Clinical course of peritonitis due to Pseudomonas species complicating peritoneal dialysis: A review of 104 cases

Background. Peritonitis due to Pseudomonas species is a serious complicatio n in continuous ambulatory peritoneal dialysis (CAPD) patients. The clinica l course of peritonitis due to Pseudomonas complicating CAPD remains unclea r. Methods. All of the Pseudomonas species episodes of peritonitis in our dial ysis unit were studied from 1995 to 1999. During this period, there were 85 9 episodes of peritonitis recorded, 113 of which were caused by the Pseudom onas species. Nine episodes were excluded because they were mixed growth. T he remaining 104 episodes in 68 patients were reviewed. Results. The underlying renal diagnosis and prevalence of comorbid conditio ns of the 68 patients were similar to those found in our entire dialysis po pulation. There was a history of antibiotic therapy within 30 days of the o nset of peritonitis due to the Pseudomonas species in 69 episodes (66.3%). In 47 episodes (45.2%) there was a concomitant exit site infection. The ove rall primary response rate was 60.6% and the complete cure rate was 22.1%. The presence of exit site infection was associated with a lower primary res ponse rate (22 in 47 vs. 41 in 57 episodes, P < 0.01) and a lower complete cure rate (5 in 47 vs. 18 in 57 episodes, P < 0.02). The episodes that had received recent antibiotic therapy had a significantly lower complete cure rate than the de novo cases (8 in 69 vs. 15 in 35 episodes, P < 0.001). Epi sodes receiving third-generation cephalosporin as part of the initial antib iotic regimen had a significantly higher primary response rate than the one s that initially received aminoglycoside (54 in 81 episodes vs. 8 in 22 epi sodes, P < 0.05), but their complete cure rates were similar. Twenty-four c ases failed to respond to antibiotics and the Tenckhoff catheter was remove d. The chance of returning to CAPD was higher when the Tenckhoff catheter w as removed on day 10 than on day 15 (9 in 14 cases vs. 5 in 10 cases), alth ough the result was not statistically significant. The Tenckhoff catheter w as removed and replaced at another site simultaneously in another 14 cases after the effluent cleared up. None of these patients had a relapse of peri tonitis within three months. Conclusions, Recent antibiotic therapy is the major risk factor for periton itis due to the Pseudomonas species. Exit site infection and recent antibio tic therapy are associated with poor therapeutic response to antibiotics. W hen the therapeutic response is suboptimal, early Tenckhoff catheter remova l may help preserve the peritoneum for further peritoneal dialysis. Electiv e Tenckhoff catheter exchange after clearing up the peritoneal dialysis eff luent may also reduce the likelihood of relapse. It is desirable to use thi rd-generation cephalosporin in the initial antibiotic regimen for peritonit is treatment in localities with a high incidence of peritonitis due to the Pseudomonas species.