持续性非卧床腹膜透析腹膜炎的致病菌及其耐药性

目的：探讨持续性非卧床腹膜透析（CAPD）腹膜炎的致病菌及其耐药性。方法：回顾性分析109例CAPD腹膜炎的临床表现、致病菌、耐药性和转归情况。结果：43例培养阳性,透出液培养阳性率为39．4％,其中11例为革兰阳性球菌,19例为革兰阴性杆菌,13例为真菌。主要的革兰阴性杆菌包括肺炎克雷白氏杆菌、大肠杆菌、不动杆菌和铜绿假单胞菌。革兰阴性杆菌对氨苄西林的耐药率最高,达85．7％;对阿米卡星的耐药率最低,为17．6％;庆大霉素的耐药率为44．4％;而头孢他啶的耐药率也高达42．9％。所有革兰阳性球菌对万古霉素敏感,大部分（71．4％）对头孢唑林敏感。腹腔内用抗真菌药对真菌性腹膜炎疗效不佳。腹膜炎CAPD的退出率为20．2％（22／109）。结论：革兰阴性杆菌腹膜炎比例有所增加,致病菌对庆大霉素和头孢他啶的耐药性较高,而对阿米卡星较敏感,宜作为经验用药。     

单中心腹膜透析相关性腹膜炎致病菌及原因分析

目的:分析腹膜透析相关性腹膜炎感染原因及致病菌菌谱、耐药性变化,为合理用药提供依据。方法:回顾深圳市第二人民医院近5年来腹膜透析相关性腹膜炎患者一般情况、细菌培养及药敏试验、疗效及转归。结果:96例次腹膜透析相关性腹膜炎中,常见的感染原因是不规范操作(28. 1%)及不洁饮食(41. 6%)。培养菌株65例次,其中G+菌31例次(47. 7%),G-菌25例次(38. 5%),真菌8例次(12. 3%),分支杆菌1例次(1. 5%)。本中心最主要的致病菌是G+球菌,以葡萄球菌及链球菌多见,而G-菌感染中以大肠杆菌最为常见。G+菌对万古霉素、利奈唑胺、替加环素无耐药,对青霉素G的耐药率为72. 7%。G-菌对亚胺培南、哌拉西林他唑巴坦、厄他培南无耐药,对阿米卡星(5%)、头孢他啶(5. 2%)及头孢替坦(5. 5%)低耐药,对氨苄西林耐药率为83. 33%。真菌对伊曲康唑、酮康唑、5-氟胞嘧啶无耐药。G+菌、G-菌、培养阴性腹膜炎患者治愈率分别为88%、86. 4%、92. 1%。结论:革兰阳性菌仍是腹膜透析相关性腹膜炎的主要致病菌;腹透液培养阴性的腹膜炎患者治愈率高、预后较好。革兰阳性球菌对青霉素耐药性较高,经验治疗宜首先万古霉素;革兰阴性菌腹膜炎经验治疗可选用氨基糖甙类、头孢他啶或哌拉西林/他唑巴坦。     

腹膜透析相关性腹膜炎169例次临床分析及转归

目的探讨腹膜透析相关性腹膜炎的致病菌和耐药性,及其与转归之间的关系。方法回顾性分析169例次腹膜透析相关性腹膜炎的临床资料、致病菌与耐药性,探讨其与转归的联系。结果116例次培养阳性,培养总阳性率达68．6％,近5年高达87．7％。致病菌中G^＋球菌占58例次（50％）,G^-杆菌45例次（38．8％）,真菌6例次（5．2％）,G^＋杆菌、G^-球菌及混合感染7例（6％）。G^＋球菌中最常见为葡萄球菌（56．8％）;G^-杆菌中大肠杆菌阳性率最高（62．2％）。从耐药性看,G^-杆菌对氨苄西林的耐药率最高（76．7%）,对阿米卡星和哌拉西林／他唑巴坦的耐药率较低（2．9%、3．4％）。G^＋球菌对万古霉素均敏感,对利福平和哌拉西林／他唑巴坦的耐药率较低（2．1％、7．9％）。腹膜炎致持续非卧床腹膜透析（CAPD）退出率为10．1％（17／169）,以真菌腹膜炎为主。结论近5年本中心培养阳性率较高,及时采用血培养瓶留取标本很关键。G^-杆菌对阿米卡星和哌拉西林／他唑巴坦较敏感,而万古霉素、利福平和哌拉西林／他唑巴坦宜作为抗G^＋球菌的经验用药。真菌性腹膜炎是导致腹膜透析退出的主要原因。     

