Polymicrobial peritonitis in peritoneal dialysis patients in Australia: predictors, treatment, and outcomes

Am J Kidney Dis. 2010 Jan;55(1):121-31. doi: 10.1053/j.ajkd.2009.08.020. Epub 2009 Nov 22.


Background: The study aim was to examine the frequency, predictors, treatment, and clinical outcomes of peritoneal dialysis-associated polymicrobial peritonitis.

Study design: Observational cohort study using ANZDATA (The Australia and New Zealand Dialysis and Transplant Registry) data.

Setting & participants: All Australian peritoneal dialysis patients between October 2003 and December 2006.

Predictors: Age, sex, race, body mass index, baseline renal function, late referral, kidney disease, smoking status, comorbidity, peritoneal permeability, center, state, organisms, and antibiotic regimen.

Outcomes & measurements: Polymicrobial peritonitis occurrence, relapse, hospitalization, catheter removal, hemodialysis transfer, and death.

Results: 359 episodes of polymicrobial peritonitis occurred in 324 individuals, representing 10% of all peritonitis episodes during 6,002 patient-years. The organisms isolated included mixed Gram-positive and Gram-negative organisms (41%), pure Gram-negative organisms (22%), pure Gram-positive organisms (25%), and mixed bacteria and fungi (13%). There were no significant independent predictors of polymicrobial peritonitis except for the presence of chronic lung disease. Compared with single-organism infections, polymicrobial peritonitis was associated with higher rates of hospitalization (83% vs 68%; P < 0.001), catheter removal (43% vs 19%; P < 0.001), permanent hemodialysis transfer (38% vs 15%; P < 0.001), and death (4% vs 2%; P = 0.03). Isolation of fungus or Gram-negative bacteria was the primary predictor of adverse clinical outcomes. Pure Gram-positive peritonitis had the best clinical outcomes. Patients who had their catheters removed >1 week after polymicrobial peritonitis onset were significantly more likely to be permanently transferred to hemodialysis therapy than those who had earlier catheter removal (92% vs 81%; P = 0.05).

Limitations: Limited covariate adjustment. Residual confounding and coding bias could not be excluded.

Conclusions: Polymicrobial peritonitis can be treated successfully using antibiotics alone without catheter removal in most cases, particularly when only Gram-positive organisms are isolated. Isolation of Gram-negative bacteria (with or without Gram-positive bacteria) or fungi carries a worse prognosis and generally should be treated with early catheter removal and appropriate antimicrobial therapy.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Australia / epidemiology
  • Bacteria / isolation & purification*
  • Bacterial Infections / drug therapy
  • Bacterial Infections / epidemiology
  • Bacterial Infections / etiology*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Peritoneal Dialysis / adverse effects*
  • Peritonitis / drug therapy
  • Peritonitis / epidemiology
  • Peritonitis / etiology*
  • Prognosis
  • Retrospective Studies
  • Risk Factors


  • Anti-Bacterial Agents