“Microbes Associated with Peritonitis and the Clinical Outcomes of Peritonitis on Peritoneal Dialysis at Chris Hani Baragwanath Hospital; Retrospective Study from 1st January 2011 to 31st December 2018

Abstract

Background: Peritonitis is one of the common complications of chronic peritoneal dialysis (PD). The associated microbes and their antibiotics susceptibility varies amongst institutions. African literature on the impact of clinical and demographic factors on the outcomes of peritonitis in patients on PD is insufficient. Objectives: To determine the peritonitis rate, analyse the microbes cultured from the peritoneal fluids of patients with peritonitis and their antimicrobial sensitivity. To assess factors that may contribute to the overall outcome of peritonitis and to assess if these factors could be used to predict further peritonitis related complications. Methods: A retrospective study of 177 patients on PD who developed peritonitis at Chris Hani Baragwanath academic hospital between 01 January 2011 to 31 December 2018. The relevant clinical and demographic factors were obtained from medical records and laboratory results of the specimens culture and sensitivity were obtained from the laboratory services. Results: A total of 177 incidence of peritonitis in this review. The median age was 42 years (IOR 32years – 48years, with 89.3% being black African. The unemployment rate among the patients was 61%, however the majority reported not living in overcrowded environment (93.2%). Overall peritonitis rate was 0.23 episodes/patient-year. The rate of peritonitis (in percentages) has fluctuated over the study period with the lowest rate of 18% in 2011 and the highest rate of 28.4% in 2018. There was a predominance of gram-positive microbes, followed by gram-negative at 48% and 23.2% respectively. Poor peritonitis outcome increased with increase in age [OR 1.14 (95% CI 1.02 – 1.29) p=0.02] and nearly 19-fold increase in mortality in HIV positive patients [OR 18.93 (95% CI 2.04 – 175.45) p=0.01]. Conclusion: Gram-positive microbes are the commonest isolates in culture positive peritonitis and the appropriate antibiotics of choice is vancomycin and ampicillin. There was strong association between HIV infection and peritonitis-associated mortality.