51
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Nardelli L, Scalamogna A, Messa P. The impact of the superficial cuff position on the exit site and tunnel infections in CAPD patients. J Nephrol 2020; 34:493-501. [PMID: 32648207 DOI: 10.1007/s40620-020-00788-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) related infections continue to be a major cause of morbidity and mortality in patients on PD. In the last ten years, in order to reduce cuff and exit-site infections, in continuous ambulatory peritoneal dialysis (CAPD) patients, we have positioned the superficial cuff subcutaneously 4 cm instead of 2 cm internal to the exit-site. METHODS We analysed the infective episodes occurred in 123 CAPD patients (88 men and 35 women, mean age 62.4 ± 16.8) treated for 3337 months between 1st January 2011 and 31th December 2018 at Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico. RESULTS 31 of the 123 patients (25.2%) developed 52 episodes of exit site infection, with an incidence of 1 episode every 64.1 patient-months. The cumulative probability of remaining infection free was 80.7% at 12 months and 61.8% at 36 months. Gram-positive organism accounted for 78.7% of exit site infections. Forty-one episodes (87%) were successfully treated with medical therapy. Peritonitis incidence was 1 episode every 51.7 and 1 episode every 49.2 patient-months, in patients with or without a history of exit site infection respectively. The overall incidence of tunnel infection was 1 episode every 278.1 patient-months. CONCLUSIONS Positioning the superficial cuff subcutaneously at least 4 cm internal to the exit-site might prevent the bacterial cuff colonization and reduce ESIs, tunnel infections and peritonitis.
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Affiliation(s)
- Luca Nardelli
- Division of Nephrology and Dialysis, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy. .,Università Degli Studi Di Milano, Milan, Italy.
| | - Antonio Scalamogna
- Division of Nephrology and Dialysis, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Piergiorgio Messa
- Division of Nephrology and Dialysis, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy.,Università Degli Studi Di Milano, Milan, Italy
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52
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Abstract
Peritonitis is a common complication of peritoneal dialysis that is associated with substantial morbidity and mortality. Peritonitis increases treatment costs and hospitalization events and is the most common reason for transfer to hemodialysis. Although there is much focus on preventing peritoneal dialysis–associated peritonitis, equally as important is appropriate management to minimize the morbidity of a peritonitis episode when it has occurred. Despite the presence of international guidelines on peritonitis treatment, the evidence base to support optimal peritonitis treatment practices is lacking, leaving the practitioner to rely on clinical experience and extrapolate from across other infection treatment practices. This article reviews common mistakes and misconceptions that we have observed in the management of peritonitis that may compromise treatment success. It also provides suggestions on common controversial aspects of peritonitis management based on the best available literature. Although the use of the word mistakes is somewhat controversial and subjective, we acknowledge that evidence is lacking and have based many of our suggestions on clinical judgment, experience, and available data.
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53
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Hwang TY, Kim MG, Oh SW, Jo SK, Cho WY, Yang J. Pathogens of peritoneal dialysis peritonitis: Trends from a single-center experience over 15 years. Kidney Res Clin Pract 2020; 39:221-227. [PMID: 32449332 PMCID: PMC7321667 DOI: 10.23876/j.krcp.19.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 02/20/2020] [Accepted: 03/05/2020] [Indexed: 11/14/2022] Open
Abstract
Background Concerns are increasing about the emergence of pathogens with antibiotic resistance in peritoneal dialysis (PD) peritonitis. We investigated the current pathogen trends and risk factors in PD peritonitis. Methods We conducted a retrospective study analyzing data from 643 patients who maintained PD over 3 months between January 2001 and December 2015. The isolated pathogens from PD peritonitis were compared between period A (2001-2008) and period B (2009-2015). Results Among 643 PD patients, 252 patients experienced one or more episodes of PD peritonitis (total 308 episodes) during the median follow-up of 66 months. In both periods, gram-positive bacteria were the dominant pathogens (22.2% vs. 53.8%, P < 0.01). Gram-negative bacteria showed an increasing tendency in period B, but without statistical significance (17.0% vs. 23.7%, P = 0.15). The culture-negative rate was improved from 57% in period A to 18% in period B (P < 0.01). There was no increase in the prevalence of resistant pathogens such as methicillin-resistant Staphylococcus epidermidis (MRSE), Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli between periods A and B. Preserved residual renal function was associated with a lower risk of PD peritonitis (odds ratio, 0.53; 95% confidence interval, 0.31-0.88; P = 0.01). Conclusion Over the past two decades, the pathogens of PD peritonitis have not significantly changed in Korea. Gram-positive organisms remained dominant, with S. epidermidis being the most common pathogen. Resistant bacteria such as MRSE, MRSA, ESBL-producing Gram-negative bacilli did not increase, but should be monitored.
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Affiliation(s)
- Tae Yeon Hwang
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Myung Gyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Se Won Oh
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sang-Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Won-Yong Cho
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jihyun Yang
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
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54
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Musone D, Nicosia V, Diana M, Viola V, Treglia A. Impact of peritoneal catheter intramural design on dialysis discontinuation rate. Nephrology (Carlton) 2020; 25:850-855. [PMID: 32500954 DOI: 10.1111/nep.13738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/09/2020] [Accepted: 05/15/2020] [Indexed: 11/29/2022]
Abstract
AIM Catheter dislocation is an important cause of technique failure for peritoneal dialysis (PD). Aim of this study is to evaluate the effect of intramural trait configuration on this outcome. METHODS We considered 240 swan neck, double-cuffed catheters positioned in adult patients in our Centre with mini-laparotomy technique partitioned, according with the intramural segment design, in a standard technique group (ST) (n. 199): oblique passage of the catheter through the rectus sheath in the craniocaudal direction, and in a modified technique group (MT) (n. 41): anterior fascia lanced 3 cm cranially to the deep cuff to let catheter out. The primary end-point was dialysis failure due to tip migration. Secondary end-points were any other causes of catheter removal. RESULTS Incidence of catheter removal for non-responsive tip migration was 14.3% in MT and 6.1% in ST. Neither this difference nor the catheter survival rate for this outcome was statistically significant. PD interruption for refractory exit site/tunnel infection (ESI) was in favour of ST (4% ST, 35.7% MT; P < .01) whereas ESI catheter survival rate was only marginally significant (292.8 days in MT vs 743.6 in ST, P = .045). No other recorded cause of PD discontinuation was significantly different. CONCLUSION Modified technique group is associated with a major ESI risk but, given the average survival, it seems to be due more to exit site management than to the specific surgical procedure. MT is not superior to ST to prevent catheter dislocation nevertheless, considering its simplicity and rapidity it can be deemed as first-choice option.
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Affiliation(s)
- Dario Musone
- Unit of Nephrology and Dialysis, Department of Medicine, Dono Svizzero Hospital, Formia, Italy
| | - Valentina Nicosia
- Unit of Nephrology and Dialysis, Department of Medicine, Dono Svizzero Hospital, Formia, Italy
| | - Massimo Diana
- Unit of General Surgery, Department of Surgery, Dono Svizzero Hospital, Formia, Italy
| | - Vincenzo Viola
- Unit of General Surgery, Department of Surgery, Dono Svizzero Hospital, Formia, Italy
| | - Antonio Treglia
- Unit of Nephrology and Dialysis, Department of Medicine, Dono Svizzero Hospital, Formia, Italy
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55
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Bonnal H, Bechade C, Boyer A, Lobbedez T, Guillouët S, Verger C, Ficheux M, Lanot A. Effects of educational practices on the peritonitis risk in peritoneal dialysis: a retrospective cohort study with data from the French peritoneal Dialysis registry (RDPLF). BMC Nephrol 2020; 21:205. [PMID: 32471380 PMCID: PMC7260816 DOI: 10.1186/s12882-020-01867-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/25/2020] [Indexed: 12/02/2022] Open
Abstract
Background Peritoneal dialysis (PD) is a home-based therapy performed by patients or their relatives in numerous cases, and the role of patients’ educational practices in the risk of peritonitis is not well assessed. Our aim was to evaluate the effect of PD learning methods on the risk of peritonitis. Methods This was a retrospective multicentric study based on data from a French registry. All incident adults assisted by family or autonomous for PD exchanges in France between 2012 and 2015 were included. The event of interest was the occurrence of peritonitis. Cox and hurdle regression models were used for statistical analysis to asses for the survival free of peritonitis, and the risk of first and subsequent peritonitis. Results 1035 patients were included. 967 (93%) received education from a specialized nurse. Written support was used for the PD learning in 907 (87%) patients, audio support in 221 (21%) patients, and an evaluation grid was used to assess the comprehension in 625 (60%) patients. In the “zero” part of the hurdle model, the use of a written support and starting PD learning with hands-on training alone were associated with a lower survival free of peritonitis (respectively HR 1.59, 95%CI 1.01–2.5 and HR 1.94, 95%CI 1.08–3.49), whereas in the “count” part, the use of an audio support and starting of PD learning with hands-on training in combination with theory were associated with a lower risk of presenting further episodes of peritonitis after a first episode (respectively HR 0.55, 95%CI 0.31–0.98 and HR 0.57, 95%CI 0.33–0.96). Conclusions The various PD education modalities were associated with differences in the risk of peritonitis. Prospective randomized trials are necessary to confirm causal effect. Caregivers should assess the patient’s preferred learning style and their literacy level and adjust the PD learning method to each individual.
