Evaluation Of Continuous Ambulatory Peritoneal Dialysis Associated Peritonitis Attacks and Investigation Of Risk Factors For Gram Negative Bacterial Peritonitis

Yıl 2018, Cilt: 10 Sayı: 3, 5 - 13, 26.05.2018

Arzu Altunçekiç Yıldırım

Öz

Abstract

Introduction :Continuous Ambulatory Peritoneal Dialysis (CAPD) is one of the methods currently used in the treatment of chronic renal failure. Despite all technical advances, peritonitis continues to be the most important complication of this procedure. It is important to detect the responsible microorganism andits antimicrobial sensitivity, to start the appropriate antimicrobial treatment, to decrease the morbidity and mortality inpatients who develop peritonitis.

Materials and Methods:In our study, chronic renal failure patients who were on the CAPD program in Gazi University Medical Faculty Hospital Nephrology Clinic, peritonitis symptoms were present and has peritonitis symptoms. Peritoneal fluid was, inoculation into automated blood culture bottles and viewed together with traditional culture met-hods. Risk factors for Gram negative bacterial peritonitis werequestioned. Results:Forty-six peritonitis episodes were observed in 35 patients undergoing CAPD, and clinical and laboratoryparameters were evaluated. Culture isolation rates were de-termined as % 78.3 and %63 in the evaluations performedusing blood culture systems and conventional culture methods, respectively.(p=0,001) Gram positive microorganisms were detected in %69.6 and gram negative microorganisms were detected in %27.7 of the peritonitis attacks.It was determined as an advanced age risk factor in termsof Gram negative peritonitis development (p= .000) CRP le-vels were significantly higher in gram-negative peritonitisepisodes ( p=0,004).

Conclusion:Peritonitis still remains the most importantcomplication in patients undergoing CAPD. The use of blood culture systems increases the chances of microorganismisolation. Patients with advanced age and high CRP levelsare more likely to have gram-negative peritonitis. 

Anahtar Kelimeler

peritoneal dialysis, perito-nitis, risk factors

Sürekli Ayaktan Periton Diyalizi Uygulanan Hastalarda Gelişen Peritonit Ataklarının Değerlendirilmesi ve Gram Negatif Bakteri Peritoniti İçin Risk Faktörlerinin Araştırılması

Öz

Öz

Giriş: Sürekli Ayaktan Periton Diyalizi (SAPD) uygulaması, kronik böbrek yetmezliği tedavisinde uygulanan yöntemler arasında yerini almıştır. Tüm teknik gelişmelere rağmen peritonitler, halen en önemli komplikasyondur. Hastalarda mikroorganizmanın saptanması; uygun antimikrobiyal tedavinin başlanabilmesi,  morbidite ve mortalitenin azaltılabilmesi açısından önemlidir.

Materyal ve Metod/Hastalar ve Metod: Çalışmamızda, Gazi Üniversitesi Tıp Fakültesi Hastanesi Nefroloji Kliniği, SAPD ünitesinde izlenen ve peritonit semptomlarıile başvuran hastalar yer almıştır. Hastalarda periton sıvısı kan kültür şişelerine ve rutin kültür plaklarına ekilmiştir. Gelişen Gram negatif bakteri peritonitleri açısından çeşitli risk faktörleri sorgulanmıştır.

Bulgular: Otuzbeş hastada 46 peritonit atağı takip edilmiştir. Kan kültürü ve konvansiyonel kültür yöntemleri ile izolasyon oranları %78.3 ve %63 olarak saptanmıştır.(p=0,001) Atakların %69.6’sında gram pozitif, %27.7’sinde ise gram negatif etkenler izole edilmiştir. Gram negatif peritonit açısından; ileri yaş ve CRP yüksek-liği risk faktörü olarak bulunmuştur.

Sonuç: SAPD uygulayan hastalarda peritonit en önemli komplikasyondur. Kan kültürü sistemleri izolasyon şansını artırmaktadır. İleri yaş ve CRP yüksekliği saptanan hastalarda gram negatif peritonit ihtimali yüksektir.

