Streptococcal peritonitis in Australian peritoneal dialysis patients: predictors, treatment and outcomes in 287 cases

Background There has not been a comprehensive, multi-centre study of streptococcal peritonitis in patients on peritoneal dialysis (PD) to date. Methods The predictors, treatment and clinical outcomes of streptococcal peritonitis were examined by binary logistic regression and multilevel, multivariate poisson regression in all Australian PD patients involving 66 centres between 2003 and 2006. Results Two hundred and eighty-seven episodes of streptococcal peritonitis (4.6% of all peritonitis episodes) occurred in 256 individuals. Its occurrence was independently predicted by Aboriginal or Torres Strait Islander racial origin. Compared with other organisms, streptococcal peritonitis was associated with significantly lower risks of relapse (3% vs 15%), catheter removal (10% vs 23%) and permanent haemodialysis transfer (9% vs 18%), as well as a shorter duration of hospitalisation (5 vs 6 days). Overall, 249 (87%) patients were successfully treated with antibiotics without experiencing relapse, catheter removal or death. The majority of streptococcal peritonitis episodes were treated with either intraperitoneal vancomycin (most common) or first-generation cephalosporins for a median period of 13 days (interquartile range 8–18 days). Initial empiric antibiotic choice did not influence outcomes. Conclusion Streptococcal peritonitis is a not infrequent complication of PD, which is more common in indigenous patients. When treated with either first-generation cephalosporins or vancomycin for a period of 2 weeks, streptococcal peritonitis is associated with lower risks of relapse, catheter removal and permanent haemodialysis transfer than other forms of PD-associated peritonitis.Stacey O'Shea, Carmel M Hawley, Stephen P McDonald, Fiona G Brown, Johan B Rosman, Kathryn J Wiggins, Kym M Bannister and David W Johnso

Mesozoic and Cenozoic Plate Evolution of the Caribbean Region

The reconstruction of Caribbean plate history is an uncertain task, but a task that has intrigued generations of geologists. Each worker has turned to the task of historical interpretation influenced by a particular set of experiences or a special approach, and the results have been accordingly varied. A complete history of interpretations would form the subject of a fascinating chapter in the history of geological philosophy, but such is not the purpose of this chapter. Instead, I will dwell on a set of data that call for what I believe to be a relatively conservative view of Cretaceous and Tertiary plate history. My own interpretation is based heavily on my own or my students’ field experiences in the northeastern West Indies, Guatemala, Belize, and Venezuela, as well as extensive field excursions in Hispaniola, Jamaica, the Lesser Antilles, Central America, and the Dutch Antilles. I am further heavily influenced by the results of the Deep Sea Drilling Project (DSDP), Leg 15, which produced information of fundamental interest in the Venezuelan and Colombian Basins, and by several dissertations of the Princeton University group in northern Venezuela