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Affiliation(s)
- Hélène Bonnal
- Normandie Univ, UNICAEN, CUMR, CHU de Caen Normandie, Néphrologie, Avenue de la cote de nacre, 14033, Caen-Cedex, France.,U1086 INSERM - ANTICIPE - Centre Régional de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Clémence Bechade
- Normandie Univ, UNICAEN, CUMR, CHU de Caen Normandie, Néphrologie, Avenue de la cote de nacre, 14033, Caen-Cedex, France.,U1086 INSERM - ANTICIPE - Centre Régional de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Annabel Boyer
- Normandie Univ, UNICAEN, CUMR, CHU de Caen Normandie, Néphrologie, Avenue de la cote de nacre, 14033, Caen-Cedex, France.,U1086 INSERM - ANTICIPE - Centre Régional de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Thierry Lobbedez
- Normandie Univ, UNICAEN, CUMR, CHU de Caen Normandie, Néphrologie, Avenue de la cote de nacre, 14033, Caen-Cedex, France.,RDPLF, 30 Rue Sere Depoin, 95 300, Pontoise, France
| | - Sonia Guillouët
- Normandie Univ, UNICAEN, CUMR, CHU de Caen Normandie, Néphrologie, Avenue de la cote de nacre, 14033, Caen-Cedex, France
| | | | - Maxence Ficheux
- Normandie Univ, UNICAEN, CUMR, CHU de Caen Normandie, Néphrologie, Avenue de la cote de nacre, 14033, Caen-Cedex, France
| | - Antoine Lanot
- Normandie Univ, UNICAEN, CUMR, CHU de Caen Normandie, Néphrologie, Avenue de la cote de nacre, 14033, Caen-Cedex, France. .,U1086 INSERM - ANTICIPE - Centre Régional de Lutte Contre le Cancer François Baclesse, Caen, France.
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56
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Boudville N, Johnson DW, Zhao J, Bieber BA, Pisoni RL, Piraino B, Bernardini J, Nessim SJ, Ito Y, Woodrow G, Brown F, Collins J, Kanjanabuch T, Szeto CC, Perl J. Regional variation in the treatment and prevention of peritoneal dialysis-related infections in the Peritoneal Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant 2020; 34:2118-2126. [PMID: 30053214 DOI: 10.1093/ndt/gfy204] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 05/29/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Peritoneal dialysis (PD)-related infections lead to significant morbidity. The International Society for Peritoneal Dialysis (ISPD) guidelines for the prevention and treatment of PD-related infections are based on variable evidence. We describe practice patterns across facilities participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). METHODS PDOPPS, a prospective cohort study, enrolled nationally representative samples of PD patients in Australia/New Zealand (ANZ), Canada, Thailand, Japan, the UK and the USA. Data on PD-related infection prevention and treatment practices across facilities were obtained from a survey of medical directors'. RESULTS A total of 170 centers, caring for >11 000 patients, were included. The proportion of facilities reporting antibiotic administration at the time of PD catheter insertion was lowest in the USA (63%) and highest in Canada and the UK (100%). Exit-site antimicrobial prophylaxis was variably used across countries, with Japan (4%) and Thailand (28%) having the lowest proportions. Exit-site mupirocin was the predominant exit-site prophylactic strategy in ANZ (56%), Canada (50%) and the UK (47%), while exit-site aminoglycosides were more common in the USA (72%). Empiric Gram-positive peritonitis treatment with vancomycin was most common in the UK (88%) and USA (83%) compared with 10-45% elsewhere. Empiric Gram-negative peritonitis treatment with aminoglycoside therapy was highest in ANZ (72%) and the UK (77%) compared with 10-45% elsewhere. CONCLUSIONS Variation in PD-related infection prevention and treatment strategies exist across countries with limited uptake of ISPD guideline recommendations. Further work will aim to understand the impact these differences have on the wide variation in infection risk between facilities and other clinically relevant PD outcomes.
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Affiliation(s)
- Neil Boudville
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - Beth Piraino
- Department of Medicine, Renal Electrolyte Division, University of Pittsburgh, Pittsburgh, PA, USA
| | - Judith Bernardini
- Department of Medicine, Renal Electrolyte Division, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sharon J Nessim
- Department of Nephrology, Division of Nephrology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Graham Woodrow
- Department of Nephrology, St James's University Hospital, Leeds, UK
| | - Fiona Brown
- Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia
| | - John Collins
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Internal Medicine, and Kidney & Metabolic Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Cheuk-Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Jeffrey Perl
- Department of Medicine, Division of Nephrology, St. Michael's Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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57
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van Hougenhouck-Tulleken WG, Lebre PH, Said M, Cowan DA. Bacterial pathogens in peritoneal dialysis peritonitis: Insights from next-generation sequencing. Perit Dial Int 2020; 40:581-586. [PMID: 32162597 DOI: 10.1177/0896860820908473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) peritonitis is a feared complication of PD, with significant sequelae for the patient. The cause of PD peritonitis is largely due to a single organism (≥75% of cases) and rarely due to multiple organisms. METHODS In this pilot study, we investigated 25 cases of PD peritonitis with 16S ribosomal RNA (rRNA) next-generation sequencing (NGS) techniques. RESULTS Total concordance between culture and NGS was noted. In addition, the NGS technique was highly sensitive, identifying 33 different bacteria (including a nonculturable bacterium), compared to 13 bacterial species using culture-based techniques. This was counterbalanced by a lack of specificity with NGS, largely due to the small size of the 16S rRNA gene segment sequenced. CONCLUSIONS For the clinician, our results suggest that PD peritonitis may often be a polymicrobial disease and that treating a dominant organism may not totally eradicate all bacterial contamination within the peritoneum. For the clinical scientist, additional use of a larger 16S rRNA segment (V5 or V6) is likely to outperform the use of the V4 segment only.
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Affiliation(s)
- Wesley G van Hougenhouck-Tulleken
- Department of Nephrology, Steve Biko Academic Hospital, Pretoria, South Africa.,Department of Internal Medicine, 56410University of Pretoria, South Africa
| | - Pedro H Lebre
- Centre for Microbial Ecology and Genomics, 56410University of Pretoria, South Africa
| | - Mohamed Said
- Department of Medical Microbiology, 56410University of Pretoria, South Africa.,National Health Laboratory Services, Tshwane Academic Division, 56410University of Pretoria, South Africa
| | - Don A Cowan
- Centre for Microbial Ecology and Genomics, 56410University of Pretoria, South Africa
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58
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Noppakun K, Kasemset T, Wongsawad U, Ruengorn C, Thavorn K, Sood MM, Nochaiwong S. Changes in serum albumin concentrations during transition to dialysis and subsequent risk of peritonitis after peritoneal dialysis initiation: a retrospective cohort study. J Nephrol 2020; 33:1275-1287. [PMID: 32130719 DOI: 10.1007/s40620-020-00716-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/25/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Evidence shows that lower serum albumin concentrations are associated with the risk of peritoneal dialysis (PD)-related peritonitis. However, little is known regarding its relationship and magnitude of change before PD initiation and peritonitis risk. METHODS We performed a multicenter retrospective cohort study on 1169 adult cases of PD in Thailand. The associations of serum albumin at concentration (< 2.5, 2.5-3.5, > 3.5 [reference] g/dL) and changes (unchanged + 0.1 to - 0.1 [reference], decrease or increase > 0.1 g/dL) over 3- and 6-month before PD initiation with PD-related peritonitis were examined. Time-to-first and longitudinal rates of peritonitis were examined using the multivariable Cox proportional hazards model and Poisson regression analyses, respectively. RESULTS At baseline PD initiation, patients with serum albumin concentration < 2.5 and 2.5-3.5 g/dL had an adjusted hazard ratio (HR) of 1.69 and 2.0 times higher peritonitis (vs. > 3.5 g/dL), respectively. Compared to the unchanged group, patients with a decrease and increase in serum albumin concentrations during transitioning to dialysis were significantly associated with higher and lower risk of peritonitis, adjusted HR of 2.25 (95% confidence interval [CI] 1.85-2.75) and 0.53 (95% CI 0.42-0.68) over three-month, and 1.43 (95% CI 1.15-1.79) and 0.64 (95% CI 0.52-0.79) over six-month, respectively. Similar trends of longitudinal rates of serum albumin concentrations and peritonitis risk were observed. CONCLUSIONS Serum albumin concentrations at PD initiation and its magnitude of change during the transition to dialysis are strongly associated with subsequent risk of peritonitis. Further studies are required on strategies modifying serum albumin concentration during the transition to PD.
