The Causative Organisms of Capd Peritonitis for 5 years in a Single Center

Jin, D C; Park, C W; Youn, S N; Yoon, S A; Ahn, S J; Chang, Y S; Bang, B K

Abstract

Peritonitis is the most serious complication and most common cause of discontinuation of CAPD. The number for CAPD patients has reached 24% ESRD patients at the end of 1995 in Korea. This study is an analysis on the incidence and etiology of CAPD peritonitis from 1992 to 1996 in St. Mary's Hospital, The Catholic University of Korea. All of the enrolled patients were managed with two bag CAPD system, Tenckhoff straight two cuff catheter inserted by midline surgical approach, one weeks occlusive dressing and same break-in schedule. The laboratory study and antibiotics therapy protocol were not changed for 5 years. The number of enrolled patients was 124, (71 males and 53 females) and the mean age was 54.4+/-15.0 years-old. Fifty- one percent of the patients were diabetics. The overall incidence of CAPD peritonitis was 0.635/patient.year and the peritonitis caused by Gram positive bacteria was 40.4%, Gram negative was 16.9%, others was 5.9% and peritonitis with negative bacterial culture was 36.8%. The incidence of CAPD peritonitis in each year('92-'96) were 0.611, 0.721, 0.667, 0.617, 0.559 peritonitis/pt.yr, respectively. The causative organism proportion in each year were Gram(+) bacteria : 27.3, 45.2,50.0, 37.9, 42.3%, Gram(-) bacteria : 27.3, 9.7, 20.0, 24.1, 7.7% and culture negative 36.4, 41.9, 26.7, 37.9, 34.6%, respectively. The rates of isolated causative organism(percentage in culture positive cases) were 1) Gram(+) bacteria (64.0%) : S. aureus 27.9, coagulase negative staphylococcus 23.3, streptococcus 9.3, other Gram(+) 3.5%, 2) Gram(-) bacteria(26.7%) : pseudomonas 5.8, E.coli 5.8, acinetobacter. 4.7, klebsiella 3.5, other Gram(-) 7.0%, 3) other cause(9.3%) : candida 7.0, M. tuberculosis 2.3%. In summary, the most common causative organism of CAPD with two bag system was Gram(+) bacteria(64%, especially staphylococcus : 51.2%), which indicated that the transluminal and periluminal causes were still predominant. The peritonitis with Gram(-) bacteria was 26.7% and fungal peritonitis was 7%.