Clinical course and outcomes of enterococcus peritonitis in peritoneal dialsyisi patient

Abstract

INTRODUCTION: Enterococci are part of the normal flora of the gastrointestinal tract. They can lead to enteric peritonitis which is a serious complication of peritoneal dialysis (PD). However, the clinical course and outcomes of PD-related Enterococcus peritonitis remains unclear. METHODS: We reviewed all Enterococcus peritonitis in our dialysis unit from 1995 to 2009. RESULTS: During the study period, 1421 episodes of peritonitis were recorded. A total of 29 episodes were due to single-organism Enterococcus; 12 episodes were caused by E. faecalis while nine episodes were caused by E. faecium. The overall ampicillin-resistant rate was 41.4%. Recent use of antibiotics was associated with the development of ampicillin-resistant Enterococcus (ARE) peritonitis (hazard ratio 12.53, P = 0.04). The primary response rate of Entereococcus peritonitis was significantly higher than that of Escherichia coli peritonitis (89.7% versus 69.9%, P = 0.038). When compared with ampicillin-susceptible Enterococcus (ASE) peritonitis, the primary response rate of ARE peritonitis was not significantly lower (83.3% versus 94.1%, P = 0.553). However, significantly more patients in ARE group had received vancomycin (83.3% versus 23.5%, P = 0.003) with a longer mean treatment duration (3.7 ± 6.8 days versus 11.8 ± 6.9 days, P = 0.005). CONCLUSION: Recent use of antibiotics is a risk factor for the development of ARE peritonitis. When compared with ASE peritonitis, ARE peritonitis had similar outcomes but vancomycin was required during treatment which may in turn predispose patients to infections caused by vancomycin-resistant organisms.