Audit of peritonitis rates, microbiological profiles, and outcomes among peritoneal dialysis patients in a nephrology unit at a tertiary care hospital in Sri Lanka

Background: Peritonitis remains a major complication of peritoneal dialysis (PD) and is linked to technique failure, catheter loss, and mortality. The International Society for Peritoneal Dialysis (ISPD) 2022 recommends keeping peritonitis rates at ≤0.40 episodes per patient-year and culture-negative rates below 15%. Clinical audit is essential for assessing adherence to these standards and identifying areas for quality improvement.
Methods: This retrospective clinical audit included all adult patients receiving PD in Nephrology Unit 3 at the National Hospital of Sri Lanka from 01 January 2025 to 31 December 2025. Peritonitis episodes were identified from clinical and microbiological records. Patient-years were calculated based on PD exposure during the audit period. Outcomes assessed included organism distribution, relapse frequency, catheter removal, fungal peritonitis, insertion-related peritonitis, mortality, and the proportion of patients remaining peritonitis-free. Findings were compared with ISPD 2022 guideline targets and international registry benchmarks.
Results: Twelve patients (7 females, 5 males; mean age 54.8 years) contributed 7.24 patient-years at risk. Thirteen episodes of peritonitis were recorded, corresponding to a peritonitis rate of 1.80 episodes per patient-year, substantially exceeding ISPD 2022 recommendations. Culture-negative peritonitis accounted for 30.8% of episodes. Coliform organisms and Corynebacterium species each accounted for 23.1% of infections, followed by Pseudomonas spp. (15.4%) and Acinetobacter (7.7%). No cases of fungal peritonitis were observed.
Three episodes met ISPD 2022 criteria for relapse (23.1%). Catheter removal occurred in two episodes (15.4%), and one death was associated with peritonitis. Five patients (41.7%) remained peritonitis-free during the audit period. Two episodes (22.2% of catheter insertions) were classified as catheter insertion-related peritonitis.
Conclusion: This clinical audit found that peritonitis and culture-negative rates substantially exceeded ISPD 2022 targets, with relapse rates above registry benchmarks and a low proportion of peritonitis-free patients. These findings highlight the need for targeted infection-prevention strategies and optimisation of microbiological practices. However, the small cohort size and limited patient-years at risk mean that the calculated rates should be interpreted cautiously. A structured quality-improvement initiative, followed by re-audit, is planned.