EC Microbiology

Introduction: Peritoneal dialysis (PD) is an alternative strategy of the management of end-stage renal failure However, it is associated with a high risk of infection of the peritoneum, subcutaneous tunnel and catheter exit site. If peritonitis occurs, it may require removal of the catheter and temporary or permanent transfer to hemodialysis. The aim of this work is to study the bacteriology and antibiotic resistance of peritoneal dialysis catheters infections diagnosed in the microbiology laboratory of the Hassan II University Hospital in FEZ.

Patients and Methods: We conducted a retrospective study over a period of four years, from August 2019 to August 2022, carried out at the microbiology laboratory of the Hassan II University Hospital in Fez. All PD patients followed in the nephrology department were included. For the patients who presented a peritonitis, a tunnel or catheter exit site infection, we analyzed: age, sex, types of kidney disease, white blood cell count, leukocyte count, gram stain, pathogen and its sensitivity to antibiotics.

Results: The analysis of samples from dialysis patients showed predominance of gram-positive cocci (58.24%) compared to gram-negative bacilli (37.36%) and yeasts (4.4%). We identified (52.74%) isolates as S. aureus, followed by Enterobacteriaceae (30.76%), non-fermenting gram-negative bacilli 6.6%, streptococci 5.5% and yeasts (4.4%). The most common species among gram-positive cocci are staphylococci with a predominance of S. aureus (91.66%) followed by coagulase-negative staphylococci (8.34%). Enterococcus faecalis represent 5.5% of germs. Among Enterobacteriaceae, E. coli is the predominant species (60.71%) followed by Klebsiella spp 35.71% then Citrobacter spp 3.58%. Among the non-fermenting Gram-negative bacilli, Pseudomonas aeruginosa is the most prevalent (83.33%). Candida albicans represents 4.4% of all germs. Gram-positive bacteria were susceptible to the glycopeptide family.

Conclusion: Most cases of peritoneal dialysis catheter-related infections in our study are caused by community - acquired bacteria. However, 4.39% of the isolated bacteria were multidrug resistant, which can limit available treatment options for these patients.

Keywords: Infectious Peritonitis; Peritoneal Dialysis; Catheters; Bacteria

1. Persy B and Ieven M. “Four-year analysis of microbial aetiology and antimicrobial sensitivity patterns of peritoneal-dialysis-related peritonitis in a tertiary care facility”. Acta Clinica Belgica1 (2013): 48-53.
2. Imane Jamai Amir., et al. “Bacteriological profile of infectious peritonitis in patients undergoing peritoneal dialysis: experience from Hassan II University Hospital in FÃs”. PAMJ-Clinical Medicine 3 (2020): 144.
3. Manel Jellouli., et al. “Bacteriological characteristics of peritoneal dialysis fluid infections”. The Pan African Medical Journal 22 (2015): 162.
4. Lioussfi Z., et al. “Infectious peritonitis in continuous ambulatory peritoneal dialysis at the University Hospital of Rabat: bacteriological profile over three years”. The Pan African Medical Journal (2022).
5. Laurain C., et al. “Infectious peritonitis in patients treated with peritoneal dialysis: a four-year microbiological review”. Pathos Boil10 (2004): 575-578.
6. Peacock SJ., et al. “Outcome following staphylococcal peritonitis”. Peritoneal Dialysis International: SAGE Journals2 (2000): 215-219.
7. R Leclercq. “Antibiotic resistance of staphylococci. Éditions scientifiques et médicales Elsevier SAS”. Annales Françaises d'Anesthésie et de Réanimation 21 (2002): 375-383.
8. H Ammari and M Ghaffor. “Bacteriology of peritonitis in patients on continuous ambulatory dialysis (CAPD). Elsevier SAS”. Revue Française des Laboratoires (2005): 369.
9. Nguyen DB., et al. Invasive methicillin-resistant Staphylococcus aureus infections among patients on chronic dialysis in the United States, 2005-2011 57.10 (2013): 1393-1400.
10. A Edern., et al. “Bacterial ecology and mechanisms of antibiotic resistance in peritoneal dialysis fluid infections. Elsevier Masson SAS”. Nephrology and Therapeutics 8 (2012): 456-461.
11. JL Mainardi. “Resistance of staphylococci to glycopeptides”. Médecine et Maladies Infectieuses (1997): 940-942.
12. Prasad N., et al. “Outcome of Gram-positive and Gram-negative peritonitis in patients on continuous ambulatory peritoneal dialysis: a single center experience”. Peritoneal Dialysis International: SAGE Journals 23 (2003): S144-S147.