World J Nephrol Urol

World Journal of Nephrology and Urology, ISSN 1927-1239 print, 1927-1247 online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Nephrol Urol and Elmer Press Inc

Journal website http://www.wjnu.org

Original Article

Volume 7, Number 2, June 2018, pages 45-52

Microbiology Risk Factors and Outcomes of Peritonitis in Tunisian Peritoneal Dialysis Patients

**Table 1.** Clinical Characteristics of Patients
Patients (n)	182
Sex (male/female)	109:73
Age (years, mean ± standard deviation)	43.93 ± 16.95
Mean duration of follow-up (months)	27 .75 ± 26.18
Underlying disease, n (%)
Chronic glomerulonephritis	25 (13.73)
Diabetes mellitus	64 (35.16)
Hypertension	16 (8.79)
Interstitial nephropathy	41 (22.52)
Others or unknown	36 (19.8)

Table 1. Clinical Characteristics of Patients

Patients (n)

182

Sex (male/female)

109:73

Age (years, mean ± standard deviation)

43.93 ± 16.95

Mean duration of follow-up (months)

27 .75 ± 26.18

Underlying disease, n (%)

Chronic glomerulonephritis

25 (13.73)

Diabetes mellitus

64 (35.16)

Hypertension

16 (8.79)

Interstitial nephropathy

41 (22.52)

Others or unknown

36 (19.8)

**Table 2.** Distribution of Patients According to the Number of Peritonitis
Number of peritonitis	Number of patients
1	46
2	21
3	14
4	5
5	3
6	2
9	1

Table 2. Distribution of Patients According to the Number of Peritonitis

Number of peritonitis

Number of patients

**Table 3.** Details of Causative Organisms of the First Peritonitis From 2006 to 2016
Group of microorganism	n (%)
Gram-positive cocci	26 (27.92)
Staphylococcus aureus	16 (17.20)
Staphylococcus epidermidis	3 (3.22)
Streptococcus	7 (7.5)
Gram-negative rods	22 (23.9)
Pseudomonas	6 (6.45)
Acinetobacter	2 (2.15)
Enterobacter	3 (3.22)
Klebsiella pneumoniae	5 (5.37)
Escherichia coli	6 (6.45)
Candida albicans	5 (5.37)
Aspergillus	1 (1.07)
Others	4 (4.3)
Culture-negative	34 (36.55)

Table 3. Details of Causative Organisms of the First Peritonitis From 2006 to 2016

Group of microorganism

n (%)

Gram-positive cocci

26 (27.92)

Staphylococcus aureus

16 (17.20)

Staphylococcus epidermidis

3 (3.22)

Streptococcus

7 (7.5)

Gram-negative rods

22 (23.9)

Pseudomonas

6 (6.45)

Acinetobacter

2 (2.15)

Enterobacter

3 (3.22)

Klebsiella pneumoniae

5 (5.37)

Escherichia coli

6 (6.45)

Candida albicans

5 (5.37)

Aspergillus

1 (1.07)

Others

4 (4.3)

Culture-negative

34 (36.55)

**Table 4.** Causes of Peritonitis
	Number	Percentage
Lack of asepsis	140	78.2
Extender crack	2	1.1
Endogenous cause	2	1.1
Other infectious source	4	2.2
Exit-site infection	14	7.8
Catheter disconnection	3	1.6
Catheter breaking	1	0.5
Catheter crack	2	1.1
Defective material	4	2.2
Unknown cause	7	3.9

Table 4. Causes of Peritonitis

Number

Percentage

Lack of asepsis

140

78.2

Extender crack

1.1

Endogenous cause

1.1

Other infectious source

2.2

Exit-site infection

7.8

Catheter disconnection

1.6

Catheter breaking

0.5

Catheter crack

1.1

Defective material

2.2

Unknown cause

3.9

**Table 5.** Comparison Between Peritonitis-Free and Peritonitis Group
	Peritonitis-free (n = 89), %	Peritonitis** (n = 93), %	P value
Values are expressed as mean ± SD, or number (%). GFR: glomerular filtration rate (estimated by the average of renal BUN and creatinine clearance). Defined as the presence of coronary artery disease, cerebrovascular disease or peripheral artery disease. *At least one peritonitis. CRP: C-reactive protein.
Sex (men)	50	56	0.67
Age (years)	43 ± 15	44 ± 18	0.62
Anuria	11 (12.3)	12 (12.9)	0.52
Ultrafiltration (mL)	1,715 ± 732	1,632 ± 594	0.67
Diabetes mellitus	26	35	0.08
Hypertension	36	52	0.08
Cardiovascular disease*	8	15	0.33
Serum albumin (g/dL)	28.6 ± 5.23	28.88 ± 5.4	0.87
Blood hemoglobin (g/dL)	8.54 ± 1.31	8.57 ± 1.54	0.94
Serum calcium (mg/dL)	2.15 ± 0.24	2.12 ± 0.26	0.67
Serum phosphorous (mg/dL)	1.8 ± 0.64	1.73 ± 0.56	0.52
Serum cholesterol (mg/dL)	3.51 ± 2.35	3.01 ± 1.51	0.41
CRP	8.18 ± 15	10.36 ± 17	0.6
Ferritin (µg/L)	29.61 ± 253	351 ± 460	0.53
NPCR (g/kg/day)	0.91 ± 0.43	1 ± 0.29	0.27
Baseline PD adequacy
Total KT/V urea	2.63 ± 0.88	2.69 ± 0.95	0.75
Residual GFR (mL/min/1.73 m²)	2.19 ± 2.06	3.54 ± 3.6	0.16
Total creatinine clearance (L/week)	77.27 ± 31.59	83.88 ± 28.51	0.33