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Affiliation(s)
- Kajohnsak Noppakun
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.,Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Thanit Kasemset
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Uraiwan Wongsawad
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Chidchanok Ruengorn
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand.,Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Kednapa Thavorn
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand.,Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, ON, K1H 8L6, Canada.,Institute of Clinical and Evaluative Sciences, ICES uOttawa, Ottawa, ON, K1Y 4E9, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1G 5Z3, Canada
| | - Manish M Sood
- Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, ON, K1H 8L6, Canada.,Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, K1H 8L6, Canada
| | - Surapon Nochaiwong
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand. .,Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand.
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59
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Harmanjeet H, Jani H, Zaidi STR, Wanandy T, Castelino RL, Sud K, Peterson GM, Patel RP. Stability of ceftolozane and tazobactam in different peritoneal dialysis solutions. Perit Dial Int 2020; 40:470-476. [PMID: 32052692 DOI: 10.1177/0896860820902590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Peritonitis is a common and serious complication of peritoneal dialysis (PD). PD-associated peritonitis (PDAP) caused by Pseudomonas is usually resistant to most antibiotics, resulting in high failure rates. Ceftolozane/tazobactam (C/T) has been shown to be effective in treating urinary tract and intra-abdominal infections caused by beta-lactam resistant Pseudomonas and other gram-negative bacteria. Given its favourable adverse effects profile, it has a potential role in the treatment of PDAP caused by Pseudomonas species resistant to other antibiotics. Intraperitoneal administration of antibiotics admixed with PD solutions for the treatment of PDAP is associated with superior outcomes. However, there is a lack of published data on the stability of C/T in PD solutions. Therefore, this study investigated the physical and chemical stability of C/T in commonly used PD solutions at different temperatures. METHODS A total of 27 PD bags (3 PD bags for each type of PD solution including Dianeal®, Extraneal®, Balance® and Physioneal® PD bags) containing C/T were prepared and stored at 25°C for 6 h, followed by 4°C for 168 h and then 37°C for 12 h. An aliquot from each PD bag was withdrawn, and the concentration of C/T before (0 h) and after predefined time points was determined using a stability-indicating high-performance liquid chromatography assay. Samples were also assessed for pH, colour change and particulate matter immediately after preparation and on each day of analysis. RESULTS C/T retained more than 97% of their initial concentration when stored at 25°C for 6 h followed by storage at 4°C for 168 h and then at 37°C for 12 h. Particle formation was not detected at any time under the tested storage conditions. The pH and colour remained essentially unchanged throughout the study. CONCLUSIONS These results provide a platform for clinical studies to determine the safety and therapeutic efficacy of intraperitoneal C/T for the treatment of PDAP caused by resistant Pseudomonas species.
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Affiliation(s)
| | - Het Jani
- Division of Pharmacy, School of Medicine, 3925University of Tasmania, Australia
| | - Syed Tabish R Zaidi
- Division of Pharmacy, School of Medicine, 3925University of Tasmania, Australia.,School of Healthcare, University of Leeds, UK
| | - Troy Wanandy
- Division of Pharmacy, School of Medicine, 3925University of Tasmania, Australia.,Department of Pharmacy, 497744Royal Hobart Hospital, Australia
| | - Ronald L Castelino
- Division of Pharmacy, School of Medicine, 3925University of Tasmania, Australia.,School of Nursing, 4334University of Sydney, Australia.,Peritoneal Dialysis Unit, Regional Dialysis Centre, Blacktown Hospital, Australia
| | - Kamal Sud
- Peritoneal Dialysis Unit, Regional Dialysis Centre, Blacktown Hospital, Australia.,Department of Renal Medicine, Nepean Hospital and Nepean Clinical School, 4334The University of Sydney, Australia
| | - Gregory M Peterson
- Division of Pharmacy, School of Medicine, 3925University of Tasmania, Australia
| | - Rahul P Patel
- Division of Pharmacy, School of Medicine, 3925University of Tasmania, Australia
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60
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Zelenitsky SA, Howarth J, Lagacé-Wiens P, Sathianathan C, Ariano R, Davis C, Verrelli M. Microbiological Trends and Antimicrobial Resistance in Peritoneal Dialysis-Related Peritonitis, 2005 to 2014. Perit Dial Int 2020; 37:170-176. [DOI: 10.3747/pdi.2016.00136] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/26/2016] [Indexed: 12/27/2022] Open
Abstract
BackgroundInformation related to the microbiology of peritonitis is critical to the optimal management of patients receiving peritoneal dialysis (PD). The goal was to characterize the microbiological etiology and antimicrobial susceptibilities of PD-related peritonitis (PDRP) from 2005 to 2014, inclusive.MethodsThe distribution of organisms in culture-positive PDRP was described for new episodes and relapse infections, and further detailed for monomicrobial and polymicrobial peritonitis. Annual and overall rates of PDRP were also characterized. Antimicrobial susceptibility rates were calculated for the most common and significant organisms.ResultsWe identified 539 episodes of PDRP including 501 new and 38 relapse infections. New episodes of peritonitis were associated with a single organism in 85% of cases, and 44% of those involved staphylococci. Polymicrobial PDRP was more likely to involve gram-negative organisms, observed in 58% versus 24% of monomicrobial infections. Antimicrobial resistance was relatively stable from 2005 to 2014. Methicillin resistance was present in 57% of Staphylococcus epidermidis and 20% of other coagulase-negative staphylococci. Methicillin-resistant Staphylococcus aureus (MRSA) accounted for only 11% of S. aureus peritonitis compared with 2% in our previous study of PDRP from 1991 to 1998. Ciprofloxacin resistance in Escherichia coli increased from 3% in our previous study to 24% in 2005 – 2014.ConclusionsThis study characterizes important differences in the distribution of organisms in new episodes of PDRP and relapse infections, as well as monomicrobial versus polymicrobial peritonitis. It also shows relatively stable rates of antimicrobial resistance from 2005 to 2014, but some increases compared with our previous study.
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Affiliation(s)
- Sheryl A. Zelenitsky
- College of Pharmacy, Manitoba, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; St. Boniface Hospital, Manitoba, Canada
| | | | - Philippe Lagacé-Wiens
- Max Rady College of Medicine, Manitoba, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; St. Boniface Hospital, Manitoba, Canada
| | - Christie Sathianathan
- Max Rady College of Medicine, Manitoba, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; St. Boniface Hospital, Manitoba, Canada
- Winnipeg, Manitoba, Canada; and Manitoba Renal Program, Manitoba, Canada
| | - Robert Ariano
- College of Pharmacy, Manitoba, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; St. Boniface Hospital, Manitoba, Canada
| | - Christine Davis
- College of Pharmacy, Manitoba, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; St. Boniface Hospital, Manitoba, Canada
- Winnipeg, Manitoba, Canada; and Manitoba Renal Program, Manitoba, Canada
| | - Mauro Verrelli
- Max Rady College of Medicine, Manitoba, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; St. Boniface Hospital, Manitoba, Canada
- Winnipeg, Manitoba, Canada; and Manitoba Renal Program, Manitoba, Canada
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Campbell DJ, Mudge DW, Gallagher MP, Lim WH, Ranganathan D, Saweirs W, Craig JC. Infection Prophylaxis in Peritoneal Dialysis Patients: Results from an Australia/New Zealand Survey. Perit Dial Int 2020; 37:191-197. [DOI: 10.3747/pdi.2016.00037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 08/03/2016] [Indexed: 11/15/2022] Open
Abstract
BackgroundClinical practice guidelines aim to reduce the rates of peritoneal dialysis (PD)-related infections, a common complication of PD in end-stage kidney disease patients. We describe the clinical practices used by Australian and New Zealand nephrologists to prevent PD-related infections in PD patients.MethodsA survey of PD practices in relation to the use of antibiotic and antifungal prophylaxis in PD patients was conducted of practicing nephrologists identified via the Australia and New Zealand Society of Nephrology (ANZSN) membership in 2013.ResultsOf 333 nephrologists approached, 133 (39.9%) participated. Overall, 127 (95.5%) nephrologists prescribed antibiotics at the time of Tenckhoff catheter insertion, 85 (63.9%) routinely screened for nasal S. aureus carriage, with 76 (88.4%) reporting they treated S. aureus carriers with mupirocin ointment. Following Tenckhoff catheter insertion, 79 (59.4%) prescribed mupirocin ointment at the exit site or intranasally, and 93 (69.9%) nephrologists routinely prescribed a course of oral antifungal agent whenever their PD patients were given a course of antibiotics.ConclusionsAlthough the majority of nephrologists prescribe antibiotics at the time of Tenckhoff catheter insertion, less than 70% routinely prescribe mupirocin ointment and/or prophylactic antifungal therapy. This variation in practice in Australia and New Zealand may contribute to the disparity in PD-related infection rates that is seen between units.
