Empiric Therapy with Cefazolin and Ceftazidime (or Aminoglycoside) is Effective as the Initial Choice for the Treatment of Peritoneal Dialysis Related Peritonitis / 대한신장학회잡지

ABSTRACT

BACKGROUND: This study aims to verify the effectiveness of initial empirical antibiotic choice recommended by the International Society for Peritoneal Dialysis (ISPD) guideline for PD related peritonitis among the Korean PD population. METHODS: 227 episodes of PD-related peritonitis from January 2000 to June 2003 in two tertiary care hospitals were reviewed retrospectively for the antibiotic resistance pattern and their clinical outcome after treatment based on the ISPD guideline. RESULTS: There was 349 prevalent patients during this period. The incidence of peritonitis was 1 episode/41.3 patient-month. For 173 episodes, the etiologic organism was identified. Among the isolates, 99 (43.6%) were gram positive organisms and 57 (25.1%) were gram negative organisms. Among gram positive bacterial peritonitis, multiple logistic regression analysis showed that antibiotic resistance was not a risk factor for treatment failure (OR=0.84, p=0.79). Among the 45 cases with Staphylococcus- associated peritonitis, and empirical cefazolin and ceftazidime (or aminoglycoside) administration, 27 were methicillin-sensitive (MS) and 18 were methicillin-resistant (MR). There was no significant difference in the rate of relapse, catheter removal and death and successful treatment. Patients in the MR group were more likely to change antibiotics during the therapy than MS group (55.6% vs 7.4%, p=0.01) CONCLUSION: Despite a high rate of antibiotic resistance, initial empirical therapy with cefazolin and ceftazidime (or aminoglycoside) based on ISPD guideline is effective as the initial antibiotics choice for gram positive bacterial peritonitis.