Prevention of recurrence of enteric peritonitis in peritoneal dialysis with Escherichia coli Nissle 1917: A case-series study

Introduction: Peritonitis is still a major cause of drop-out in peritoneal dialysis (PD) and is often the consequence of the migration of bacteria across the intestinal wall, configuring an enteric peritonitis (EP). EP is usually caused by commensals of the gastrointestinal (GI) tract, it relapses commonly and may result in catheter removal. Aims: Currently, no specific therapeutic measures are available to effectively prevent recurrence of EP, thus we reported our clinical experience with use of probiotics Escherichia coli Nissle (EcN). Materials and methods: This is a case-series study performed in PD patients affected by recurrent peritonitis due to GI commensals. In these patients, we added prophylactic treatment with EcN 100 mg twice a day (in addition to 10 days monthly of 200 mg rifaximin) to the standard management of peritonitis. Results: We enrolled 14 PD patients (mean age: 53.1 +/- 11.9 years; 67% males; dialysis vintage: 7.5 (3.1 - 27.7) months; 64% automated PD). Causative organisms were Escherichia coli (N = 5), Klebsiella pneumoniae (N = 3), Enterococcus faecalis (N = 2), Enterobacter cloacae (N = 2), Aeromonas caviae (N = 1), Streptococcus gallolyticus (N = 1). No exit-site infection was associated with peritonitis. Patients were successfully treated with intraperitoneal antibiotics adjusted to culture results and antibiotic sensitivities for 14 - 21 days. During the subsequent 18 months of follow-up, no recurrence of EP was registered. No adverse effect was reported. Conclusion: In PD patients, the use of EcN is associated with no recurrence of EP. Further studies or clinical trials are needed to confirm our results.