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Affiliation(s)
- Denise J. Campbell
- Centre for Kidney Research, Auckland, New Zealand
- Sydney Children's Hospital Network (Westmead), Westmead, NSW, Australia; School of Public Health, Auckland, New Zealand
| | - David W. Mudge
- University of Sydney, Sydney, NSW, Australia; University of Queensland at Princess Alexandra Hospital, Auckland, New Zealand
| | - Martin P. Gallagher
- Brisbane, QLD, Australia; University of Sydney and George Institute for Global Health, Auckland, New Zealand
| | - Wai Hon Lim
- Sydney, NSW, Australia; Sir Charles Gairdner Hospital, Auckland, New Zealand
| | - Dwaraka Ranganathan
- Perth, WA, Australia; Royal Brisbane and Women's Hospital, Auckland, New Zealand
| | - Walaa Saweirs
- Herston, QLD, Australia; Whangarei Hospital, Auckland, New Zealand
- Northland District Health Board, Whangarei, New Zealand; and University of Auckland, Auckland, New Zealand
| | - Jonathan C. Craig
- Centre for Kidney Research, Auckland, New Zealand
- Sydney Children's Hospital Network (Westmead), Westmead, NSW, Australia; School of Public Health, Auckland, New Zealand
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Sahlawi MA, Wilson G, Stallard B, Manera KE, Tong A, Pisoni RL, Fuller DS, Cho Y, Johnson DW, Piraino B, Schreiber MJ, Boudville NC, Teitelbaum I, Perl J. Peritoneal dialysis-associated peritonitis outcomes reported in trials and observational studies: A systematic review. Perit Dial Int 2020; 40:132-140. [PMID: 32063197 DOI: 10.1177/0896860819893810] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD)-associated peritonitis carries significant morbidity, mortality, and is a leading cause of PD technique failure. This study aimed to assess the scope and variability of PD-associated peritonitis reported in randomized trials and observational studies. METHODS Cochrane Controlled Register of Trials, MEDLINE, and Embase were searched from 2007 to June 2018 for randomized trials and observational studies in adult and pediatric patients on PD that reported PD-associated peritonitis as a primary outcome or as a part of composite primary outcome. We assessed the peritonitis definitions used, characteristics of peritonitis, and outcome reporting and analysis. RESULTS Seventy-seven studies were included, three were randomized trials. Thirty-eight (49%) of the included studies were registry-based observational studies. Twenty-nine percent (n = 22) of the studies did not specify how PD-associated peritonitis was defined. Among those providing a definition of peritonitis, three components were reported: effluent cell count (n = 42, 54%), clinical features consistent with peritonitis (e.g. abdominal pain and/or cloudy dialysis effluent) (n = 35, 45%), and positive effluent culture (n = 19, 25%). Of those components, 1 was required to make the diagnosis in 6 studies (8%), 2 out of 2 were required in 22 studies (29%), 2 out of 3 in 11 studies (14%), and 3 out of 3 in 4 studies (5%). Peritonitis characteristics and outcomes reported across studies included culture-negative peritonitis (n = 47, 61%), refractory peritonitis (n = 42, 55%), repeat peritonitis (n = 9, 12%), relapsing peritonitis (n = 5, 7%), concomitant exit site (n = 16, 21%), and tunnel infections (n = 8, 10%). Peritonitis-related hospitalization was reported in 38% of the studies (n = 29), and peritonitis-related mortality was variably defined and reported in 55% of the studies (n = 42). Peritonitis rate was most frequently reported as episodes per patient year (n = 40, 52%). CONCLUSION Large variability exists in the definitions, methods of reporting, and analysis of PD-associated peritonitis across trials and observational studies. Standardizing definitions for reporting of peritonitis and associated outcomes will better enable assessment of the comparative effect of interventions on peritonitis. This will facilitate continuous quality improvement measures through reliable benchmarking of this patient-important outcome across centers and countries.
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Affiliation(s)
- Muthana Al Sahlawi
- Division of Nephrology, St. Michael's Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Internal Medicine, College of Medicine, King Faisal University, Al-Hasa, Saudi Arabia
| | - Gregory Wilson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Belinda Stallard
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Karine E Manera
- Sydney School of Public Health, The University of Sydney, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, New South Wales, Australia
| | | | | | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Beth Piraino
- Renal Electrolyte Division, University of Pittsburgh, PA, USA
| | | | - Neil C Boudville
- Medical School, University of Western Australia, Perth, Australia
| | - Isaac Teitelbaum
- Division of Hypertension and Renal Diseases, University of Colorado Denver, Aurora, CO, USA
| | - Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Chow JS, Adams K, Cho Y, Choi P, Equinox KL, Figueiredo AE, Hawley CM, Howard K, Johnson DW, Jose MD, Lee A, Longergan M, Manera KE, Moodie JA, Paul-Brent PA, Pascoe EM, Reidlinger D, Steiner GZ, Tomlins M, Tong A, Voss D, Boudville NC. Targeted Education ApproaCH to improve Peritoneal Dialysis Outcomes (TEACH-PD): A feasibility study. Perit Dial Int 2020; 40:153-163. [PMID: 32063194 DOI: 10.1177/0896860819887283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is substantial variation in peritonitis rates across peritoneal dialysis (PD) units globally. This may, in part, be related to the wide variability in the content and delivery of training for PD nurse trainers and patients. AIM The aim of this study was to test the feasibility of implementing the Targeted Education ApproaCH to improve Peritoneal Dialysis Outcomes (TEACH-PD) curriculum in real clinical practice settings. METHODS This study used mixed methods including questionnaires and semi-structured interviews (pretraining and post-training) with nurse trainers and patients to test the acceptability and usability of the PD training modules implemented in two PD units over 6 months. Quantitative data from the questionnaires were analysed descriptively. Interviews were analysed using thematic analysis. RESULTS Ten PD trainers and 14 incident PD patients were included. Mean training duration to complete the modules were 10.9 h (range 6-17) and 24.9 h (range 15-35), for PD trainers and patients, respectively. None of the PD patients experienced PD-related complications at 30 days follow-up. Three (21%) patients were transferred to haemodialysis due to non-PD-related complications. Ten trainers and 14 PD patients participated in the interviews. Four themes were identified including use of adult learning principles (trainers), comprehension of online modules (trainers), time to complete the modules (trainers) and patient usability of the manuals (patient). CONCLUSION This TEACH-PD study has demonstrated feasibility of implementation in a real clinical setting. The outcomes of this study have informed refinement of the TEACH-PD modules prior to rigorous evaluation of its efficacy and cost-effectiveness in a large-scale study.
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Affiliation(s)
- Josephine Sf Chow
- Clinical Innovation and Business Unit, South Western Sydney Local Health District, Liverpool Hospital, NSW, Australia.,Faculty of Nursing, The University of Sydney, NSW, Australia.,School of Health Science, University of Tasmania, Hobart, Australia
| | - Kelly Adams
- Department of Renal Medicine, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Yeoungjee Cho
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Peter Choi
- Department of Renal Medicine, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Keri-Lu Equinox
- Department of Renal Medicine, Cairns Hospital, QLD, Australia
| | - Ana E Figueiredo
- Faculty of Nursing, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carmel M Hawley
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, QLD, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - David W Johnson
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia
| | - Matthew D Jose
- School of Medicine, University of Tasmania, Hobart, Australia
| | - Anna Lee
- Department of Renal Medicine, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Maureen Longergan
- Department of Renal Medicine, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Karine E Manera
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, NSW, Australia
| | - Jo-Anne Moodie
- Department of Nephrology, The Royal Melbourne Hospital, VIC, Australia
| | - Peta-Anne Paul-Brent
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Elaine M Pascoe
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Donna Reidlinger
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Genevieve Z Steiner
- NICM Health Research Institute and Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Melinda Tomlins
- Department of Renal Medicine, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, NSW, Australia
| | - David Voss
- Department of Renal Medicine, Middlemore Hospital, Auckland, New Zealand
| | - Neil C Boudville
- Medical School, University of Western Australia, Perth, Australia
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Kim YA, Kang EW, Moon HS, Kim D, Yong D. Application of 16S rRNA Gene-Targeted Next-Generation Sequencing for Bacterial Pathogen Detection in Continuous Ambulatory Peritoneal Dialysis Peritonitis. ANNALS OF CLINICAL MICROBIOLOGY 2020. [DOI: 10.5145/acm.2020.23.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Young Ah Kim
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Ea Wha Kang
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hye Su Moon
- Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Daewon Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
- Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Dongeun Yong
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
- Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
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Li M, Yan J, Zhang H, Wu Q, Wang J, Liu J, Xing C, Zhou Y. Analysis of outcome and factors correlated with maintenance peritoneal dialysis. J Int Med Res 2019; 47:4683-4690. [PMID: 31446816 PMCID: PMC6833380 DOI: 10.1177/0300060519862091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objectives This study aimed to analyze the outcome and factors correlated with maintenance peritoneal dialysis (PD) to provide guidance for improving prognosis, and prolonging the catheterization and survival times of patients on PD with end-stage renal disease. Methods Clinical data of patients at The Third Xiangya Hospital of Central South University were retrospectively analyzed. We compared the survival and technique survival rates of patients, and analyzed relevant factors. Results A total of 510 cases of PD were included. Two hundred thirty-nine patients continued to receive PD treatment, 73 received kidney transplants, 72 transferred to hemodialysis, and 126 died. The main reasons of death were cardiovascular (27.00%) and cerebrovascular diseases (23.80%). The main reasons of transfer to HD were peritonitis and inadequate dialysis. The survival rates at 1, 2, 3, 5, and 7 years were 95.75%, 90.34%, 82.35%, 66.21%, and 54.32%, respectively. The technique survival rates at 1, 2, 3, 5, and 7 years were 93.22%, 86.76%, 77.91%, 63.16%, and 47.67%, respectively. Female sex and older age were protective factors that affected patients’ withdrawal from PD and survival time. Conclusions Death is the primary reason for withdrawal from PD. Female sex and older age affect patients’ withdrawal from PD and survival.
