Coagulase Negative Staphylococcal Peritonitis in Peritoneal Dialysis Patients: Review of 232 Consecutive Cases

Coagulase-negative Staphylococcus species is the most common cause of peritoneal dialysis-related peritonitis; however, the optimal treatment strategy of coagulase-negative Staphylococcus species peritonitis remains controversial. All of the coagulase-negative Staphylococcus species peritonitis in a...

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Bibliographic Details
Published in:Clinical journal of the American Society of Nephrology 2008-01, Vol.3 (1), p.91-97
Main Authors: Szeto, Cheuk-Chun, Kwan, Bonnie Ching-Ha, Chow, Kai-Ming, Lau, Miu-Fong, Law, Man-Ching, Chung, Kwok-Yi, Leung, Chi-Bon, Li, Philip Kam-Tao
Format: Article
Language:English
Subjects:
Adult
Aged
Anti-Bacterial Agents - therapeutic use
Cefazolin - therapeutic use
Dialysis
Female
Humans
Kidney Failure, Chronic - complications
Kidney Failure, Chronic - epidemiology
Kidney Failure, Chronic - therapy
Male
Methicillin Resistance
Middle Aged
Peritoneal Dialysis
Peritonitis - complications
Peritonitis - drug therapy
Peritonitis - epidemiology
Risk Factors
Secondary Prevention
Staphylococcal Infections - complications
Staphylococcal Infections - drug therapy
Staphylococcal Infections - epidemiology
Treatment Outcome
Vancomycin - therapeutic use
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Summary:Coagulase-negative Staphylococcus species is the most common cause of peritoneal dialysis-related peritonitis; however, the optimal treatment strategy of coagulase-negative Staphylococcus species peritonitis remains controversial. All of the coagulase-negative Staphylococcus species peritonitis in a dialysis unit from 1995 to 2006 were reviewed. During this period, there were 2037 episodes of peritonitis recorded; 232 episodes (11.4%) in 155 patients were caused by coagulase-negative Staphylococcus species. The overall primary response rate was 95.3%; the complete cure rate was 71.1%. Patients with a history of recent hospitalization or recent antibiotic therapy had a higher risk for developing methicillin-resistant strains. Episodes that were treated initially with cefazolin or vancomycin had similar primary response rate and complete cure rate. There were 33 (14.2%) episodes of relapse and 29 (12.5%) episodes of repeat peritonitis; 12 (60.6%) of the repeat episodes developed within 3 mo after completion of antibiotics. Relapse or repeat episodes had a significantly lower complete cure rate than the other episodes. For relapse or repeat episodes, treatment with effective antibiotics for 3 wk was associated with a significantly higher complete cure rate than the conventional 2-wk treatment. Coagulase-negative Staphylococcus species peritonitis remains a common complication of peritoneal dialysis. Methicillin resistance is common, but the treatment outcome remains favorable when cefazolin is used as the first-line antibiotic. A 3-wk course of antibiotic can probably achieve a higher cure rate in relapse or repeat episodes.
ISSN:1555-9041
1555-905X
DOI:10.2215/CJN.03070707