Microbiology, Clinical Profile and Outcomes of Continuous Ambulatory Peritoneal Dialysis associated Peritonitis

Abstract

INTRODUCTION
Continuous ambulatory peritoneal dialysis (CAPD) is a preferred modality of treatment in well selected patients with end-stage kidney disease (ESKD). Peritonitis in patients on CAPD is a common complication. It is associated with high morbidity, mortality and financial burden and is the major cause of technique failure and dropout from CAPD. The clinical data regarding peritonitis is scarce from low-income countries like Nepal. In this study, we aimed to determine the microbiology, clinical profile and outcomes of peritonitis in CAPD patients at a tertiary referral center in Nepal.

METHODS
A retrospective, observational study was conducted at a tertiary care teaching hospital in Kathmandu over a period of 2 years from August, 2022 to July 2024. Data on demographics, clinical presentation, organisms isolated, duration of treatment and outcomes were retrieved.  Statistical Analysis was done by using SPSS version 26.The categorical data and continuous data were analyzed using mean, standard deviation and percentage. The data was presented in tables.

RESULTS
There were 20 episodes of peritonitis in 17 patients. There were 8 male and 9 female patients. Mean age of the patients was 48.45± 9.6 years. Amongst the 20 peritonitis episodes, 16 were culture positive (80%). Peritonitis due to gram-negative organisms 10 (62.5%) was higher than that due to gram-positive organisms 6 (37.5%). The most common organisms isolated were Pseudomonas aeruginosa (4) followed by Escherichia coli (2), Klebsiella sp. (2), Staphylococcus aureues (2), coagulase negative Staphylococcus (2) and Enterococcus sp. (2). The most common clinical presentation was abdominal pain and cloudy effluent.  Fifteen percent episodes were constituted by refractory, recurrent and repeat peritonitis. Outcomes were recovery (95%), catheter removal (5%), switch to hemodialysis (5%). There were no deaths due to peritonitis in the study population.

CONCLUSIONS
CAPD peritonitis due to Gram-negative organisms was more frequent than that due to gram-positive organisms in our CAPD population in Nepal and was associated with poor outcome.

KEY WORDS

CAPD, Continuous Ambulatory, Microbiology, Outcome, Peritonitis