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Affiliation(s)
- Min Li
- Department of Nephrology, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Jin Yan
- Department of Nursing, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Hao Zhang
- Department of Nephrology, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Qiongying Wu
- Department of Nephrology, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Jianwen Wang
- Department of Nephrology, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Jishi Liu
- Department of Nephrology, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Chengling Xing
- Department of Nephrology, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Yuqiong Zhou
- Department of Nephrology, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
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Ndlovu KCZ, Swe Swe-Han K, Assounga A. Association of Staphylococcus nasal colonization and HIV in end-stage renal failure patients undergoing peritoneal dialysis. Ren Fail 2019; 41:303-313. [PMID: 30991864 PMCID: PMC6484474 DOI: 10.1080/0886022x.2019.1598433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Staphylococcal infections can cause significant morbidity in patients undergoing dialysis. This study evaluated the effects of HIV infection on nasal carriage of Staphylococcus aureus, staphylococcal peritonitis, and catheter infection rates in patients with end-stage renal failure managed with continuous ambulatory peritoneal dialysis (CAPD). METHODS Sixty HIV-positive and 59 HIV-negative CAPD patients were enrolled and followed up for up to 18 months. S. aureus nasal carriage (detected by nasal swab culture), Staphylococcal peritonitis (diagnosed by clinical presentation, and CAPD effluent Staphylococcal culture and white blood cell count ≥100 cells/µL), and catheter infections (including exit site and tunnel infections) were assessed monthly. RESULTS At 18 months, S. aureus nasal carriage rates were 43.3% and 30.5% (p = 0.147) and the methicillin-resistant S. aureus (MRSA) nasal carriage rates were 31.7% and 13.6% (p = 0.018) for the HIV-positive and HIV-negative cohorts, respectively. The HIV-positive cohort was associated with increased hazards for staphylococcal peritonitis, (adjusted hazard ratio [AHR] 2.85, 95% confidence interval [CI] 1.19-6.84, p = 0.019) due to increased coagulase-negative staphylococcal (CNS) peritonitis rate in the HIV-positive cohort compared with the HIV-negative cohort (0.435 vs. 0.089 episodes/person-years; AHR 7.64, CI 2.18-26.82, p = 0.001). On multivariable analysis, CD4+ cell count <200 cells/µL, diabetes, and S. aureus nasal carriage were found to be independent predictors of S. aureus peritonitis. CONCLUSIONS These findings suggest that HIV infection may be a risk factor for MRSA nasal colonization and may increase the risks of CNS peritonitis, while a CD4+ cell count <200 cells/µL and S. aureus nasal carriage may be important predictors of S. aureus peritonitis.
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Affiliation(s)
- Kwazi C Z Ndlovu
- a Department of Internal Medicine, Division of Nephrology , University of the Free State , Bloemfontein , South Africa
| | - Khine Swe Swe-Han
- b Inkosi Albert Luthuli Central Hospital , Durban , South Africa.,c Department of Medical Microbiology, School of Laboratory Medicine & Medical Science , University of KwaZulu-Natal , Durban , South Africa
| | - Alain Assounga
- b Inkosi Albert Luthuli Central Hospital , Durban , South Africa.,d Department of Nephrology , University of KwaZulu-Natal , Durban , South Africa
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67
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Balzer MS, Claus R, Haller H, Hiss M. Are ISPD Guidelines on Peritonitis Diagnosis Too Narrow? A 15-Year Retrospective Single-Center Cohort Study on PD-Associated Peritonitis Accounting for Untrained Patients. Perit Dial Int 2019; 39:220-228. [DOI: 10.3747/pdi.2018.00179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/10/2018] [Indexed: 12/23/2022] Open
Abstract
Background Peritoneal dialysis (PD)-associated peritonitis remains by far the most important complication requiring patients to transfer to hemodialysis and has a major impact on patient morbidity and mortality. Current International Society for Peritoneal Dialysis (ISPD) guidelines on peritonitis recommend analysis of peritonitis episodes only in trained patients. In a large tertiary care center, we analyzed peritonitis episodes accounting for different groups of untrained patients and compared these with episodes in the trained patient population. Methods We analyzed data collected prospectively over a 15-year time span regarding differences between peritonitis episodes in trained patients and episodes in untrained patients post-catheter insertion but prior to training completion as well as on in-center intermittent PD with respect to incidence rates, pathogenic organisms, outcome, and peritonitis predictors. Results In 275 patients, a total of 160 peritonitis episodes in trained patients were counted. A total of 27 additional episodes in untrained patients were recorded. When accounting for these episodes, the peritonitis incidence significantly increased and the percentage of peritonitis-free patients decreased. Peritonitis episodes in untrained patients were most often culture-negative and the pathogen spectrum differed significantly compared with episodes counted as per ISPD recommendations, while outcome of peritonitis episodes did not differ. Predictors of peritonitis after multivariate logistic regression analysis included glomerulonephritis as primary kidney disease, being on home PD rather than being on in-center intermittent PD, and higher dialysis vintage. Conclusions Depending on local practice patterns, we argue that centers should additionally monitor peritonitis episodes in untrained patients because computation of statistics as per ISPD recommendations could underestimate peritonitis incidence and may depict a distorted pathogen spectrum.
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Affiliation(s)
- Michael S. Balzer
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Robert Claus
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Hermann Haller
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Marcus Hiss
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
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68
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Gupta S, Sahu C, Nag S, Saha US, Prasad N, Prasad KN. First report of peritonitis caused by the vancomycin-resistant coccus Pediococcus pentosaceus in a patient on continuous ambulatory peritoneal dialysis. Access Microbiol 2019; 1:e000007. [PMID: 32974525 PMCID: PMC7470283 DOI: 10.1099/acmi.0.000007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Worldwide, about one-tenth of end-stage renal disease (ESRD) patients are on peritoneal dialysis (PD). Peritonitis is a major cause of PD failure and change of therapy to haemodialysis. An update on peritoneal dialysis-related infections has recommended the use of a first generation cephalosporin or vancomycin as an empirical therapy for Gram-positive organisms. Pediococcus spp. is a Gram-positive environmental cocci that have been increasingly reported from various nosocomial infections but very rarely from peritoneal dialysis infections. It is intrinsically resistant to Vancomycin but sensitive to ampicillin. So, diagnosis of this bacteria is important if isolated from PD infections. Case presentation. An elderly female patient of ESRD on continuous ambulatory peritoneal dialysis (CAPD) was admitted with complaints of high fever and cloudy PD effluent for 2 days. She was started with vancomycin and imipenem empirically but did not improve even after 4 days. Pus cells were seen when PD fluid was examined microscopically. BACTEC culture of PD fluid isolated growth of Gram-positive cocci, which was confirmed as Pediococcus pentosaceus. It was resistant to vancomycin. The antibiotic of the patient was changed to ciprofloxacin IV. The patient responded in 2 days and was discharged after 7 days. Conclusion This is the first case report of Pediococcus pentosaceus peritonitis in an ESRD patient on CAPD. Accurate diagnosis and antibiotic sensitivity test of the bacteria is important especially if isolated in critical patients as it is intrinsically resistant to vancomycin.
