Causative organisms and patterns of antibiotics sensitivity of CAPD peritonitis in different dialysis centers

Park, Sun Hee; Lee, Duk Hyun; Cho, Young Jun; Cho, Dong Kyu; Shin, Suk Kyun; Kim, Dae Joong; Kim, Yong Lim

Abstract

BACKGROUND: The International Society for Peritoneal Dialysis (ISPD) changed their recommendations for empiric therapy of peritonitis to a first generation cephalosporin to substitute vancomycin and a ceftazidime or an aminoglycoside to cover Gram negative organisms. These guidelines have been recently challenged based on microbiologic evidence and practical considerations. We believe that the management of CAPD peritonitis should be adapted to the specific circumstances affecting the patient, geographic location, local epidemiology of causative bacteria and availability of specific antibiotics.
METHODS
To evaluate causative microorganisms and patterns of antibiotics sensitivity of CAPD peritonitis in different dialysis centers, we performed retrospective analysis in three dialysis centers located at different geographic area : Kyungpook University Hospital (Center A), Samsung Seoul Hospital (Center B), Ilsan Hospital (Center C). Among a total of 642 patients on CAPD from January 2001 to December 2001, 113 patients who experienced peritonitis (157 episodes of peritonitis) were included. For microbiologic culture, dialysate effluent was plated in blood agar, thioglycollate broth and McConkey medium. The pattern of antibiotic sensitivity was assessed using broth dilution and disc diffusion method.
RESULTS
The sex ratio and proportion of diabetic patients were not different among each center, but the age of center C was higher than that in center A (A: 56.2 13.6, C: 64.6 14.1, p<0.05). Distribution of the causative microorganisms was not different among each center but the pattern of antibiotic sensitivity was different. The incidence of methicillin-resistant staphylococcus species and aztreonam-resistant Gram negative organisms was significantly different among each center. Regimen of 2000 ISPD empiric treatment protocol was ineffective in about 23% of all peritonitis episodes. A treatment with cefazolin instead of vancomycin was associated with resistance in 32.1% of Gram positive organisms and with mobactam instead of ceftazidime was associated with resistance in 23.1% of Gram negative organisms.
CONCLUSION
Individual centers should continue to monitor the epidemiology of CAPD peritonitis and the epidemiology of the causative organisms and their sensitivity patterns in order to adapt general guidelines into a center-tailored empirical treatment protocols.