Campylobacter peritonitis complicating peritoneal dialysis: a review of 12 consecutive cases

Abstract

Background: Peritoneal dialysis-associated peritonitis secondary to Campylobacter organisms is uncommon. Few studies have assessed either treatment or clinical outcomes.

Methods: We reviewed all Campylobacter peritonitis episodes occurring in a single dialysis unit from 1994 to 2011.

Results: During the study period, 12 episodes of Campylobacter peritonitis (0.45% of all peritonitis episodes) were recorded. Diarrhea was uncommon (8.3%). The overall primary response rate was 91.7%; the complete cure rate was 75.0%. Among 6 patients who failed to respond to standard antibiotics by day 5, all improved after administration of an oral macrolide (erythromycin or clarithromycin). Of those 6 patients, 5 experienced a complete cure, and 1 patient experienced relapse of culture-negative peritonitis. No patient required Tenckhoff catheter removal or temporary hemodialysis support. The 30-day mortality was 0%.

Conclusions: Campylobacter peritonitis might not respond to first-line conventional antibiotics, and an oral macrolide is recommended if Campylobacter is confirmed. The findings from our analysis do not support the use of fluoroquinolone, which is associated with a high resistance rate.

Figure 1

— Flow diagram of clinical outcomes after Campylobacter peritonitis. “Relapse” is defined as an episode that occurs within 4 weeks of completion of therapy for a previous Campylobacter peritonitis with the same organism (or culture-negative). Two relapse episodes were culture-negative, and one relapse episode was confirmed to be Campylobacter peritonitis.