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Affiliation(s)
- Shefali Gupta
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Chinmoy Sahu
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Soumyabrata Nag
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Uma Shankar Saha
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Kashi Nath Prasad
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Viron C, Lobbedez T, Lanot A, Bonnamy C, Ficheux M, Guillouet S, Bechade C. Simultaneous Removal And Reinsertion of the PD Catheter in Relapsing Peritonitis. Perit Dial Int 2019; 39:282-288. [PMID: 30852521 DOI: 10.3747/pdi.2018.00230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/14/2019] [Indexed: 11/15/2022] Open
Abstract
Background:Relapsing peritonitis in peritoneal dialysis (PD) is associated with lower cure rates and more hemodialysis (HD) transfers, as catheter removal is recommended in these situations. The aim of our study was to evaluate the continuation of PD without perioperative transfer to HD in patients who underwent a simultaneous catheter removal and replacement for relapsing peritonitis.Methods:This was a retrospective monocentric study. Patients with simultaneous catheter removal and replacement for relapsing peritonitis or peritonitis at high risk of relapse (fungal or Pseudomonas infection) between 1 January 2007 and 31 December 2016 were included. The events of interest were the continuation of PD without perioperative transfer to HD, postoperative complications, new infection with the same organism, and technique survival.Results:Of the 271 incident patients in PD during this period, 11 had a simultaneous catheter removal and replacement for relapsing peritonitis (8) or high risk of relapse peritonitis (3). Eight (72.7%) patients pursued PD without transfer to HD. Six infections were due to microorganisms other than gram-positive cocci. At 1 year, 7 (63.6%) of the 11 patients were still on PD. After the surgery, there were no peritonitis or catheter-related infections caused by the same organism.Conclusion:Simultaneous catheter removal and replacement for peritonitis appears to be an effective procedure for maintaining patients on PD.
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Affiliation(s)
- Caroline Viron
- CHU de Caen, Department of Nephrology - Dialysis - Transplantation, Caen, France
| | - Thierry Lobbedez
- CHU de Caen, Department of Nephrology - Dialysis - Transplantation, Caen, France .,RDPLF, Pontoise, France
| | - Antoine Lanot
- CHU de Caen, Department of Nephrology - Dialysis - Transplantation, Caen, France
| | - Cécile Bonnamy
- CH de Bayeux, Department of General Surgery, Bayeux, France
| | - Maxence Ficheux
- CHU de Caen, Department of Nephrology - Dialysis - Transplantation, Caen, France
| | - Sonia Guillouet
- CHU de Caen, Department of Nephrology - Dialysis - Transplantation, Caen, France
| | - Clémence Bechade
- CHU de Caen, Department of Nephrology - Dialysis - Transplantation, Caen, France.,U1086 INSERM - ANTICIPE - Centre Régional de Lutte contre le Cancer François Baclesse, Caen, France
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Lichodziejewska-Niemierko M, Chmielewski M, Wojtaszek E, Suchowierska E, Gołembiewska E, Grajewska M, Matuszkiewicz-Rowińska J, Naumnik B, Sulikowska B, Niemczyk S, Kłak R, Mosakowska M, Jagodziński P, Marcykiewicz B, Kalita K, Krawczyk R, Cieszyński K, Adamski M, Bronk M. Current epidemiology and practice patterns in prevention and treatment of PD-related infections in Poland. Int Urol Nephrol 2019; 51:335-341. [PMID: 30604230 DOI: 10.1007/s11255-018-2057-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 12/10/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) related infections are associated with technique failure and mortality. The aim of this multicentre study was to examine epidemiology, treatment and outcomes of PD-related infections in Poland as well as practice patterns for prevention of these complications in the context of current ISPD recommendations. METHODS A survey on PD practices in relation to infectious complications was conducted in 11 large Polish PD centres. Epidemiology of peritonitis and exit-site infections (ESI) was examined in all patients treated in these units over a 2 year period. RESULTS The study included data on 559 PD patients with 62.4% on CAPD. Practice patterns for prevention of infectious complications are presented. The rate of peritonitis was 0.29 episodes per year at risk, with Gram positive microorganisms responsible for more than 50% of infections and 85.8% effectively treated. Diagnosis and treatment followed ISPD guidelines however most units did not provide an anti-fungal prophylaxis. Although neither of the centres reported routine topical mupirocin on catheter exit-site, the rate of ESI was low (0.1 episodes per year at risk), with Staphylococcus aureus as most common pathogen and full recovery in 78.3% of cases. CONCLUSION The study shows rewarding outcomes in prevention and treatment of PD-associated infections, mainly due to a thorough compliance with the current ISPD guidelines, although some deviations from the recommendations in terms of practice patterns have been observed. More studies are needed in large numbers of patients to differentiate the importance of specific recommendations and further support the guidelines.
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Affiliation(s)
- Monika Lichodziejewska-Niemierko
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland. .,Dialysis Unit, Fresenius Nephrocare, Gdańsk, Poland.
| | - Michał Chmielewski
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Ewa Wojtaszek
- Department of Nephrology, Dialysis and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Suchowierska
- 1st Department of Nephrology and Transplantation with Dialysis Unit, Medical University of Białystok, Białystok, Poland
| | - Edyta Gołembiewska
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Magdalena Grajewska
- Department of Nephrology, Hypertension and Internal Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | | | - Beata Naumnik
- 1st Department of Nephrology and Transplantation with Dialysis Unit, Medical University of Białystok, Białystok, Poland
| | - Beata Sulikowska
- Department of Nephrology, Hypertension and Internal Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Stanisław Niemczyk
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Renata Kłak
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland
| | - Magdalena Mosakowska
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | | | | | | | - Robert Krawczyk
- Dialysis Unit, Fresenius Nephrocare, Ostrów Wielkopolski, Poland
| | | | | | - Marek Bronk
- Clinical Microbiology Laboratory, University Hospital of Gdańsk, Gdańsk, Poland
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71
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Yang J, Qi XM, Wu YG. The Application Analysis of Multiplex Real-Time Polymerase Chain Reaction Assays for Detection of Pathogenic Bacterium in Peritoneal Dialysis-Associated Peritonitis. Blood Purif 2019; 47:337-345. [PMID: 30602148 DOI: 10.1159/000495780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/26/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS To estimate the clinical value of bacterial detection in peritoneal dialysis-associated peritonitis (PDAP) by multiplex real-time polymerase chain reaction (RT-PCR). This study was undertaken to evaluate multiplex RT-PCR for identifying clinically significant bacteria in PDAP. METHODS Seventy peritoneal dialysate specimens were collected and traditional bacterial culture and universal primer RT-PCR detection of the bacterial were used. RESULTS The positive rate of traditional culture method was 65.71% (46/70) and that of universal primer RT-PCR was 81.42% (57/70). For 6 clinical commonly pathogenic bacteria, multiplex, and monoplex RT-PCR all detected 38 positive ones within the 57 specimens that were detected positive by universal primer RT-PCR. The results of the 2 methods were completely identical. Detecting bacteria by universal primer PCR and Monoplex RT-PCR needs 4-5 and 6-9 h, respectively, while multiplex RT-PCR needs less than 3 h. CONCLUSION Our results demonstrated that the multiplex RT-PCR can detect several kinds of bacteria simultaneously and it is also more practical and convenient than monoplex RT-PCR.
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Affiliation(s)
- Jing Yang
- Department of Nephropathy, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiang-Ming Qi
- Department of Nephropathy, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yong-Gui Wu
- Department of Nephropathy, The First Affiliated Hospital of Anhui Medical University, Hefei, China,
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72
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Bieber S, Mehrotra R. Peritoneal Dialysis Access Associated Infections. Adv Chronic Kidney Dis 2019; 26:23-29. [PMID: 30876613 DOI: 10.1053/j.ackd.2018.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 11/11/2022]
Abstract
Infection is a significant driver of morbidity and mortality in patients with end-stage renal disease undergoing maintenance dialysis. In the United States, septicemia and other infections account for 8% deaths in patients undergoing dialysis. In patients undergoing peritoneal dialysis (PD), PD-related peritonitis remains the most frequent treatment-related infection and is the greatest contributor to infection-related morbidity, including risk for hospitalization, and temporary or permanent transfer to hemodialysis. In the 4 decades since the introduction of ambulatory PD in clinical practice, a large number of treatment innovations have been shown to be effective in reducing the risk for exit site infection and PD-related peritonitis. Notwithstanding the evidence for efficacy of these innovations and the numerous adverse health consequences with PD-related peritonitis, the uptake of these interventions in clinical practice around the world remains inconsistent. This article reviews current knowledge with regards to prevention of PD-associated infections, and the diagnosis and management of exit site infections and peritonitis.
