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Microbiology, Clinical Spectrum and Outcome of Peritonitis in Patients Undergoing Peritoneal Dialysis in India: Results from a Multicentric, Observational Study
Georgi Abraham, Amit Gupta, Kashi Natha Prasad, Anusha Rohit, Vishwanath Billa, Rajasekhar Chakravarti, Tonmoy Das, Thadakanathan Dhinakaran, Arup Ratan Dutta, Padmanabhan Giri, Gokul nath, Tarun Jeloka, Vivekanand Jha, Sampath Kumar, Arghya Majumdar, Ajay Marwaha, Sunil Prakash S, Radha Vijay Raghavan and Rajaram KG
Background: Peritoneal dialysis related peritonitis is a major risk factor for drop out of patients on Continuous ambulatory peritoneal dialysis (CAPD) and Automated peritoneal dialysis (APD). Factors affecting PD related peritonitis and center specific microbiological data are lacking in India. A multicentric prospective observational study was designed to overcome the gaps in the existing data regarding causative organism and outcome.
Methods: The present study was a prospective, uncontrolled, open-label; observational study conducted in 21 centers representing all the four geographical regions (North, South, East and West) of India between April 2010 and December 2011.
Results: A total of 244 patients on chronic PD with peritonitis were enrolled in the study from 21 centres covering the different geographical areas of India. A total of 244 episodes (patients 244) were identified to meet the criteria for the definition of peritonitis. Climatically, 44 (18.1%) episodes occurred during winter and 35 (14.3%) in summer. Amongst the 85 samples that were culture positive, 38 (44.7%) were in the monsoon season followed by 23 (27.1%) in the postmonsoon, 18 (21.2%) during winter and 11 (12.9%) during summer. Maximum culture positivity (72.7%) was observed with an automated technique. Micro-organisms could be isolated in only 85 cases (35.3%) while the remaining samples were culture negative (156/241, 64.7% of samples). Organisms isolated were Gram negative in 47.8%, Gram positive in 36.7%, fungal in 13.3% and Mycobacterium tuberculosis in 2.2%.
Conclusion: This large multicenter study of peritonitis offers insights into the etiology and outcomes of infectious complications of PD in India that are germane to clinical decision making.