222例次腹膜透析相关性腹膜炎的转归与预后分析

目的:分析腹膜透析相关性腹膜炎(CAPD)患者的病原菌特点及转归预后情况,为临床腹膜透析相关性腹膜炎的防治提供依据。方法:回顾性分析2009年1月~2013年12月在上海长海医院肾内科腹膜透析中心接受腹透治疗,且并发腹膜透析相关性腹膜炎患者的病原菌特点及转归情况。结果:共收治腹透相关性腹膜炎患者131例,发生腹膜透析相关性腹膜炎222例次,培养致病菌结果阳性143例次(64.4%),阴性79例次(35.6%)。185例次治愈;退出37例次,总治愈率为83.8%,病死率为4.1%,因感染导致腹膜透析退出率为16.3%,真菌感染的退出率为81.8%,显著高于G+球菌及G-杆菌感染(P0.001);多重感染退出率33%,4例均合并真菌感染。G-杆菌退出率明显高于培养阴性及G+球菌退出率(P0.001)。结论:腹透相关性腹膜炎是导致腹透患者退出的主要原因,其中多重感染比例增高,预后较差,且多与反复操作不当有关,故对腹透患者定期加强操作指导及监督尤为重要。     

单中心327例次腹膜透析相关性腹膜炎致病菌及药敏结果分析

目的 探讨持续性非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)相关性腹膜炎的致病菌及其耐药性.方法 回顾性分析2008年1月至2013年5月在我中心就诊的180例327例次CAPD相关性腹膜炎的致病菌及其耐药性.结果 202例次培养阳性,培养阳性率为61.77％.革兰阳性球菌154例次,其中金黄色葡萄球菌及凝固酶阴性葡萄球菌123例次,占病原微生物培养阳性的60.89％;革兰阴性杆菌38例次,其中大肠埃希菌11例次,占病原微生物培养阳性的5.45％;真菌10例次,其中假丝酵母菌7例次,占病原微生物培养阳性的3.47％.革兰阳性球菌对万古霉素耐药率最低,为3.25％,其次为莫西沙星,为5.19％,对利福平、庆大霉素、左氧氟沙星耐药率分别为12.99％、35.71％、45.45％,对青霉素的耐药率最高,达84.42％.革兰阴性菌对哌拉西林/他唑巴坦耐药率最低,为10.53％,其次为头孢他啶,为23.68％,对左氧氟沙星、头孢匹美、庆大霉素耐药率分别为26.32％、28.21％、36.84％,对氨苄西林/舒巴坦的耐药率最高,达50.00％.重复感染54例,共114例次,72例次培养阳性,阳性率为63.16％,其中革兰阳性球菌63例次,占87.50％,革兰阴性杆菌9例次,占12.50％,革兰阳性球菌以金黄色葡萄球菌为主,革兰阴性杆菌以大肠埃希菌为主.结论 本中心CAPD相关性腹膜炎致病菌以革兰阳性球菌为多,接触污染是导致腹膜炎的主要原因.革兰阳性球菌对青霉素耐药率最高,革兰阴性杆菌对氨苄西林/舒巴坦耐药率最高.     

124株腹膜透析相关性腹膜炎致病菌及耐药性分析

目的探讨腹膜透析相关性腹膜炎（PDAP）致病菌的耐药性。方法回顾性分析2008年7月-2012年7月我院腹膜透析中心PDAP患者的临床资料及药敏结果。结果（1）203例次PDAP培养阳性率为59．1％,共培养出致病菌124株。124株致病菌中革兰阳性球菌68株,占54．8％;革兰阴性杆菌28株,占22．6％;革兰阳性杆菌12株,占9．7％;奈瑟茵属5株,占4．0％;真菌11株,占8．9%。其中耐药菌株54株,包括多药耐药菌50株,泛耐药菌4株,本中心PDAP患者尚未培养出全耐药菌。（2）药敏结果：对革兰阳性球菌敏感性较高的前3种药物为：利奈唑胺100％,莫西沙星95．8％,万古霉素95．2％。对革兰阴性杆菌敏感性较高的前3种药物为：阿米卡星85．7％,亚胺培南82．1％,左氧氟沙星75．0％。（3）转归：PDAP患者总治愈率为77．3％。结论PDAP致病菌耐药性的产生导致临床上可供选择的药物减少,临床医牛府采取多种措施延缓致病菌耐药件。     

