Peritoneal dialysis associated infections: An update on diagnosis and management

Table 1 Incidence and spectrum of peritonitis in peritoneal dialysis patients

Ref.	No.	Infection rate (episodes/patient-year)	Organisms	Comments
Lobo et al[12]	330	0.42	S. aureus 27.5%	Brazil
2003-2007			E. coli 13.4%	Hypoalbuminaemia a risk factor
			Culture neghative 32.5%
Shyr et al[13]	55	0.56		Experience surgeon may be a factor preventing infection
1990-1993		0.36 (ESI)
Cleper et al[14]	29	1.66	S. aureus 32.5%	Children; modality change in 18%
1997-2007			Pseudomonas 16%
Shigidi et al[15]	241	0.24 ± 0.1	S. aureus 21%	Qatar; Catheter loss 19%; Mortality 3% due to candida and pseudomonas peritonitis
2003-2007			E. coli 9%
			Culture negative 28%
Kofteridis et al[16]	82	0.89	G+ve 42%	Greece
1990-2007			G-ve 19%
			Polymicrobial 5%
			Fungal 4%
Freitas et al[17]	137	0.31 (ESI)	G+ve 56%	Cure rate 96%
2005-2008			G-ve 27%	Catheter loss in 3 patrients; peritonitis in two
			Pseudomonas
			Fungi
Edey et al[18]	103	116 episodes in 103 pts	Polymicrobial	Enterococci peritonitis is associated with catheter loss
2003-2006
Prasad et al[19]	168	0.63	G-ve 60%	G-ve peritonitis has worse outcome than G+ve
1993-2001			G+ 40%
			Polymicrobial
			Fungal
Boehm et al[20]	30	0.82		USA and European data
1994-2003
Goffin et al[21]	101	0.41	G+ve 51.5%
1991-2000			G-ve 27.7%
			Polymicrobial 13%
			Culture negative 7.9%
Nessim et al[22]	4247	0.36		Double cuff catheters had better results
1996-2005
Tan et al[23]	64	0.23		Singapore
Li et al[24]	110	0.29		Hong Kong
Han et al[25]	2301	0.38	G+ve 42.6%	Korea
1981-2005			G-ve 17.0%	Peritonitis rates fell from 0.57 in earlier to 0.29 in latter period
			Fungal 2.1%
			Culture negative 37.3%

S. aureus: Staphylococcus aureus; E. coli: Escherichia coli.

Table 2 Organisms causing peritoneal dialysis associated infections

Organism	Comments	Ref.
Gram-positive cocci	Commonest cause of PDAI	Gupta et al[30]; Fedorowsky et al[33]; Renaud et al[8]
Staphylococcus epidermidis
Staphylococcus aureus
Α andβ-haemolytic Streptococus
Micrococci
Gram-negative	Recent change from HD to PD	Gupta et al[30]; Chang et al[34]; Lobo et al[12]; Kofteridis et al[16]; Krishnan et al[35]
Enterobacteriaceae	Polymicrobial/catheter loss/transfer to HD
Pseudomonas aeroginosa
VRE
Escherichia coli
Klebsiellla oxytoca
Acinectobacter sp
Serratia marcescens
Enterococci
Fungi		García-Agudo et al[36]; Predari et al[37]; Kazancioglu et al[38]; Troidle et al[31]
Candida albicanns
Candida parapsilosis
Candida glabrata
Neosartorya hiratsukae
Aspergillus fumigatus
Anaerobes		Troidle et al[31]
Unusual	India and mainly developing economies	Lunde et al[39]; Chan et al[40]; Vera et al[41]; Renaud et al[8]; Mendoza-Guevara et al[42]; Byrd et al[43]; Kimura et al[44]
Mycobacteria sp	More common in immunosuppressed patients
Rapidly growing nontuberculous Mycobacteria
Listeria monocytogenes
Serratia marcenseus
Bordetella bronchiseptica
Corynebacterium ulcerans
Acanthoamoeba	May be confused with peritoneal macrophages or lymphocytes	Tilak et al[45]

PD: Peritoneal dialysis PDAI: PD associated infections.

Table 3 Exit site management

Ref.	No.	Trial/protocol	Results	Comments
Mahaldar et al[132]	100	Mupirocin vs Gentamicin	No difference in ESI rates	Trend to higher peritonitis in gentamicin group. Retrospective study
Wong et al[133]	154	Mupirocin vs Control	Mupirocin effective in preventing G+ve peritonitis	Randomised controlled trial. No adverse effects with mupirocin
Fong[122]	69	Providone-iodine vs Control	PVI 2.9%	Nasal carriers high in PVI group!
			Control 8.8%	Randomised controlled trial
Bernardini et al[134]	133	Gentamicin (67) vs Mupirocin (66)	0.23 peritonitis episodes per patient-year (gentamicin) vs 0.54 for mupirocin	Time to first infection longer with Gentamicin
McQuillan et al[135]	201	Polysporin Triple Ointment (P3) vs Mupirocin	No difference in time to ESI or peritonitis but higher rate of fungal infections and more redness of exit site in P3 group	Multicentre randomised controlled trial

ESI: Exit site infection.