The Changing Profile of PD-Related Peritonitis in Thailand: A Single Center’s Experience
Noppanit Pattanachaiwit MD*, Pongsathorn Gojaseni MD*, Jukrit Junrak MD**, Pattaya Riengchan MD**, Thaweepong Pajareya MD*, Anutra Chittinandana MD*
Affiliation : * Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Directorate of Medical Services, Royal Thai Air Force, Bangkok, Thailand ** Division of Infectious disease, Department of Medicine, Bhumibol Adulyadej Hospital, Directorate of Medical Services, Royal Thai Air Force, Bangkok, Thailand
Objective : The percentage of utilizing peritoneal dialysis (PD) in Thailand was increased dramatically since the implementation
of PD-First policy in 2008. However, peritonitis remains a major obstacle to achieve success of this modality. The aim of the
present study, was to assess the clinical characteristics of PD peritonitis in the PD-first policy era.
Material and Method: The PD peritonitis patients in Bhumibol Adulyadej Hospital between October 2008 and December
2010 were reviewed. Microbiological diagnosis, treatment responses, technique, and patient survival were analyzed.
Results : Since October 2008, 93 peritoneal dialysis patients were followed-up in Bhumibol Adulyadej Hospital including 75
new cases. During the present study period of 1,560 patient-months, 51 episodes of peritonitis from 33 cases were recorded
and analyzed. The mean age of the peritonitis patients was 57.9 + 16.1 years and 63.6% were females. The most common
isolates were gram negative organisms (33.3%) followed by gram positive (17.6%) and fungi (5.9%). Nocardiosis was
diagnosed in 1 patient. However, 43.1% of episodes were culture-negative peritonitis. Treatment of peritonitis resulted in a
complete cure in 74.5% of patients while 7.8% of patients required catheter removal, and 17.6% died. Event-free survival
was better in gram positive organisms (43.3 months) compared with those infected with gram negative (26.8 months) and
culture negative peritonitis (16.1 months).
Conclusion : The proportions of peritonitis due to gram negative organisms were increased and associated with less
favorable outcome. These findings suggest that it is necessary to prepare the appropriate protocol for prevention and
treatment of PD peritonitis under national PD-First policy scheme.
Keywords : Peritonitis, CAPD, Gram negative organisms, PD-First policy.
