SP525
MICROBIOLOGICAL PROFILE OF PERITONITIS IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS

INTRODUCTION AND AIMS: One of the major complication of Peritoneal Dialysis(PD) is peritonitis. Peritonitis is defined by elevated peritoneal fluid leukocyte count. Most common organisms are gram positive cocci, gram negative rods, fungi and mycobacteria.AIMS 1.To identify the pathogens in CAPD peritonitis 2.To determine the antibiotic susceptibility pattern of the isolated pathogens

METHODS: 125 patients with CAPD peritonitis as defined by ISPD, undergoing CAPD at department of nephrology were included. Detailed analysis of effluent dialysate including gram staining, KOH mount, AFB staining, culture and antibiotic sensitivity were conducted. The response to treatment and the need for PD catheter removal were assessed.

RESULTS: The most common clinical presentation was abdominal pain. A history of change in hand was present in 30%. 90% of patients had cloudy effluent. Of the 125 patients, 81% were culture positive. Monomicrobial infections accounted for 92% of culture positive cases. Of the culture positive, 44% isolates were gram negative bacilli,29% gram positive cocci,7% were fungi and a single non tuberculous mycobacterium was also isolated. Among the gram positive, CONS predominated and was isolated in 24 patients. Of the gram negative infections, Acinetobacter.baumannii (26 patients) predominated followed by E.coli (13). The non tuberculous mycobacteria was identified as mycobacterium abscesses by tetraplex PCR. Except for few Acinetobacter all other organism were sensitive to 3^rd generation cephalosporins and carbapenems. Among the 115 bacterial peritonitis cases 67% responded to antibiotics. 23% had recurrent episodes of peritonitis and 10% patients succumbed to illness.4.8% patients required removal of PD catheter.

CONCLUSIONS: Gram negative bacilli were mainly responsible for CAPD peritonitis. The decreased incidence of gram positive infections may be attributed to the aseptic precautions taken by all patients and better skin care. Acinetobacter baumanni was identified as the most common organism. All gram negative pathogens were sensitive to 3^rd generation cephalosporins except for few ESBL producing A.baumanni.