腹膜透析相关感染性腹膜炎致病菌及菌谱变化——单个腹膜透析中心15年回顾分析

目的 探讨腹膜透析相关感染性腹膜炎致病菌谱和耐药率变化，以及致病菌与预后之间的关系。方法 回顾性分析了2001至2005年本院腹膜透析相关感染性腹膜炎并与1990至2000年109例次资料进行比较。 结果 (1)致病菌谱分布:2001至2005年收治腹膜透析相关感染性腹膜炎145例共206例次，培养阳性108例次(52.4%)，培养阴性率从1990至2000年的60.6%下降至47.6%(P < 0.05)。革兰阳性(G+)球菌感染的发生率从25.6% 上升至39.8% (P > 0.05)；凝固酶阴性葡萄球菌的发生率从4.7%上升至26.9%(P < 0.01)；耐甲氧西林葡萄球菌发生率为22.2%。革兰阴性(G-)杆菌腹膜炎的发生率从44.2%下降至34.3%(P > 0.05)；铜绿假单孢菌与大肠埃希菌腹膜炎的发生率有一定程度的上升；肺炎克雷伯杆菌性腹膜炎的发生率显著下降(14.0% 比 3.7%，P < 0.05)。真菌性腹膜炎的发生率有所下降(30.2% 比 17.6%，P > 0.05)。(2)耐药率分析:对于G-杆菌，阿米卡星耐药率最低(10.3%)。(3)转归:与1990至2000年相比，总体治愈率从68.8% 上升至73.9%；导管拔除率从19.2%下降至14.3%；病死率从10.1% 下降至5.4%。真菌性腹膜炎退出率为100%，显著高于G+球菌、G-杆菌性腹膜炎(P < 0.01)。铜绿假单孢菌感染所致退出率为44.4%，显著高于非铜绿假单孢菌的细菌感染(P < 0.01)。结论 与1990至2000年相比，近5年腹膜透析相关感染性腹膜炎培养阴性率显著下降；凝固酶阴性葡萄球菌是最常见的致病菌；真菌性腹膜炎发生率有所下降；感染性腹膜炎治愈率有所改善。真菌性腹膜炎是导致腹膜透析退出的主要原因，其次是铜绿假单孢菌感染所致腹膜炎。     

腹膜透析相关性腹膜炎患者病原菌耐药性及预后分析

目的了解腹膜透析(PD)患者腹膜炎的病原学特点、耐药情况及预后。方法回顾性分析2009年1月至2016年9月四川省人民医院PD中心发生的318例次PD相关性腹膜炎,对病原学种类、耐药性情况及腹膜炎结局进行分析。结果(1)腹膜炎细菌的分布情况:腹透液培养阳性185例次,培养阳性率58.1%。共培养得细菌194株,其中革兰阳性菌131株(67.5%),革兰阳性杆菌49株(25.2%),真菌14株(7.2%)。革兰阳性菌以表皮葡萄球菌和金黄色葡萄球菌为主,分别占25.9%和10.6%。革兰阴性菌以大肠杆菌为主(占40.8%)。(2)腹膜炎致病菌的耐药性分析:革兰阳性菌对青霉素的耐药率较高。革兰阴性菌对氨苄西林的耐药率较高,对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦耐药率较低。真菌呈现出较低耐药性。(3)腹膜炎结局分析:共治愈腹膜炎267例次(83.9%),退出51例次,退出率16.0%,其中拔管转血液透析31例次(9.7%),死亡13例(4.0%),失访7例。(4)腹膜炎复发、再发和重现致病菌分析:腹膜炎复发感染有3例次(0.94%),其中2例次为路邓葡萄球菌感染,1例次为表皮葡萄球菌感染。再发感染有1例次(0.31%)。重现感染有2例次(0.62%)。结论本PD中心导致PD相关性腹膜炎的主要致病菌为革兰阳性菌。革兰阳性和革兰阳性菌都对非加酶抗生素具有较高耐药性,合理选择抗菌药物是治愈PD相关性腹膜炎的关键。     

