Peritoneal dialysis-associated peritonitis: clinical features and predictors of outcome

Objectives: The objective of this study was to identify the epidemiological, clinical, and microbiological factors affecting the outcome of peritoneal dialysis (PD)-associated peritonitis. Methods: All patients with PD-associated peritonitis, cared for at the University Hospital of Heraklion from 1990 to 2007, were retrospectively studied. Results: A total of 247 episodes of PD-associated peritonitis occurring in 82 patients were evaluated. The median age of patients was 68 years (range 10-92 years); 51 (62%) were males. There were 104 episodes (42%) of Gram-positive peritonitis, 46 (19%) of Gram-negative peritonitis, 13 (5%) of polymicrobial peritonitis, and 11 (4%) of fungal peritonitis. There were 64 (26%) complicated episodes. The latter included 22 (8.9%) relapses, 13 (5.3%) repeated episodes, 18 (7.3%) catheter removals, and 11 (4.5%) deaths. In multivariate analysis, the presence of a purulent exit-site infection (p < 0.001), peritoneal dialysis effluent cell count > 100 x 10(6)/l for more than 5 days (p < 0.001), use of antimicrobials during the preceding 3 months (p < 0.05), and low serum total protein level on admission (p < 0.05) were independent predictors of a complicated course. Conclusions: Exit-site infection, more than 5 days with a peritoneal dialysis effluent cell count > 100 x 10(6)/l, prior use of antimicrobials, and low serum total protein level are potential predictors of complicated PD-associated peritonitis and may distinguish high-risk cases. (C) 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.