Outcome of patients with repeat peritonitis in peritoneal dialysis: 3 case reports

Peritonitis is one of the most common and serious complications of peritoneal dialysis (PD), significantly impacting the survival of the peritoneal membrane and, consequently, the overall success of dialysis. Repeat peritonitis, defined as the occurrence of another episode of peritonitis more than four weeks after the completion of treatment for a prior episode, often requires catheter removal. The most frequent pathogens involved are skin-related, such as Staphylococcus aureus and coagulase-negative Staphylococcus, though other bacteria like Escherichia coli (E.coli) and Serratia marcescens (SM) also pose significant risks, especially with recurrence and poor prognosis. We report three cases of repeat peritonitis due to different pathogens, which ultimately led to the removal of the PD catheter. The first case involved a 45-year-old female with repeat E.coli and SM infections. Despite antibiotic treatment, her peritonitis recurred, leading to catheter removal. The second case featured a 17-year-old female with repeat SM infection, where treatment included catheter removal and successful replacement. The last one described a 74-year-old male with multiple episodes of peritonitis caused by Staphylococcus species, culminating in severe complications, including Candida superinfection, requiring both catheter removal and transition to hemodialysis. These cases highlight the challenges in managing repeat peritonitis and emphasize the importance of timely catheter removal in preventing further complications and improving patient outcomes. Moreover, they underline the need for comprehensive monitoring and appropriate antimicrobial therapy in preventing recurrent peritonitis in PD patients.