单中心腹膜透析相关性腹膜炎致病菌的分布及耐药情况分析

目的:分析单中心腹膜透析相关性腹膜炎致病菌的分布及耐药情况,为腹膜炎防治提供理论依据。方法:回顾性分析2012年05月01日~2016年12月31日温岭市第一人民医院腹膜透析中心接受治疗的84例(155例次)腹膜透析相关性腹膜炎患者的临床资料,统计腹膜炎相关致病菌的分布及耐药情况。结果:155例次腹膜炎中,致病菌培养阳性117例次,阳性率为75.48%,其中革兰氏阳性菌86例次,革兰氏阴性菌24例次,真菌感染7例;革兰氏阳性菌中最多为表皮葡萄球菌,占22.09%,革兰氏阴性菌中最多者为大肠埃希菌,占37.5%;真菌感染7例次,包括近平滑念珠菌4例,罗伦特隐球酵母2例及白色念珠菌1例。革兰阳性菌对红霉素耐药率最高,对头孢噻肟、呋喃妥英、利奈唑烷敏感,对万古霉素、替加环素耐药率较低,分别为1.23%、1.96%,革兰阴性菌对氨苄西林耐药率最高,对丁胺卡那霉素敏感,对亚胺培南、头孢吡肟、哌拉西林他唑巴坦耐药率均较低,分别为4%、4.17%、4.17%,4例患者死亡,12例转血透治疗,2例拔管后重新置管。操作不规范是引起腹膜炎的主要原因,占41.3%,主要为G+菌感染,28.4%原因不清楚,10.3%为腹泻引起腹膜炎。结论:腹膜透析相关性腹膜炎致病菌以革兰氏阳性菌为主,多为操作源性感染,推荐万古霉素作为革兰阳性菌的经验性用药,丁胺卡那霉素可作为革兰阴性菌的经验性用药。     

万古霉素联合美罗培南作为腹膜透析相关性腹膜炎经验用药的疗效分析

目的通过万古霉素联合美罗培南作为腹膜透析相关性腹膜炎(peritoneal dialysis-related peritonitis,PDRP)经验用药的疗效分析,为临床经验性用药提供一定的依据。方法回顾性分析2011年6月至2014年6月在安徽医科大学第一附属医院住院的106例PDRP病例,按治疗方案分为治疗组44例和对照组62例。治疗组给予万古霉素十美罗培南治疗,对照组给予万古霉素+其他(三代头孢或氨基糖苷类)治疗。抽取PDRP患者首袋浑浊的腹膜透析液,送检细胞计数分类,并进行培养及药敏试验。收集患者临床资料,包括出现症状至入院时间,腹膜透析液白细胞计数、血红蛋白、白蛋白、血白细胞、中性比、C反应蛋白等指标,腹膜透析液培养及药敏结果等情况。结果 106例患者中以革兰阳性球菌为主,革兰阳性菌中耐药率最低的是利奈唑胺,万古霉素,莫西沙星;革兰阴性菌中耐药率最低的是美罗培南、妥布霉素、哌拉西林他唑巴坦。万古霉素联合美罗培南治疗后腹膜透析液白细胞计数显著下降,与对照组相比有统计学意义(P0.05),且退出率、病死率、霉菌检出率低于对照组,预后较好。结论腹腔经验性应用万古霉素联合碳青霉烯类能迅速控制腹膜透析液白细胞计数,预后较好,且符合我中心的药敏结果,推荐作为部分腹膜透析相关性腹膜炎初始经验用药,以供临床医生参考。     

Clinical reports for peritoneal dialysis-related peritonitis

Objective To investigate causes and risk factors of peritoneal dialysis-related peritonitis, explore the pathogenic bacteria and drug sensitivity. Methods CAPD patients suffered peritoneal dialysis-related peritonitis were recruited in the First Affiliated Hospital of Nanjing Medical University in 2012. Gender, age and possible risk factors were analyzed by unvaried and multivariate logistic regression analysis. The causes, pathogenic bacteria, drug susceptibility, and validity treated with cefazolin plus ceftazidime were also analyzed. Results Thirty patients suffered peritoneal dialysis-related peritonitis and 129 peritoneal dialysis patients without peritonitis as control were included. The main causes for peritoneal dialysis-related peritonitis were nonstandard operating steps and intestinal infection. Multivariate logistic regression analysis showed that peritoneal dialysis-related peritonitis was significantly associated with higher CRP level. Of the peritoneal fluid culture, 26 cases were found positive and the positive rate was 76.47%, 19 cases (73.08％) were infected with Gram-positive cocci, 6 cases (23.08％) with Gram-negative bacillus and 1 case (3.85％) with fungi. Drug sensitivity test showed that Gram-positive cocci had the resistance rate to cefazolin(16.67％), and was sensitive to vancomycin in all cases. Gram-negative bacilli had the resistance to ceftazidime (20.00％), and was sensitive to imipenem and meropenem in all cases. All patients were given cefazolin plus ceftazidime as initial treatment. Twenty-seven cases were effective and the primary efficiency were 79.41％. Conclusions The main causes of peritoneal dialysis-related peritonitis in our centre were nonstandard operating steps and intestinal infection. The higher CRP level is an independent risk factor of peritoneal dialysis-related peritonitis. Gram-positive cocci are the main pathogenic bacteria leading to peritoneal dialysis-related peritonitis. There is lower resistance rate in Gram-positive cocci to cefazolin and Gram-negative bacilli to ceftazidime. Cefazolin plus ceftazidime can be an effective medicine on initiinal treatment of peritoneal dialysis-related peritonitis.     

