Changes of Incidence and Microbiological Spectrum of Hospitalized Patients with Peritoneal Dialysis-Associated Peritonitis over Time: Results from the TRI-PoD Consortium

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Background: PD-associated peritonitis is the most common infectious complication of PD. The incidence and microbiological spectrum in hospitalized patients with PD-associated peritonitis in Germany is not known, which holds especially true for the time of the SARS-CoV-2 pandemic. The TRI-PoD project, a consortium of three major German nephrology centers (Braunschweig Municipal Hospital, Kiel University Hospital and Robert Bosch Hospital Stuttgart) investigated this topic as part of our mission to overcome barriers to PD initiation and improving PD care. Methods: The incidence, baseline data and microbiological spectrum of hospitalized patients with PD-associated peritonitis in the period 2017-2023 from the three nephrological centres in Braunschweig, Kiel and Stuttgart were prospectively recorded and retrospectively evaluated. Results: A total of n=368 patients were included in the analysis. Median (IQR) age was 62 years (50-75). 42.4% of the patients were of female sex. Median body mass index (BMI) was 28.0 kg/m2 (24.4-32.0). Median initial cell count from the peritoneal dialysate was 6,306/µL (1,980-14,123). Median hospital stay was 9 days (5-18). In 19.8% of the cases catheter removal was necessary. Microbiological results showed sterile peritonitis in 22.0% of the cases. In total, 48.1% were gram positive and 24.2% gram-negative pathogens. A mixed spectrum with gram-positive and negative pathogens was found in 7.1% of cases. Conclusion: Incidence of PD-associated peritonitis requiring hospitalization has declined over the 5 years, possibly due to increased outpatient management. Beyond that, our data showed a trend towards a lower rate of hospitalized patients with PD associated peritonitis and an increased percentage of gram-positive results in PD dialysate during the SARS-CoV-2 pandemic. A high rate of sterile cultures was found, presumably due to outpatient pretreatment. In addition, a high rate of gram-negative bacteria found. The latter one was related to a high catheter explantation rate. This relative increase in risk might be attributed to the fact that only more severe cases of PD associated peritonitis had been hospitalized.

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