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73
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Cho Y, Htay H, Johnson DW. Centre effects and peritoneal dialysis-related peritonitis. Nephrol Dial Transplant 2018; 32:913-915. [PMID: 28505351 DOI: 10.1093/ndt/gfx054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 03/06/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Australasian Kidney Trial Network, Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - Htay Htay
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Australasian Kidney Trial Network, Centre for Health Services Research, University of Queensland, Brisbane, Australia.,Department of Nephrology, Singapore General Hospital, Singapore
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Australasian Kidney Trial Network, Centre for Health Services Research, University of Queensland, Brisbane, Australia
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74
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Abraham G, Gupta A, Prasad KN, Rohit A, Bhalla AK, Billa V, Chakravati R, Das T, Dhinakaran T, Dutta AR, Giri P, Jeloka T, Kumar S, Marwaha A, Raghavan RV, Ravichandran R, Rohit R, Sarkar CN, Singh NSK. Microbiology, clinical spectrum and outcome of peritonitis in patients undergoing peritoneal dialysis in India: Results from a multicentric, observational study. Indian J Med Microbiol 2018; 35:491-498. [PMID: 29405139 DOI: 10.4103/ijmm.ijmm_17_392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD)-related peritonitis is a major risk factor for drop out of patients on continuous ambulatory PD (CAPD) and automated PD (APD). Factors affecting PD-related peritonitis and centre-specific microbiological data are lacking in India. A multicentric prospective observational study was designed to overcome the gaps in the existing data regarding causative organism and outcome. METHODOLOGY The present study was a prospective, uncontrolled, open-label; observational study conducted in 21 centres representing all the four geographical regions (North, South, East and West) of India between April 2010 and December 2011. RESULTS A total of 244 patients on chronic PD with peritonitis were enrolled in the study (CAPD and APD), who met the inclusion criteria, from 21 centres covering the different geographical areas of India. Amongst the 85 samples that were culture positive, 38 (44.7%) were in the monsoon season followed by 23 (27.1%) in the post-monsoon, 18 (21.2%) during winter and 11 (12.9%) during summer. Maximum culture positivity (72.7%) was observed with automated culture technique. Microorganisms could be isolated in only 85 cases (35.3%) while the remaining samples were culture negative (156/241, 64.7% of samples). Organisms isolated were Gram-negative in 47.8%, Gram-positive in 36.7%, fungal in 13.3% and Mycobacterium tuberculosis in 2.2%. CONCLUSION This large multicentre study of peritonitis offers insights into the aetiology and outcomes of infectious complications of chronic PD in India that are germane to clinical decision-making.
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Affiliation(s)
- Georgi Abraham
- Department of Nephrology, Madras Medical Mission, Chennai, India
| | - Amit Gupta
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kashi Nath Prasad
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anusha Rohit
- Department of Microbiology, Madras Medical Mission, Chennai, India
| | | | | | | | - Tonmoy Das
- Department of Nephrology, International Hospital, Guwahati, Assam, India
| | - Thadakanathan Dhinakaran
- Department of Nephrology, Madurai Kidney Center and Transplantation Research Center, Madurai, India
| | - Arup Ratan Dutta
- Department of Nephrology, Fortis Hospital and Kidney Institute, Kolkata, West Bengal, India
| | - Padmanabhan Giri
- Department of Nephrology, Renal Care Hospital, Trichy, Tamil Nadu, India
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- Department of Nephrology, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Tarun Jeloka
- Department of Nephrology, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
| | - Sampath Kumar
- Department of Nephrology, Meenakshi Mission Hospital and Research Center, Madurai, India
| | - Ajay Marwaha
- Department of Nephrology, Kidney Hospital, Jalandhar, Punjab, India
| | | | | | - Roshan Rohit
- Department of Medical Research and Medical Affairs-Industry, Baxter Pvt. Ltd, India
| | - Chandra Nath Sarkar
- Department of Nephrology, Fortis Hospital and Kidney Institute, Kolkata, West Bengal, India
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75
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Mendes K, Harmanjeet H, Sedeeq M, Modi A, Wanandy T, Zaidi STR, Ming LC, Castelino RL, Sud K, Peterson GM, Patel RP. Stability of Meropenem and Piperacillin/Tazobactam with Heparin in Various Peritoneal Dialysis Solutions. Perit Dial Int 2018; 38:430-440. [PMID: 29991562 DOI: 10.3747/pdi.2017.00274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/17/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Infections caused by ceftazidime-resistant Pseudomonas and extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacteria are increasing worldwide. Meropenem and piperacillin/tazobactam (PIP/TZB) are recommended for the treatment of peritoneal dialysis-associated peritonitis (PDAP) caused by ceftazidime-resistant Pseudomonas and other resistant gram-negative bacteria. Patients may also receive intraperitoneal heparin to prevent occlusion of their catheters. However, the stability of meropenem or PIP/TZB, in combination with heparin, in different types of peritoneal dialysis (PD) solutions used in clinical practice is currently unknown. Therefore, we investigated the stability of meropenem and PIP/TZB, each in combination with heparin, in different PD solutions. METHODS A total of 15 PD bags (3 bags for each type of PD solution) containing meropenem and heparin and 24 PD bags (3 bags for each type of PD solution) containing PIP/TZB and heparin were prepared and stored at 4°C for 168 hours. The same bags were stored at 25°C for 3 hours followed by 10 hours at 37°C. An aliquot withdrawn before storage and at defined time points was analyzed for the concentration of meropenem, PIP, TZB, and heparin using high-performance liquid chromatography. Samples were also analysed for particle content, pH and color change, and the anticoagulant activity of heparin. RESULTS Meropenem and heparin retained more than 90% of their initial concentration in 4 out of 5 types of PD solutions when stored at 4°C for 168 hours, followed by storage at 25°C for 3 hours and then at 37°C for 10 hours. Piperacillin/tazobactam and heparin were found to be stable in all 8 types of PD solutions when stored under the same conditions. Heparin retained more than 98% of its initial anticoagulant activity throughout the study period. No evidence of particle formation, color change, or pH change was observed at any time under the storage conditions employed in the study. CONCLUSIONS This study provides clinically important information on the stability of meropenem and PIP/TZB, each in combination with heparin, in different PD solutions. The use of meropenem-heparin admixed in pH-neutral PD solutions for the treatment of PDAP should be avoided, given the observed suboptimal stability of meropenem.
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Affiliation(s)
- Karryl Mendes
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Mohammed Sedeeq
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Ankit Modi
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Troy Wanandy
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.,Department of Pharmacy, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Syed Tabish R Zaidi
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Long C Ming
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.,School of Pharmacy, KPJ Healthcare University College, Nilai, Negeri Sembilan, Malaysia
| | - Ronald L Castelino
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.,School of Nursing, Peritoneal Dialysis Unit, Blacktown Hospital, Blacktown, New South Wales, Australia.,Regional Dialysis Centre, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Kamal Sud
- Regional Dialysis Centre, Blacktown Hospital, Blacktown, New South Wales, Australia.,Department of Renal Medicine, Nepean Hospital and Nepean Clinical School, The University of Sydney, Kingswood, New South Wales, Australia
| | - Gregory M Peterson
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Rahul P Patel
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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76
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A Case of Relapsing Peritoneal Dialysis-Associated Peritonitis by Dokdonella koreensis. Case Rep Infect Dis 2018; 2018:3820513. [PMID: 30073100 PMCID: PMC6057316 DOI: 10.1155/2018/3820513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/14/2018] [Indexed: 12/05/2022] Open
Abstract
Peritonitis is a common and serious complication of peritoneal dialysis (PD) with significant morbidity. We report the first case of relapsing Dokdonella koreensis peritonitis in a patient on peritoneal dialysis. A 63-year-old Chinese man, with history of renal failure on continuous ambulatory peritoneal dialysis, presented with cloudy peritoneal effluent and abdominal pain. There was no sign or symptom suggestive of exit-site/tunnel tract infection. Peritoneal effluent cultures yielded Dokdonella koreensis which was initially misidentified as Weeksella virosa and Brevundimonas species by the API® 20 NE and VITEK® 2 GN ID card, respectively. He was treated with intraperitoneal amikacin, but the infection relapsed within a few days upon completing each antibiotic course. He eventually required removal of catheter and was transferred to hemodialysis. Infections due to unusual organisms may pose a diagnostic issue as currently available commercial tests will not be able to identify them. There is a role for using 16S rRNA sequencing to help identify these organisms and guide patient management.
