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@ARTICLE{Kraft:307663,
      author       = {L. Kraft and J. Oppold$^*$ and D. Kitterer and N. Braun and
                      M. Kimmel and L. Twardowski and D. Biegger and T. Oberacker
                      and A. Schwab and S. Merz and K. Wirkus and K. Schulte and
                      R. Schmitt and J. T. Kielstein and G. Eden and N. Schmid and
                      S. Schricker and J. Latus and M. Schanz},
      title        = {{C}hanging microbiology and outcomes of {PD}-associated
                      peritonitis over four decades.},
      journal      = {Clinical kidney journal},
      volume       = {19},
      number       = {1},
      issn         = {2048-8505},
      address      = {Oxford},
      publisher    = {Oxford Univ. Press},
      reportid     = {DKFZ-2026-00120},
      pages        = {sfaf387},
      year         = {2026},
      abstract     = {Peritoneal dialysis (PD)-associated peritonitis remains a
                      major complication affecting patient outcomes and modality
                      survival. This study aims to evaluate temporal trends in
                      pathogen distribution and antibiotic susceptibility over
                      four decades as well as clinical outcomes in PD-associated
                      peritonitis.We retrospectively analyzed 832 peritonitis
                      cultures of PD patients across four decades from 1979 to
                      2024 treated at Robert Bosch Hospital, Stuttgart (Germany).
                      For longitudinal comparison of pathogen distribution and
                      antibiotic susceptibility, the study period was divided into
                      four time periods: P1 (1979-1992), P2 (1993-2003), P3
                      (2004-2014), and P4 (2015-2024). Clinical response and
                      outcomes were assessed in P4.Gram-positive bacteria was the
                      most frequent causative organisms $(56\%),$ followed by
                      Gram-negative bacteria $(30\%)$ and culture-negative
                      peritonitis (CNP, $13\%).$ Gram-negative peritonitis
                      increased significantly in P4 compared to P1-P3, while
                      coagulase-negative staphylococci (CNS) declined from $31\%$
                      in P1 to $14\%$ in P4 (P = .0446). Vancomycin susceptibility
                      among Gram-positive organisms remained high, whereas
                      cefazolin susceptibility changed over time. In P4, the
                      overall cure rate was $63\%,$ with the highest in
                      gram-positive $(72\%)$ and lowest in polymicrobial
                      peritonitis $(43\%).Regarding$ clinical outcomes, transition
                      to permanent hemodialysis (HD) was significantly more
                      frequent in Gram-negative than Gram-positive peritonitis
                      $(27\%$ vs. $12\%;$ P = .03). Both catheter removal and
                      transition to permanent HD occurred significantly more often
                      in polymicrobial peritonitis $(54\%$ and $40\%)$ compared
                      with Gram-positive $(24\%$ and $12\%;$ P = .001 and P =
                      .0008) and CNP $(30\%$ and $17\%;$ P = .01 and P = .04).
                      Regarding individual pathogens, Staphylococcus aureus (MSSA)
                      was associated with a significantly higher catheter removal
                      rate compared to other Gram-positive organisms.Our findings
                      show temporal changes of microbiological spectrum of
                      PD-associated peritonitis over four decades. Polymicrobial
                      and Gram-negative peritonitis were associated with poorer
                      outcomes, emphasizing the need for ongoing microbiological
                      surveillance and antibiotic stewardship to optimize PD
                      care.},
      keywords     = {clinical response (Other) / long-term observation (Other) /
                      microbiological pattern (Other) / peritoneal dialysis
                      (Other) / peritonitis (Other)},
      cin          = {E010},
      ddc          = {610},
      cid          = {I:(DE-He78)E010-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41536568},
      pmc          = {pmc:PMC12798722},
      doi          = {10.1093/ckj/sfaf387},
      url          = {https://inrepo02.dkfz.de/record/307663},
}