Anahtar Kelimeler

periton diyalizi, peritonit, risk faktörleri

Kaynakça

• Kaynaklar 1.Krishnan M, Thodis E, Ikonomopoulos D, Vidgen E, Chu M, Barg-man JM, et al. Predictors of outcome following bacterial perito-nitis in peritoneal dialysis. Perit Dial Int 2002;22: 573-81 2.Levison ME, Bush LM. Peritonitis and Intraperitoneal Abs-cesses. In: Mandell GL, Bennett JE, Dolin R (eds). Princip-les and Practice of Infectious Diseases. 6th edition. New York:Churchill Livingston, 2005: 927-51. 3.Dawson MS, Harford AM, Garner BK, Sica DA, LandwehrDM, Dalton HP.Total volume culture technique for the iso-lation of microorganisms from continuous ambulatory peri-toneal dialysis patients with peritonitis. J Clin Microbiol1985;22(3): 391-94. 4.Gould IM, Reeves I, Chauhan N. Novel plate culture methodto improve the microbiological diagnosis of peritonitis in pa-tients on continuous ambulatory peritoneal dialysis. J Clin Mic-robiol 1988;26(9):1687-90. 5.Holley JL, Moss AH. A prospective evaluation of blood cul-ture versus standard plate techniques for diagnosing perito-nitis in continuous ambulatory peritoneal dialysis. Am JKid-ney Dis 1989;13(3):184-88. 6.Karadenizli A, Bakioğlu I, Kolaylı F, Koçanali Y, Bingöl R.Kronik ambulatuar periton diyaliz hastalarının peritonitataklarının bakteriyolojik yönden incelenmesi. Klimik Dergi-si 2002;15(2):49-51. 7.Kim DK, Yoo TH, Ryu DR, Xu ZG, Kim HJ, Choi KH, et al.Changes in causative organisms and their antimicrobial sus-ceptibilities in CAPD peritonitis: A single center’s experien-ce over one decade. Perit Dial Int 2004; 24(5): 424-32. 8.Troidle L, Gorban-Brennan N, Kliger A, Finkelstein FO. Con-tinuous peritoneal dialysis- associated peritonitis: A reviewand current concepts. Semin Dial 2003; 16(6):428-37 9.ISPD Guidelines/ Recommendations: Peritoneal Dialysis-Re-lated Infections Recommendations: 2005 Update. Perit DialInt 2005;25:107-31. 10.Clinical Laboratory Standards Institute. Performance Stan-dards for Antimicrobial Susceptibility Testing; Fifteenth In-formation Supplement. CLSI Document M100- S15. Wayne,Pa: CLSI, 2005 11.Erek E, Serdengeçti K, Süleymanlar K. Registry of the Neph-rology, Dialysis and Transplantation in Turkey, Registry 2004:1-94. 12.Tao Li PK, Szeto CC, Piraino B, Arteaga J, Fan S, Figueire-do AE, et al. ISPD Perıtonıtıs Recommendatıons: 2016 Up-date On Preventıon And Treatment. Perit Dial Int 2016;36(5):481–508. 13.Saklayen MG. CAPD Peritonitis. Incidence, pathogens, diag-nosis and management. Med Clin North Am 1990;74(4):997-1010. 14.Peterson PK, Matzke G, Keane WF. Current concepts in themanagement of peritonitis in patients undergoing continuousambulatory peritoneal dialysis. Rev Infect Dis 1987;9:604-12. 15.Ateş K, Karatan O, Erbay B, Duman N, Duranay M, Aylı D,et al. CAPD tedavisi uygulanan son dönem böbrek yetmezlik-li hastalarda infeksiyöz komplikasyonlar ( 7,5 yıllık gözlem-lerin analizi). Türk Nefroloji Diyaliz ve Transplantasyon Der-gisi 1993;2:85-93. 16.Pollock CA, Ibels LS, Caterson RJ, Mahony JF, Waugh DA,Cocksedge B. Continuous ambulatory peritoneal dialysis. Eightyears of experience at a single center. Medicine 1989;68:293-308. 17.Piraino B, Bernardini J, Sorkin M. The influence of peritone-al catheter exit site infections on peritonitis tunnel infectionsand catheter loss on CAPD. Am J Kidney Dis 1986;8:436-40. 18.Thomas MC, Harris DC. Management of bacterial peritoni-tis and exit-site infections in continuous ambulatory perito-neal dialysis. Nephrology 2002;7: 267-71. 19.Boeschoten EW. Continuous ambulatory peritoneal dialysis.In:Gokal R, Khanna R, Kredietend R.T, Nolph K (ed). Textbo-ok of Peritoneal Dialysis. 2nd edition., Kluwer Academic Pub-lishers, Great Britain 2000:387-17. 