维持性腹膜透析患者腹膜透析相关性葡萄球菌腹膜炎的发生率及危险因素分析

目的 探讨维持性腹膜透析患者腹膜透析相关性葡萄球菌腹膜炎的发生率及相关危险因素.方法 以中山大学附属东华医院腹膜透析中心192例患者为研究对象.根据腹膜透析液培养结果分成腹膜炎组与正常组.采用多因素logistic回归分析腹膜透析相关性葡萄球菌腹膜炎的危险因素.结果 共16例（8.3％）患者发生腹膜透析相关性葡萄球菌腹膜炎.致病菌以表皮葡萄球菌为主,占50.0％（8/16）.治愈12例（75.0％）,死亡1例.高龄（OR=1.35,95％ CI 1.16～7.68,P=0.026）、糖尿病（OR =3.34,95％ CI 1.90～6.54,P＜0.001）、低血红蛋白（OR=1.68,95％ CI 1.21～6.48,P=0.022）及低白蛋白血症（OR=1.04,95％ CI1.02～1.07,P=0.036）是腹膜透析相关性葡萄球菌腹膜炎的相关危险因素.结论 腹膜透析相关性葡萄球菌腹膜炎发生率较高;高龄、低血红蛋白、糖尿病及低白蛋白血症是其相关危险因素.     

Micrococcus species-related peritonitis in patients receiving peritoneal dialysis

Peritonitis is a major complication of peritoneal dialysis (PD) and remains the most common cause of PD failure. Micrococci are catalase-positive, coagulase-negative, and gram-positive cocci that are spherical, often found in tetrad, and belong to the family Micrococcaceae. Micrococcus species are commonly found in the environment, and it is now recognized that Micrococcus species can be opportunistic pathogens in immunocompromised patients. The only consistent predisposing factor for Micrococcus infection is an immunocompromised state. We report three cases of Micrococcus PD peritonitis. Improper practice of PD may have been the causative factor. Although Micrococcus species are low-virulence pathogens, infection could result in refractory peritonitis and subsequent PD failure. Intraperitoneal administration of vancomycin for at least 2 weeks is recommended for Micrococcus peritonitis.     

Treatment of gram-positive peritonitis with two intraperitoneal doses of vancomycin in continuous ambulatory peritoneal dialysis patients

Eight patients with end-stage renal failure on continuous ambulatory peritoneal dialysis (CAPD), who developed peritonitis, received an intraperitoneal dose of vancomycin (30 mg/kg body weight) with 6 h of peritoneal dwell and then resumed their routine CAPD schedule. Vancomycin concentration in serum, peritoneal dialysate (PD) from an overnight dwell and 1, 2 and 3 h after a new exchange was measured at 48 h (in 5 patients) and 7 days (in 6 patients). Except for an occasional 1-hour peritoneal fluid sample on the 7th day, all samples had satisfactory vancomycin levels. Five of the 8 patients who had gram-positive peritonitis and 1 with 'sterile' peritonitis received another similar intraperitoneal dose of vancomycin at the 7th day. All of these patients had good therapeutic response with a negative PD culture 3 weeks after the cessation of therapy and no relapse of infection in at least 1 month of follow-up. We conclude that 2 intraperitoneal doses of vancomycin (30 mg/kg body weight) given 1 week apart with 6 h of intraperitoneal dwell is an effective and adequate treatment for gram-positive and 'sterile' peritonitis in CAPD patients.     

