The Catheter Removal of Polymicrobial Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD)

Kim, Sang Wook; Lee, Young Kee; Shin, Jin Ho; Cha, Dae Ryong; Kwon, Young Ju; Cho, Won Yong; Pyo, Hee Jeong; Kim, Hyeong Kyu

Abstract

Polymicrobial peritonitis is a relatively uncommon complication and it's clinical characteristics, risk factor and optimal managernent remain controversial. To identify indications for catheter removal in polymicrobial peritonitis, we reviewed the 340 episodes that occured in 168 patients of CAPD peritonitis during past 7 years to identify those. Polymicribial peritonitis was the 18 epoisodes in 18 patients of all peritonitis. First, 18 patients with polymicrobial peritonitis (P-P) did not show significant differences in the demographic features compared to 130 patients with single organism peritonitis (S-P). In contrast to Staphylococcus in S-P, the most common causative organisrn in P-P was pseudomonas (23%). Also sgnificantly more catheters were removed in P-P than S-P (P=0.001). Second, we cornpared group I, the patients responded to antibiotics only, and group II, those who needed catheter removal. The group I was 7 (39%) and the group II was 11 (61%). No patient of group I died and two patients of group II died. Between group I and group II, there were no significant differences in the demographic features. However, patients whose dialysate-WBC counts were below 100 at 3rd day after start of antibiotics were more significantly frequent in group I than group II. Among combination of causative organisms in P-P, most of Pseudornonas (6/9) and fungus (4/4) were treated by catheter removal. In conclusion, more catheters were removed in P-P than S-P. When dialysate WBC at 3rd day after start of antibiotics were over 100 and causative organism included pseudomonas or fungus in P-P, catheter removal was needed. We suggest that the kinds of organisms isolated and early response to antibiotics influence on the outcome of polymicrobial peritonitis.