Publication: Etiology and the impact of refractory peritonitis on clinical outcomes of patients on peritoneal dialysis-12 years' single-center experience from Turkey
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Date
2022-05-01
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Abstract
BACKGROUND AND AIMS: The outcomes of refractory peritonitis in peritoneal
dialysis (PD) patients have been reported to be inferior to those of solitary peritonitis.
The current study aimed to examine the factors associated with treatment failure in
PD patients experiencing refractory peritonitis.
METHOD: This single-center retrospective study included all episodes of refractory
peritonitis in adult PD patients in Marmara University Hospital, Turkey, between 2009
and 2020. Patient characteristics, microbiological data, outcomes and factors associated
with refractory peritonitis were analysed. The primary outcome was peritonitis-related
catheter loss. Secondary outcomes were hospitalization and peritonitis-related death.
RESULTS: Overall, 236 episodes of refractory peritonitis occurring in 135 patients
were included. Gram-positive, gram-negative and fungal infections accounted
for 44.1%, 20.4% and 2.4% of all peritonitis episodes, respectively. Forty-seven
patients (34.8%) needed catheter removal, 2 patients (1.5%) died due to peritonitis
complications and 59 episodes (25%) needed hospitalization. Mean fifth day PD
fluid cell count was significantly greater among patients who required PD catheter
removal (3621.3 ± 3144.1 versus 1589.4 ± 2316.6 P < 0.001). Furthermore, patients
with >1000/mm3 cell count on the fifth day had higher rate of catheter removal
(72.3% versus 37.6%, P < 0.001) as compared to patients with cell count und 00/mm3. Treatment failure was more common in peritonitis episodes caused by
gram (−) organisms (31.9% versus 14.8%, P:0.012). Pseudomonas and fungi-associated
peritonitis were also significantly correlated with catheter loss (P:0.001 and P: <0.001)
(Table 1). When peritonitis episodes with more and <1000 cells/mm3 on the fifth
day were compared, there were more episodes with gram (−) bacteria (29.7% versus
12.9%, P:0.003) and hospitalization (41.9% versus 11.4%, P: <0.001) in the group
with more than 1000 cells/mm3. In the multivariate analysis, factors associated with
catheter loss were a cell count of >1000 on the fifth day and hospitalization, while
presence of gram (+) bacteria related peritonitis was inversely correlated with catheter
loss (Table 2).
CONCLUSION: Our study shows that the PD cell count on the fifth day of peritonitis
can be used as a prognostic tool to determine the prognosis of refractory peritonitis
episodes. Although we were unable to show the adverse prognostic effect of gram (−)
bacteria related peritonitis, gram (+) bacteria related peritonitis was associated with
better outcome. Prospective studies are needed to assess the risk factors for adverse
outcomes of patients with refractory peritonitis, as the evidence in this area is sparse.
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Keywords
Tıp, Sağlık Bilimleri, Dahili Tıp Bilimleri, İç Hastalıkları, Nefroloji, Medicine, Health Sciences, Internal Medicine Sciences, Internal Diseases, Nephrology, TRANSPLANTASYON, Klinik Tıp, Klinik Tıp (MED), ÜROLOJİ VE NEFROLOJİ, TRANSPLANTATION, CLINICAL MEDICINE, Clinical Medicine (MED), UROLOGY & NEPHROLOGY, Üroloji, Transplantasyon, Urology, Transplantation
Citation
Mentese I. B., Atas D., Arikan I. H., Tugcu M., Velioglu A., Asicioglu E., "ETIOLOGY AND THE IMPACT OF REFRACTORY PERITONITIS ON CLINICAL OUTCOMES OF PATIENTS ON PERITONEAL DIALYSIS-12 YEARS' SINGLE-CENTER EXPERIENCE FROM TURKEY", NEPHROLOGY DIALYSIS TRANSPLANTATION, cilt.37, 2022
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https://watermark.silverchair.com/gfac078_039.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAA4EwggN9BgkqhkiG9w0BBwagggNuMIIDagIBADCCA2MGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMEUTHaVtoVCDFSNFoAgEQgIIDNOvlqzAA2gKoSOKpw5BoHMrWLD5dzoSjCzeAmlnSAzUD0wSQD2UHpibVkYV8QkNTOLvfkNqcqgfAqD9-8snsDFsqUnr5rhp5Izc_IC_ec4fwJdDdoPZnu9u7fCjnNMJtqIxpqj26oaLcLTN_YbcEAWu8D_dOf2iqvIm9eDcPxNRcN9GV3f5hLs7QR5wK4OB9SfwLPwr_MbPUJiBAAU-sHHHAKvRUgghsqjq_QJABA79AqqC_uopWsfotpT6nwEj_2YTXejI0dUkvEhlvLsJs4NTu8GOLSKpkEWBzGOEgHugBr5xaI21zcNA4WtjCkqXvkNsTwZnQlDhUJZVpht31r7-x09goS4jKyxqNl_GUmOmighz8ZjVjJk-SjIEJ2OBuzh0nnEDnmbwkuI5aLczh1b2se7x9WJbq9RKfeAvSnUpc3zt8G7R4Uu46P-D0veORWTQSo7HzUa7qz7kezFzQJgIgcUmQ5OtmiC1vOAZ2e7-68ep4zwSPuJVdJqGzFlPWCFUhbT06RGyM10VBvIZUSlDkmv4EHmeYSj1Pc1ymFHGB0i9KU3ZobpzvSp88bQgLThS40YGcPY1cp5PJ3eb13o48hthRgPz2gyuJ3eWfJfopGZcemvWd8--SSwnvW4uTTf7xhp0-tY3ZrKEoeiHVahszqVNizPO7wYs7mgoNj9uJy_agKXbMkXti7kR50TDYoZOGzuzEojkxOslgDS6Of6q5Q2YycrIKesidI8TN88pXQD4bNC_ujWIHpL9K51rjW2wjL5WBaaXe1uv7m6nJowsjUUm9DVLp6UPPtS0Kgc1htpWYoKk2y4_CBufOLYlfqO00m0BQm89qiaE6oYCmBj4XrL5Bbqu4il6Mvh4v6icz7Ls8qZ05Cu1nbpTYOaqvgnSep7iF-uFOQDJQXhbvUDEEco3j5sueuDvCLQcdxdkG13dzzgHwIrjFFgAOupENs-BcZsvvJR0nj60Bml_oHTAeMoYXtIIM0ZVjnPEP_TC5A_uDNa3dZSs1a5LPt50hPCPHr6U1zxh75PNDrPTRHQHBsrfuR0v7yVaZ3clIwx42WCPtTyi__ruRiTINHh_zN905Ad4
https://hdl.handle.net/11424/291596
https://hdl.handle.net/11424/291596