Acinetobacter co-infection and coagulase-negative Staphylococcus: case report and literature review

Continuous ambulatory peritoneal dialysis (CAPD) is a safe, convenient, and cost-effective therapy in end-stage renal disease. The major complication of peritoneal dialysis (PD) is peritonitis. Gram-positive cocci are isolated in majority of the episodes. Among gram-negative bacteria, Acinetobacter species have been reported in peritonitis, sometimes as a concomitant that may be asymptomatic and require no treatment. Little has been written about the clinical features and outcome of PD-related peritonitis caused by co-infection of Acinetobacter species with other pathogens. We herein present a case of peritonitis caused by co-infection with Acinetobacter species and coagulase-negative staphylococci, which resulted in patient dropout and mortality. We review the literature about Acinetobacter peritonitis and current treatment protocols.     

Intravenous or intraperitoneal vancomycin for the treatment of continuous ambulatory peritoneal dialysis associated gram-positive peritonitis?

A clinical and pharmacokinetic study was carried out to determine whether an intraperitoneal (IP) loading dose of vancomycin was as effective as an intravenous (IV) load in the treatment of continuous ambulatory peritoneal dialysis (CAPD)-associated gram-positive peritonitis. Each patient continued a 14-day treatment on IP maintenance doses. All cases of peritonitis (10 in each group) were eradicated. Side effects occurred in 3 patients following IV vancomycin and in none following IP vancomycin. Serum and peritoneal vancomycin concentrations equilibrated fully and rapidly with each route. It is concluded that an IP loading dose of vancomycin, followed by IP maintenance doses, is as effective as and produces fewer side effects than an IV loading dose in the treatment of CAPD peritonitis.     

Aeromonas hydrophila as a causative organism in peritoneal dialysis-related peritonitis: case report and review of the literature

Most episodes of peritoneal dialysis (PD)-related peritonitis could be attributed to a single organism, but in almost 10% of peritonitis episodes multiple organisms are identified. Polymicrobial peritonitis is often related to intra-abdominal pathology, and the prognosis may be poor. Aeromonas spp. have rarely been identified as the causative pathogen in PD-related peritonitis, and a very small number of cases has been reported in the literature. These rod-shaped, gram-negative microorganisms have been isolated from wastewater drainage systems, food, vegetables, and soil. Herein we report a case of polymicrobial peritonitis in a continuous ambulatory peritoneal dialysis (CAPD) patient with systemic lupus erythematosus (SLE), due to a combination of Streptococcus viridans and Aeromonas hydrophila infection. The patient was involved in gardening and was not compliant with her technique protocol. She did not wear a mask and omitted thorough hand washing. The patient was treated with i.p. vancomycin and ceftazidime and peritonitis was resolved. The patient's technique was reassessed, and she was retrained by our PD nurses.     

Peritoneal dialysis-associated peritonitis in Scotland (1999-2002).

BACKGROUND: Peritonitis is a major complication of peritoneal dialysis (PD). We have performed a national study of all patients on PD in Scotland over a 3.5 year period examining the causes of technique failure, rates of peritonitis, causative organisms, clinical outcomes and differences between automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). METHODS: All 10 adult renal units in Scotland participated in the study and the data include all 1205 patients who were on PD in Scotland from January 1999 to June 2002. The data were collected prospectively by the PD nurses and reported to the Scottish Renal Registry every 6 months. RESULTS: Refractory or recurrent peritonitis was the cause of technique failure in 167 patients (42.6% of all cases of technique failure). There were 928 cases of peritonitis in 1487 patient-years, which equates to an overall peritonitis rate of one episode every 19.2 months. The peritonitis rates for APD and CAPD were similar at one episode every 20.3 months and one episode every 18.6 months, respectively. These results include 88 cases of peritonitis due to relapse or re-infection. There was a statistically significant difference (P = 0.012) in peritonitis rates between units using nasal mupiricin (one episode every 21.9 months) and those that did not (one episode every 18.3 months). Coagulase-negative Staphylococcus was the most common cause of peritonitis (29%), although this rate is lower than in historic studies. The overall initial cure rate was 75%. The initial cure rate for APD was 77.2% and for CAPD was 73.7%. No causative organism was isolated in 17% of cases. CONCLUSION: PD-associated peritonitis is the leading cause of technique failure in Scotland. We validate previous studies showing a decrease in the proportion of peritonitis episodes that are caused by coagulase-negative staphylococci. APD peritonitis rates are not significantly better than CAPD peritonitis rates in Scotland, and the initial cure rates for APD and CAPD are similar.