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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#58;</span></p><p class="elsevierStylePara">Peritonitis is the primary cause of morbidity&#44; mortality&#44; and technique failure in patients on peritoneal dialysis &#40;PD&#41;&#46; More than one-fourth of all patients suffer a case of peritonitis at some point that requires interruption of PD and transferral of the patient to haemodialysis&#46;<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">In this context&#44; we performed a retrospective study to evaluate the prevalence and aetiology of cases of peritonitis that have occurred in our department during the last 20 years&#46;</p><p class="elsevierStylePara">We included all patients who abandoned PD during the study period due to peritonitis&#46; We established two study periods of 10 years each&#44; with the dividing point between them characterised by changes to antibiotic protocols&#44; the use of anti-fungal prophylaxis&#44; and advancements in hook-up technology&#46;</p><p class="elsevierStylePara">Peritonitis was the third-leading cause of abandoning PD &#40;15&#37;&#41;&#44; surpassed only by transplantation &#40;43&#37;&#41; and death &#40;22&#37;&#41;&#46;</p><p class="elsevierStylePara">A total of 13 cases of peritonitis caused interruption of PD during the first time period &#40;A&#41; and 14 in the second period &#40;B&#41;&#46; The causative agents of these cases of peritonitis are described in the Table 1&#46; We observed a notable change in the aetiology of the cases of peritonitis between the two study periods&#59; infection by <span class="elsevierStyleItalic">S&#46; aureus</span> predominated in period B&#44; as compared to predominantly fungal and gram-negative bacterial infections in the first period&#46;</p><p class="elsevierStylePara">Cases of peritonitis caused by gram-negative bacteria and fungi are the primary infectious causes of abandoning PD&#44;<span class="elsevierStyleSup">2</span> as we observed in period A&#46;</p><p class="elsevierStylePara">In our study&#44; the change in antibiotic protocols&#44; with the advent of the use of intra-peritoneal ciprofloxacin&#44; has produced a change in the relative frequencies of the various microorganisms responsible for the most aggressive types of peritonitis&#44; thus significantly decreasing the rate of infection by gram-negative bacteria&#46;</p><p class="elsevierStylePara">Cases of peritonitis caused by <span class="elsevierStyleItalic">S&#46; aureus</span> are&#44; in general&#44; the most severe types of peritonitis caused by gram-positive bacteria&#44; and these occur most commonly in patients with nasal <span class="elsevierStyleItalic">S&#46; aureus</span> carriage or colonisation of the skin and hands&#44; or in relation to colonisation and infection of the catheter outflow orifice&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">In our experience&#44; we also observed an increase in the virulence of <span class="elsevierStyleItalic">S&#46; aureus</span> that produced peritonitis in the second period&#44; as this bacterium became the primary infectious cause of abandoning PD&#46; We believe that resistance to vancomycin was the primary factor in impeding the resolution of these infections and thus the continuity of PD&#46;</p><p class="elsevierStylePara">This increase in the resistance to vancomycin will also require reformulating the antibiotic protocol&#44; orientating treatment for the best coverage of gram-positive infections&#46;</p><p class="elsevierStylePara">Fungal peritonitis constitutes between 1&#37; and 15&#37; of all peritonitis episodes occurring in patients on PD&#44; although its incidence has decreased notably with the use of adequate preventative measures&#44; such as the administration of fluconazole whenever antibiotics are prescribed to the patient for any reason&#46;<span class="elsevierStyleSup">4</span> This led to the decrease in the percentage of cases of peritonitis produced by fungi that caused patients to abandon PD from 38&#37; in the first period to 7&#37; in the second period&#46;</p><p class="elsevierStylePara">The epidemiology of peritoneal infections is heavily influenced by the antibiotic regimens utilised in each hospital department&#44; causing the frequency and resistance of the microorganisms responsible for these infections to vary over time&#46; This requires a critical regimen of periodical changes to antibiotic protocols&#44; changing and adapting them as needed to emerging scenarios of causative microorganisms and their acquired resistances&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors state that they have no potential conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><a href="grande&#47;11496&#95;108&#95;39778&#95;en&#95;t18&#46;jpg" class="elsevierStyleCrossRefs"><img src="11496_108_39778_en_t18.jpg" alt="Aetiology of cases of peritonitis that caused abandonment of peritoneal dialysis"></img></a></p><p class="elsevierStylePara">Table 1&#46; Aetiology of cases of peritonitis that caused abandonment of peritoneal dialysis</p>"
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