Spectrum of organisms causing peritonitis in peritoneal dialysis patients--experience from Bangladesh.

In the present study, organisms responsible for peritonitis and their sensitivity to antibiotics were evaluated in peritoneal dialysis (PD) patients in Bangladesh. We collected PD effluent from 100 peritonitis cases and sent samples to the laboratory for Gram stain and cytology. Cultures used direct inoculation of PD fluid in plate media and broth media simultaneously. Organisms were isolated by Gram stain in 60% of cases. Cell counts showed a mean of 700 (range: 90-7000) white blood cells per milliliter Plate media yielded 33% growth, and broth media, 67% growth. In continuous ambulatory PD, 77% samples were culture-positive; the organisms isolated were gram-positive bacteria in 41% of cases, gram-negative bacteria in 52%, and fungus in 7%. In intermittent PD, only 43% samples were culture-positive; the isolated organisms were gram-positive bacteria in 18% cases and gram negative bacteria in 82%. Gram-positive organisms (Staphylococcus and Streptococcus species) were sensitive to vancomycin and rifampicin; moderately sensitive to ciprofloxacin, ceftriaxone, and ceftazidime; and resistant to ampicillin, cloxacillin, and cephalexin. Gram-negative organisms (Escherichia coli, Klebsiella species) were sensitive to imipenem and aztreonam, and moderately sensitive to ciprofloxacin, ceftriaxone, ceftazidime, and gentamicin. Pseudomonas species were sensitive to aztreonam and ceftazidime, and moderately sensitive to ciprofloxacin, ceftriaxone, and gentamicin. Gram-negative organisms were predominantly responsible for peritonitis in PD patients, and before culture results are received, combined empiric therapy with vancomycin and imipenem or aztreonam may be started.

Outcome of peritoneal dialysis and hemodialysis in elderly patients with diabetes: early experience from Bangladesh.

In the present study, we analyzed the short-term outcome of continuous ambulatory peritoneal dialysis (PD) and hemodialysis (HD) in a group of elderly Bangladeshi patients with diabetes. Over a period of 2 years, we tracked various parameters in 60 patients on maintenance dialysis (25 on PD, 35 on HD). Mean age of the patients was 62 +/- 12 years (PD) and 57 +/- 8 years (HD), p < 0.03. Pre-dialysis systolic blood pressures (SBP) were 156 +/- 12 mmHg and 160 +/- 15 mmHg, and diastolic blood pressures (DBP) were 86 +/- 7 mmHg and 84 +/- 6 mmHg, both p = nonsignificant (NS). Pre-dialysis serum creatinine (SCr) levels were 1036 +/- 139 micromol/L and 1028 +/- 408 micromol/L, and daily urine volumes (UV) were 1.1 -/+ 0.4 L and 1 +/- 0.1 L, both also p=NS. At the end of the 2 years, durations of dialysis were 14 +/- 8 months (PD) and 13 +/- 12 months (HD), p=NS; SBPs were 142 +/- 15 mmHg and 155 +/- 18 mmHg, p < 0.004; DBPs were 81 +/- 6 mmHg and 80 +/- 7 mmHg, p=NS; and SCr levels were 538 +/- 154 micromol/L and 578 +/- 195 micormol/L, p=NS. The daily UVs had declined to 0.7 +/- 0.3 L and 0.3 +/- 0.3 L (p < 0.001) after periods of 12 +/- 7 months and 7 +/- 5 months (p < 0.001) respectively. During the study period, mortality in the PD group was 60% and in the HD group was 43% (p=NS). We conclude that elderly diabetic patients on PD have better control of blood pressure and maintain residual renal function longer than do similar patients on HD; at the same time, mortality in the two groups is comparable.

Outcome of continuous ambulatory peritoneal dialysis in a group of elderly patients from Bangladesh.

In the present study, we evaluated the clinical course and outcome of chronic peritoneal dialysis (PD) in a group of elderly patients. We enrolled 60 elderly patients (37 men, 23 women) starting PD over a 4-year study period and assessed outcomes. The mean age of our patients was 61 +/- 7 years; mean PD duration was 16 months (range: 3 - 40 months). Primary diseases were mainly diabetic nephropathy (54%) and glomerulonephritis (20%). In most patients, the PD modality was chosen because of cardiac instability. Complications during PD included peritonitis (1 episode per 9 patient-months) and exit-site infection (1 episode per 26 patient-months). Technique survival was 89% at 1 year. Patient survival was 83% and 32% at 1 and 4 years respectively. The most frequent causes of death were cerebrovascular accident, cardiac complications, and sepsis. We also compared predialysis parameters to final parameters for 20 deceased patients. Mean age in this group was 62 +/- 8 years, and mean PD duration was 13 +/- 8 months. Body mass index (BMI) was 23 +/- 3 kg/m2 predialysis versus 22 +/- 3 kg/m2 at the end of dialysis (p < 0.01); residual renal creatinine clearance was 4.4 +/- 2 mL/min versus 2.3 +/- 2 mL/min (p < 0.003), and weekly total Kt/V was 2.1 +/- 0.3 versus 1.8 +/- 0.3 (p < 0.002). Albumin showed positive correlations with BMI (r = 0.40, p < 0.02) and with creatinine (r = 0.40, p < 0.01). We conclude that survival of elderly patients on continuous ambulatory peritoneal dialysis is reasonable in the first year, and that further improvement may be achieved by initiating dialysis early, by increasing the dialysis dose, and by improving the patients' nutrition status.