysis transfer (50%) and death (5.8%). In contrast, clinical outcomes were broadly comparable for pure enterococcal and non-enterococcal peritonitis (hospitalization 75% vs 69%, respectively; catheter removal 25% vs 21%; permanent haemodialysis transfer 17% vs 17%; death 1.6% vs 2.2%) although worse than non-enterococcal Gram-positive peritonitis (63%, 12%, 3% and 0.6%, respectively). Removal of the PD catheter within 1 week of enterococcal peritonitis onset was associated with a lower probability of permanent haemodialysis transfer than later removal (74% vs 100%, P = 0.03).Conclusions. Enterococcal peritonitis is associated with an increased risk of catheter removal, permanent haemodialysis transfer and death, particularly when other organisms are isolated in the same episode.

AB - Background. Enterococcal peritonitis is a serious complication of peritoneal dialysis (PD), although reports of this condition in the literature are exceedingly limited.Methods. The frequency, predictors, treatment and clinical outcomes of enterococcal peritonitis were investigated in all 4675 patients receiving PD in Australia between 1 October 2003 and 31 December 2006.Results. One hundred and sixteen episodes of enterococcal peritonitis occurred in 103 individuals. Enterococcal peritonitis tended to be associated with older age, Maori and Pacific Islander racial origin, renovascular disease and coronary artery disease. Polymicrobial peritonitis, defined as recovery of two or more organisms from dialysate effluent, was significantly more common when an Enterococcus species was isolated than when it was not (45% vs 5%, respectively, P < 0.001, odds ratio 13.4, 95% CI 9.45-19.0). Although international guidelines recommend intraperitoneal ampicillin therapy, only 8% of patients with pure enterococcal peritonitis were treated with this agent, whilst the majority (78%) received vancomycin monotherapy. Overall, 59 (51%) patients with enterococcal peritonitis were successfully treated with antibiotics without experiencing relapse, catheter removal or death. The sole independent predictor of adverse clinical outcomes was recovery of additional (non-Enterococcus) organisms. Polymicrobial enterococcal peritonitis was associated with very high rates of hospitalization (83%), catheter removal (52%), permanent haemodialysis transfer (50%) and death (5.8%). In contrast, clinical outcomes were broadly comparable for pure enterococcal and non-enterococcal peritonitis (hospitalization 75% vs 69%, respectively; catheter removal 25% vs 21%; permanent haemodialysis transfer 17% vs 17%; death 1.6% vs 2.2%) although worse than non-enterococcal Gram-positive peritonitis (63%, 12%, 3% and 0.6%, respectively). Removal of the PD catheter within 1 week of enterococcal peritonitis onset was associated with a lower probability of permanent haemodialysis transfer than later removal (74% vs 100%, P = 0.03).Conclusions. Enterococcal peritonitis is associated with an increased risk of catheter removal, permanent haemodialysis transfer and death, particularly when other organisms are isolated in the same episode.

KW - Antibiotics

KW - Bacteria

KW - Enterococcus faecalis

KW - Enterococcus faecium

KW - Outcomes

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DO - 10.1093/ndt/gfp641

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JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

SN - 0931-0509

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