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Clinical and microbiological characteristics of peritoneal dialysis-related peritonitis caused by Escherichia coli in southern Taiwan

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Abstract

Peritonitis is a serious complication and major cause of treatment failure in patients undergoing peritoneal dialysis (PD). Escherichia coli is the major pathogen in extraintestinal Gram-negative infections, including PD-related peritonitis. The outcomes of E. coli peritonitis in PD varied from relatively favorable outcomes to a higher incidence of treatment failure. The aim of this study was to investigate the impact of bacterial virulence and host characteristics on the outcomes of PD-related peritonitis caused by E. coli. From January 2000 to June 2016, a total of 47 episodes of monomicrobial and 10 episodes of polymicrobial E. coli PD-related peritonitis, as well as 89 episodes of monomicrobial Gram-positive (56 Staphylococcus spp. and 33 Streptococcus spp.) PD-related peritonitis cases, were retrospectively enrolled. Clinical features, E. coli bacterial virulence, and outcomes were analyzed. Compared to Streptococcus spp. peritonitis, E. coli peritonitis had a higher peritoneal catheter removal rate (38 versus 12%; P = 0.0115). Compared to the monomicrobial group, patients in polymicrobial group were older and had higher peritoneal catheter removal rate (80 versus 38%; P = 0.0324). Treatment failure of E. coli peritonitis was associated with more polymicrobial peritonitis and immunocompromised comorbidity, longer duration of PD therapy, and more antimicrobial resistance. E. coli isolates with more iron-related genes had higher prevalence of phylogenetic group B2 and papG II, iha, ompT, and usp genes. This study demonstrates the important roles of clinical and bacterial characteristics in the outcomes of monomicrobial and polymicrobial E. coli PD-related peritonitis.

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Acknowledgements

We would like to thank all the technical staff at the Division of Nephrology at the National Cheng Kung University Hospital.

Funding

This work was supported partially by grants from NCKUH-10702019 and Ministry of Science and Technology, Taiwan (MOST) (102-2314-B-006-015).

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Author notes

  1. Wei-Hung Lin and Chin-Chung Tseng contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Wei-Hung Lin

  2. Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Wei-Hung Lin

  3. Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan, 70428, Taiwan

    Chin-Chung Tseng, An-Bang Wu, Yu-Tzu Chang, Te-Hui Kuo, Jo-Yen Chao & Ming-Cheng Wang

  4. Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Ming-Cheng Wang

  5. Department of Biotechnology and Laboratory Science in Medicine, School of Biomedical Science and Engineering, National Yang Ming University, No. 155, Section 2, Li-Nong Street, Taipei, 11221, Taiwan

    Jiunn-Jong Wu

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  1. Wei-Hung Lin
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Correspondence to Ming-Cheng Wang or Jiunn-Jong Wu.

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Lin, WH., Tseng, CC., Wu, AB. et al. Clinical and microbiological characteristics of peritoneal dialysis-related peritonitis caused by Escherichia coli in southern Taiwan. Eur J Clin Microbiol Infect Dis 37, 1699–1707 (2018). https://doi.org/10.1007/s10096-018-3302-y

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