Repeat peritonitis in peritoneal dialysis: retrospective review of 181 consecutive cases.

BACKGROUND AND OBJECTIVES

The clinical behavior of repeat-peritonitis episodes, defined as peritonitis with the same organism occurring more than 4 weeks after completion of therapy for a prior episode, is poorly understood.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We compared outcomes of 181 episodes of repeat peritonitis from 1995 to 2009 (Repeat Group) with 91 episodes of relapsing peritonitis (Relapsing Group) and 125 episodes of peritonitis preceded 4 weeks or longer by another episode with a different organism (Control Group).

RESULTS

In Repeat Group, 24% were due to Staphylococcus aureus, as compared with 5.5% in Relapsing Group and 15% in Control Group. The majority of the organisms causing relapsing peritonitis were Gram negative (62%), whereas the majority of that in Repeat Group were Gram positive (56%). Repeat Group had a lower complete-cure rate (70.7% versus 54.9%) than Relapsing Group, but rates of primary response, catheter removal, and mortality were similar. Repeat Group had a higher primary response rate (89.0% versus 73.6%) and a lower rate of catheter removal (6.1% versus 15.2%) than Control Group, whereas the complete-cure rate and mortality were similar. Repeat Group had a higher risk of developing relapsing (14.3% versus 2.2%) and repeat peritonitis (26.1% versus 5.4%) than Control Group, whereas the risk of recurrent peritonitis was similar.

CONCLUSIONS

Repeat peritonitis is a distinct clinical entity. Although repeat-peritonitis episodes generally have a satisfactory response to antibiotic, they have a substantial risk of developing further relapsing or repeat peritonitis.