Clinical characteristics in continuous ambulatory peritoneal dialysis related peritonitis patients and the comparison of tigecyclin and vancomycin+amikacin treatment

Peritoneal dialysis is an important alternative in the treatment of end-stage renal failure patients. Despite all the technical advances provided, peritonitis remains the most important complication of continuous ambulatory peritoneal dialysis (CAPD). Detection of the causative agent and known sensitivity in patients considered to be clinically peritonitis are important in terms of beginning of appropriate antimicrobial therapy, reduction of morbidity and mortality. Tigecyclin which is a drug approved in complicated intra-abdominal infections draws attention because of that drug interactions are low and it does not require renal dose adjustment. In our study, it is aimed that determination of the clinical and laboratory characteristics of peritonitis associated with CAPD and comparison of vancomycin-amikacin (intraperitoneal) treatment that is conventional treatment and tigecycline (intravenous) treatment. In this study, there are 20 patients with vancomycin plus amikacin arm and 10 patients with tigecycline arm which are on the point of being 55 cases which followed in continuous ambulatory peritoneal dialysis unit by application for peritionitis exacerbation. Study was a prospective, randomized, single-blind made. When culture results were evaluated, positive culture was present in 28 of 30 patients (93.3%) , it was negative in 2 patients (6.7%). Looking at the distribution of micro-organisms as the causative agent of peritonitis; we have found the most frequent coagulase-negative staphylococcus (53.3%) , the second most common S. aureus (13.3%) and Streptococcus spp. (13.3%) was isolated. E. coli was isolated in two patients (6.7%). Methicillin-resistant percentage that was detected in staphylococci species and isolated was determined as %9.5. All strains isolated were sensitive to tigecycline. When patients were evaluated in terms of response to treatment, in the treatment of patients that was made 48.hour, clinical symptoms, especially abdominal pain, decreased in vancomycin plus amikacin arm, 18 (90%), in tigecycline arm 8 (80%). It was detected that dialysate leukocyte count decreased significantly (p> 0.05). While relapse was observed in 4 of 10 patients (40%) in tigecycline arm, it was not observed in vancomycin-amikacin arm (p<0.05). Observation of high relapse in tigecycline arm of the study was shown that the use of tigecycline especially intravenous usage of it can not be alternative of vancomycin-amikacin therapy in the peritonitis related CAPD. We think that new studies are necessary in terms of the use of intraperitoneal. Although methicilin resistance rate is not high in unit, we think that vancomycin-amikacin treatment can be chosen in empirical treatment because of that peritoneal reserve was effected negatively in cost and methicillin-resistant cases and high patient compliance. However, in the cases that were not detected methicillin resistance as a result of culture and did not have a problem about compliance, to cut vancomycin treatment and to continue with cefazolin would be more accurate. Key Words: CAPD-related peritonitis, tigecycline, vancomycin