Table 5. Comparison Between Peritonitis-Free and Peritonitis Group

Peritonitis-free (n = 89), %

Peritonitis** (n = 93), %

P value

Values are expressed as mean ± SD, or number (%). GFR: glomerular filtration rate (estimated by the average of renal BUN and creatinine clearance). *Defined as the presence of coronary artery disease, cerebrovascular disease or peripheral artery disease. **At least one peritonitis. CRP: C-reactive protein.

Sex (men)

0.67

Age (years)

43 ± 15

44 ± 18

0.62

Anuria

11 (12.3)

12 (12.9)

0.52

Ultrafiltration (mL)

1,715 ± 732

1,632 ± 594

0.67

Diabetes mellitus

0.08

Hypertension

0.08

Cardiovascular disease*

0.33

Serum albumin (g/dL)

28.6 ± 5.23

28.88 ± 5.4

0.87

Blood hemoglobin (g/dL)

8.54 ± 1.31

8.57 ± 1.54

0.94

Serum calcium (mg/dL)

2.15 ± 0.24

2.12 ± 0.26

0.67

Serum phosphorous (mg/dL)

1.8 ± 0.64

1.73 ± 0.56

0.52

Serum cholesterol (mg/dL)

3.51 ± 2.35

3.01 ± 1.51

0.41

CRP

8.18 ± 15

10.36 ± 17

0.6

Ferritin (µg/L)

29.61 ± 253

351 ± 460

0.53

NPCR (g/kg/day)

0.91 ± 0.43

1 ± 0.29

0.27

Baseline PD adequacy

Total KT/V urea

2.63 ± 0.88

2.69 ± 0.95

0.75

Residual GFR (mL/min/1.73 m²)

2.19 ± 2.06

3.54 ± 3.6

0.16

Total creatinine clearance (L/week)

77.27 ± 31.59

83.88 ± 28.51

0.33

**Table 6.** Cox Regression Model for Peritonitis Risk Factors
	Multivariate analysis
Residual GFR (mL/min/1.73 m²)	1.17	0.97 - 1.42	0.085
Diabetes mellitus	0.77	0.27 - 2.15	0.61
Hypertension	1.37	0.55 - 3.43	0.49

Table 6. Cox Regression Model for Peritonitis Risk Factors

Multivariate analysis

95 % CI

Residual GFR (mL/min/1.73 m²)

1.17

0.97 - 1.42

0.085

Diabetes mellitus

0.77

0.27 - 2.15

0.61

Hypertension

1.37

0.55 - 3.43

0.49

**Table 7.** Summary of Published Microbiology Studies
N: number of episodes. CoNS: coagulase-negative staph.
Country	Scotland	USA	Canada	Korea	Tokyo	Toronto	Australia
Source	Registry	Multicenter database	Multicenter database	Single center	13 centers	Single center	Regional
Episodes (N)	928	1,142	2,886	1,108	-	485	145
Period of observation	1999 - 2002	1998 - 2004	1998 - 2004	1992 - 2001	2005 - 2007	1995 - 2000	2000 - 2001
Gram-positive	-	62%	61%	44.9%	42.7%	53.6%	46.9%
CoNS	29.5%	18.07	16.36	25.2%	12%	25.15%	24.13%
S. aureus	19.2%	31.05	42.48	13.6%	26	14.4%	6.9%
Gram-negative	15.7%	20.5	23.6	14.7%	18.6%	20.4%	24.13%
Fungi	15.2%	3.92	3.66	2.16%	3.3%	6.8%	4.8%
Culture-negative	3.6%	15.9	18.5	36.9%	31.8%	10.9%	16%
Author	Kavanagh et al [1]	Mujais [14]	Mujais [14]	Kim et al [15]	Masashi et al [12]	Krishnan et al [16]	Kan et al [17]

Table 7. Summary of Published Microbiology Studies

N: number of episodes. CoNS: coagulase-negative staph.

Country

Scotland

USA

Canada

Korea

Tokyo

Toronto

Australia

Source

Registry

Multicenter database

Single center

13 centers

Single center

Regional

Episodes (N)

928

1,142

2,886

1,108

485

145

Period of observation

1999 - 2002

1998 - 2004

1992 - 2001

2005 - 2007

1995 - 2000

2000 - 2001

Gram-positive

62%

61%

44.9%

42.7%

53.6%

46.9%

CoNS

29.5%

18.07

16.36

25.2%

12%

25.15%

24.13%

S. aureus

19.2%

31.05

42.48

13.6%

14.4%

6.9%

Gram-negative

15.7%

20.5

23.6

14.7%

18.6%

20.4%

24.13%

Fungi

15.2%

3.92

3.66

2.16%

3.3%

6.8%

4.8%

Culture-negative

3.6%

15.9

18.5

36.9%

31.8%

10.9%

16%

Author

Kavanagh et al [1]

Mujais [14]

Kim et al [15]

Masashi et al [12]

Krishnan et al [16]

Kan et al [17]