Bacterial ecology of peritonitis in a sub-saharan peritoneal dialysis unit

Abstract

ntroduction: Peritonitis is a common and serious complication of Peritoneal Dialysis (PD). Peritonitis is a major cause of PD technique failure and conversion to long-term hemodialysis. After acquiring 10 years of experience with this complication, we conducted this study to determine the bacterial ecology profile of peritoneal infections in Dakar. Patients and methods: A retrospective descriptive and analytical study in PD unit of the Nephrology Department at Aristide Le Dantec University Hospital was performed during the period of 1 January 2011 to 31 December 2013. We included all patients on PD who had a peritoneal infection. Results: Seventy two (72) episodes of peritonitis were diagnosed in 51 patients with a peritonitis rate of 1 episode/21.03 patient-months. The sex ratio was 0.6. Nephroangiosclerosis (56.87%), chronic glomerulonephritis (25.49%), and diabetic nephropathy (3.92%) were the most common causes of end stage renal disease. Among the patients who had infectious peritonitis, 50 (98.03%) were on continuous ambulatory peritoneal dialysis. Peritonitis was more common during the wet season (41 cases (56.94%)) than during the dry season (31 cases (43.06%)). The drained fluid was cloudy in 76.4%, purulent in 2.77% and clear in 20.83% of cases. The culture was negative in 21 cases and positive in 51 cases. The pathogens found were Gram-positive organisms in 60.78% and Gram negative in 39.22% of cases. Staphylococcus aureus was present in 25 patients (45.12%) and Pseudomonas aeruginosain 8 patients (17.64%). Antimicrobial susceptibility testing did not detect any multidrug resistance or vancomycin-resistant strains. Therapeutically, ciprofloxacin per OS was used as a first-line therapy in all patients (100%) and intraperitoneal ceftriaxone in 61 episodes (84.72%). The average duration of treatment was 17 ± 3 days. The treatment was favorable in 48 cases. Conclusion: Peritoneal infections remain common in our patients, mainly with Gram-positive bacilli. Prevention and better care of peritoneal infections are necessary to ensure an effective PD technique.