Peritonitis is one of the major complications of peritoneal dialysis (PD) and, despite reductions in overall peritonitis rates, remains the primary reason why patients switch from PD to hemodialysis (HD) [1,2]. This topic reviews the microbiology and therapy of peritonitis in continuous peritoneal dialysis. The approach to the diagnosis of peritonitis, including exclusion of predisposing intra-abdominal diseases (such as pancreatitis), is discussed separately. (See "Clinical manifestations and diagnosis of peritonitis in peritoneal dialysis".)
The reported incidence of peritonitis ranges widely [3-7]. A retrospective study of 1677 incident PD patients revealed a first-year peritonitis rate of 42 per 100 patient-years . Of 463 peritonitis cases, 336 (72.6 percent) occurred within the first six months of PD.
Over the past 20 years, multiple innovations in PD connectology and the use of prophylactic antibiotics have reduced overall peritonitis rates. Reported peritonitis rates vary widely, with reported incidence noted in one review varying from 0.06 episodes per patient-year at risk in a Taiwanese program to as high as 1.66 episodes per patient-year at risk in a pediatric program in Israel .
The overwhelming majority of peritonitis cases are caused by pathogenic bacteria, with a small number of cases being caused by fungi, mostly Candida species. The role of viral infection is uncertain. Although anecdotal cases of viral peritonitis have been reported , viruses are more likely to predispose patients to bacterial peritonitis [10,11].
The epidemiology and microbiology of peritonitis among PD patients has varied by location and over time [3,12-16]. As an example, a large review of 3366 patients who started continuous ambulatory peritoneal dialysis (CAPD) in the first six months of 1989 provided important epidemiologic information on the first episode of peritonitis :