Acinetobacter peritoneal dialysis peritonitis: A changing landscape over time
Journal
PLoS ONE
Journal Volume
9
Journal Issue
10
Pages
e110315
Date Issued
2014
Abstract
Background: Acinetobacter species are assuming an increasingly important role in modern medicine, with their persistent presence in health-care settings and antibiotic resistance. However, clinical reports addressing this issue in patients with peritoneal dialysis (PD) peritonitis are rare. Methods: All PD peritonitis episodes caused by Acinetobacter that occurred between 1985 and 2012 at a single centre were retrospectively reviewed. Clinical features, microbiological data, and outcomes were analysed, with stratifications based upon temporal periods (before and after 2000). Results: Acinetobacter species were responsible for 26 PD peritonitis episodes (3.5% of all episodes) in 25 patients. A. baumannii was the most common pathogen (54%), followed by A. iwoffii (35%), with the former being predominant after 2000. Significantly more episodes resulted from breaks in exchange sterility after 2000, while those from exit site infections decreased (P = 0.01). The interval between the last and current peritonitis episodes lengthened significantly after 2000 (5 vs. 13.6 months; P = 0.05). All the isolates were susceptible to cefepime, fluoroquinolone, and aminoglycosides, with a low ceftazidime resistance rate (16%). Nearly half of the patients (46%) required hospitalisation for their Acinetobacter PD-associated peritonitis, and 27% required an antibiotic switch. The overall outcome was fair, with no mortality and a 12% technique failure rate, without obvious interval differences. Conclusions: The temporal change in the microbiology and origin of Acinetobacter PD-associated peritonitis in our cohort suggested an important evolutional trend. Appropriate measures, including technique re-education and sterility maintenance, should be taken to decrease the Acinetobacter peritonitis incidence in PD patients. ? 2014 Chao et al.
SDGs
Other Subjects
aminoglycoside; carbapenem; cefalexin; cefazolin; cefepime; ceftazidime; cephalosporin; ciprofloxacin; gentamicin; levofloxacin; piperacillin; quinoline derived antiinfective agent; ticarcillin; vancomycin; Acinetobacter; Acinetobacter baumannii; Acinetobacter iwoffii; Acinetobacter junii; Acinetobacter ursingii; adult; aged; antibiotic resistance; antibiotic sensitivity; Article; bacterial peritonitis; bacterium isolate; clinical article; clinical feature; coagulase negative Staphylococcus; controlled study; end stage renal disease; Enterococcus faecalis; female; hospitalization; human; longitudinal study; male; mortality; outcome assessment; peritoneal dialysis; retrospective study; septic shock; very elderly; young adult; Acinetobacter Infections; adverse effects; comorbidity; middle aged; peritoneal dialysis; peritonitis; Acinetobacter; Acinetobacter; Acinetobacter Infections; Adult; Aged; Aged, 80 and over; Comorbidity; Female; Humans; Male; Middle Aged; Mortality; Patient Outcome Assessment; Peritoneal Dialysis; Peritonitis; Retrospective Studies; Young Adult
Type
journal article