20.Gokal R.Peritoneal Dialysis. Prevention and control of infec-tion. Drugs & Aging 2000;17(4):269-82. 21.Rocklin MA, Teitelbaum I. Noninfectious causes of cloudy pe-ritoneal dialysate. Semin Dial 2001;14(1):37-40. 22.Doyle PW, Crichton EP, Mathias RG, Werb R. Clinical andmicrobiological evaluation of four culture methods for the di-agnosis of peritonitis in patients on continuous ambulatory pe-ritoneal dialysis. J Clin Microbiol 1989;27(6): 1206-09. 23.Poole-Warren LA, Taylor PC, Farrell PC. Laboratory diag-nosis of peritonitis in patients treated with continuous ambu-latory peritoneal dialysis. Pathology 1986;18(2):237-39. 24.Ludlam HA, Price TNC, Berry AJ, Phillips I. Laboratory di-agnosis of peritonitis in patients on continuous ambulatory pe-ritoneal dialysis. J Clin Microbiol 1988; 26(9): 1757-62. 25.Rayner BL, Williams DS, Oliver S. Inoculation of peritonealdialysate fluid into blood culture bottles improves culture ra-tes. S Afr Med J 1993;83(1):42-3. 26.Ryan S, Fessia S. Improved method for recovery of peritoni-tis causing microorganisms from peritoneal dialysate. J ClinMicrobiol 1987;25(2):383-4. 27.Gloor HJ. 20 years of peritoneal dialysis in a mid-sized Swisshospital. Swiss Med Wkly 2003;133:619-24. 28.Kaya M, Altıntepe L, Baysal B, Güney İ, Türk S, Tonbul Z.SAPD peritonitinde kültür pozitiflik oranı ve tedavi sonuçla-rı. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi2005;14(3):132-5. 29.Neville LO, Baillod R, Grady D, Brumfitt W, Hamilton-Mil-ler JM. Teicoplanin in patients with chronic renal failure ondialysis: microbiological and pharmacokinetic aspects. Int JClin Pharmacol Res 1987; 7(6):485-90. 30.Toussaint N, Mullins K, Snider J, Murphy B, Langham R, GockH. Efficacy of a non-vancomycin-based peritoneal dialysis pe-ritonitis protocol. Nephrology 2005;10(2):142-46. 31.Golper TA, Brier ME, Bunke M, Schreiber MJ, Bartlett DK,Hamilton RW, et al. Risk factors for peritonitis in long-termperitoneal dialysis: the Network 9 peritonitis and catheter sur-vival studies. Academic Subcommitee of the Steering Commit-tee of the Network 9 Peritonitis and Catheter Survival Studi-es. Am J Kidney Dis 1996;28(3):428-36. 32.De Vecchi AF, Maccario M, Braga M, Scalamogna A, Cas-telnovo C, Ponticelli C. Peritoneal dialysis in nondiabetic pa-tients older than 70 years: comparison with patients aged 40to 60 years. Am J Kidney Dis 1998; 31(3):479-90. 33.Nebel M, Finke K. CAPD in patients over 60 years of age re-view from 1984-1989. Adv Perit Dial (suppl) 1990;6:56-60. 34.Valente J, Rappaport W. Continuous ambulatory peritonealdialysis associated with peritonitis in older patients. Am J Surg1990;159(6):579-81. 35.Von Graevenitz A, Amsterdam D. Microbiological aspects ofperitonitis associated with continuous ambulatory peritone-al dialysis. Clin Microbiol Rev 1992;5(1):36-48. 36.Bathon J, Graves J, Jens P, Hamrick R, Mayes M. The eryth-rocyte sedimentation rate in end-stage renal failure. Am J Kid-ney Dis 1987;10(1): 34-40. 37.Wang AY, Woo J, Lam CW, Wang M, Sea MM, Lui SF, et al.Is a single time point C-reactive protein predictive of outco-me in peritoneal dialysis patients? J Am Soc Nephrol2003;4(7):1871-79. 38.Hind CRK, Thomson SP, Winearls CG, Pepys MB. Serum C-reactive protein concentration in the management of infecti-on in patients treated by continuous ambulatory peritoneal di-alysis. J Clin Pathol 1985;38 (4):459-63. 39.Beck FK, Rosenthal TC: Prealbumin: a marker for nutritio-nal evaluation. Am Fam Physician 2002;65(8):1575-78. 40.Sarıkaya M, Tuncer M, Varan Hİ, Sarı R, Ersoy F, Süleyman-lar G, et al. Sürekli ayaktan periton diyalizi hastalarında pe-ritonit sıklığı ile diyaliz yeterliliği ve nutrisyonel parametre-lerin ilişkisi. Türk Nefroloji Diyaliz ve Transplantasyon Der-gisi 2001;10(4):216-18.