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77
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Htay H, Cho Y, Pascoe EM, Hawley C, Clayton PA, Borlace M, Badve SV, Sud K, Boudville N, McDonald SP, Johnson DW. Outcomes of Acinetobacter Peritonitis in Peritoneal Dialysis Patients: A Multicenter Registry Analysis. Perit Dial Int 2018; 38:257-265. [DOI: 10.3747/pdi.2017.00199] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/29/2017] [Indexed: 11/15/2022] Open
Abstract
Background Acinetobacter is a rare but important cause of peritonitis in peritoneal dialysis (PD) patients. As the complication has not been comprehensively evaluated previously, the present study examined the outcomes of Acinetobacter peritonitis in a large, national cohort of PD patients. Methods The study included all episodes of peritonitis in Australia from January 2004 to December 2014 using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data. The primary outcome was peritonitis cure and secondary outcomes were catheter removal, hemodialysis transfer, recurrent/relapsing peritonitis, peritonitis-related hospitalization, and death. Outcomes were compared using multivariable logistic regression. Results Overall, 5,367 patients experienced 11,122 episodes of peritonitis across 51 centers in Australia. Of these, 228 (4.2%) patients experienced 253 (2.3%) episodes of Acinetobacter peritonitis (176 episodes were due to Acinetobacter alone and 77 involved co-infection with other organisms). Of the 176 solitary Acinetobacter episodes, 131(74%) achieved cure with antibiotics alone. Compared with Acinetobacter, significantly lower odds of peritonitis cure were observed for Pseudomonas (adjusted odds ratio [AOR] 0.24, 95% confidence interval [CI]: 0.16 – 0.36), other gram-negative organisms (AOR 0.54, 95% CI 0.37 – 0.77), fungi (AOR 0.02, 95% CI 0.01 – 0.03), and polymicrobial organisms (AOR 0.36, 95% CI 0.25 – 0.51), whilst similar odds of cure were observed for Staphylococcus (AOR 0.73, 95% CI 0.50 – 1.06), other gram-positive organisms (AOR 1.32,95% CI 0.93 – 1.89), culture-negative (AOR 1.19, 95% CI 0.82 –1.71), and other organisms (AOR 0.72, 95% CI 0.49 – 1.07). The odds of catheter removal and hemodialysis transfer were higher with Pseudomonas, other gram-negative, fungal, and polymicrobial peritonitis than with Acinetobacter peritonitis. The odds of death were also higher with Pseudomonas and fungal peritonitis than with Acinetobacter peritonitis. Treatment of Acinetobacter peritonitis with gentamicin, ciprofloxacin, or ceftazidime achieved comparable outcomes. Conclusions Outcomes of Acinetobacter peritonitis were favorable compared with most other forms of organism-specific peritonitis. Commonly used antibiotics covering gram-negative bacteria achieved comparable outcomes in Acinetobacter peritonitis.
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Affiliation(s)
- Htay Htay
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, Diamantina Institute, University of Queensland, Brisbane, Australia
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Yeoungjee Cho
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, Diamantina Institute, University of Queensland, Brisbane, Australia
| | - Elaine M. Pascoe
- Australasian Kidney Trials Network, Diamantina Institute, University of Queensland, Brisbane, Australia
| | - Carmel Hawley
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, Diamantina Institute, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Philip A. Clayton
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Monique Borlace
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
| | - Sunil V. Badve
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry
- Department of Nephrology, St George Hospital, Sydney, Australia
| | - Kamal Sud
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry
- Departments of Renal Medicine, Nepean and Westmead Hospitals, Sydney, Australia
- University of Sydney Medical School, Sydney, Australia
| | - Neil Boudville
- School of Medicine and Pharmacology, University of Western Australia, Australia
| | - Stephen P. McDonald
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - David W. Johnson
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, Diamantina Institute, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
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Abstract
Peritoneal dialysis is an effective treatment modality for patients with end-stage renal disease. The relative use of peritoneal dialysis versus hemodialysis varies widely by country. Data from a 2004 survey reports the percentage of patients with end-stage renal disease treated with peritoneal dialysis to be 5%-10% in economically developed regions like the US and Western Europe to as much as 75% in Mexico. This disparity is probably related to the availability and access to hemodialysis, or in some cases patient preference for peritoneal over hemodialysis. Peritoneal dialysis-related peritonitis remains the major complication and primary challenge to the long-term success of peritoneal dialysis. Fifty years ago, with the advent of the Tenckhoff catheter, patients averaged six episodes of peritonitis per year on peritoneal dialysis. In 2016, the International Society for Peritoneal Dialysis proposed a benchmark of 0.5 episodes of peritonitis per year or one episode every 2 years. Despite the marked reduction in peritonitis over time, peritonitis for the individual patient is problematic. The mortality for an episode of peritonitis is 5% and is a cofactor for mortality in another 16% of affected patients. Prevention of peritonitis and prompt and appropriate management of peritonitis is essential for the long-term success of peritoneal dialysis in all patients. In this review, challenges and solutions are addressed regarding the pathogenesis, clinical features, diagnosis, treatment, and prevention of peritoneal dialysis-related peritonitis from the viewpoint of an infectious disease physician.
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79
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Yang X, Tong Y, Yan H, Ni Z, Qian J, Fang W. High Intraperitoneal Interleukin-6 Levels Predict Peritonitis in Peritoneal Dialysis Patients: A Prospective Cohort Study. Am J Nephrol 2018; 47:317-324. [PMID: 29779030 DOI: 10.1159/000489271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 04/13/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND To evaluate the predictive value of dialysate interleukin-6 (IL-6) representing local subclinical intraperitoneal inflammation for the development of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS Stable prevalent CAPD patients were enrolled in this prospective study. IL-6 concentration in the overnight effluent was determined and expressed as the IL-6 appearance rate (IL-6AR). Patients were divided into 2 groups according to the median of IL-6AR and prospectively followed up until the first episode of peritonitis, cessation of PD, or the end of the study (December 30, 2017). The utility of IL-6AR in predicting peritonitis-free survival was analyzed using the Kaplan-Meier and Cox proportional hazards models. RESULTS A total of 149 patients were enrolled, including 72 males (48%) with mean age 52.0 ± 13.6 years and median PD duration 26 (5.9-45.5) months. During follow-up, 7,923 patient months were observed and 154 episodes of peritonitis occurred in 82 patients. Previous peritonitis episodes were significantly associated with log dialysate IL-6AR levels (β = 0.187 [0.022-0.299], p = 0.023). Patients in the high IL-6AR group showed a significantly inferior peritonitis-free survival when compared with their counterparts in the low IL-6AR group (48.8 vs. 67.7 months, p = 0.026), as well as higher treatment failure percentage of peritonitis (20.3 vs. 9.3%, p = 0.049). A multivariate Cox regression showed that high dialysate IL-6AR (hazard ratio [HR] 1.247 [1.052-1.478]; p = 0.011) and high serum C-reactive protein (HR 1.072 [1.005-1.144]; p = 0.036) were independent risk factors for inferior peritonitis-free survival. CONCLUSION This prospective study suggested that the intraperitoneal inflammation marker, dialysate IL-6 level, might be a potential predictor of peritonitis development in patients undergoing PD.
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80
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The microbiome in chronic kidney disease patients undergoing hemodialysis and peritoneal dialysis. Pharmacol Res 2018; 130:143-151. [DOI: 10.1016/j.phrs.2018.02.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 12/19/2022]
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81
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Chen JHC, Johnson DW, Hawley C, Boudville N, Lim WH. Association between causes of peritoneal dialysis technique failure and all-cause mortality. Sci Rep 2018; 8:3980. [PMID: 29507305 PMCID: PMC5838094 DOI: 10.1038/s41598-018-22335-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 02/21/2018] [Indexed: 01/27/2023] Open
Abstract
Technique failure is a frequent complication of peritoneal dialysis (PD), but the association between causes of death-censored technique failure and mortality remains unclear. Using Australian and New Zealand Dialysis and Transplant (ANZDATA) registry data, we examined the associations between technique failure causes and mortality in all incident PD patients who experienced technique failure between 1989-2014. Of 4663 patients, 2415 experienced technique failure attributed to infection, 883 to inadequate dialysis, 836 to mechanical failure and 529 to social reasons. Compared to infection, the adjusted hazard ratios (HR) for all-cause mortality in the first 2 years were 0.83 (95%CI 0.70-0.98) for inadequate dialysis, 0.78 (95%CI 0.66-0.93) for mechanical failure and 1.46 (95%CI 1.24-1.72) for social reasons. The estimates from the competing risk models were similar. There was an interaction between age and causes of technique failure (pinteraction < 0.001), such that the greatest premature mortality was observed in patients aged >60 years post social-related technique failure. There was no association between causes of technique failure and mortality beyond 2 years. In conclusion, infection and social-related technique failure are associated with premature mortality within 2 years post technique failure. Future studies examining the associations may help to improve outcomes in these patients.
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Affiliation(s)
- Jenny H C Chen
- Department of Nephrology, Prince of Wales Hospital, Sydney, Australia.
- School of Medicine, University of New South, Sydney, Australia.
| | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- Australasian Kidney Trials Network, Brisbane, Australia
| | - Carmel Hawley
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- Australasian Kidney Trials Network, Brisbane, Australia
| | - Neil Boudville
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Wai H Lim
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
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Boudville N, Cho Y, Equinox KL, Figueiredo AE, Hawley CM, Howard K, Johnson DW, Jose M, Lee A, Maley MA, Moodie JA, Pascoe EM, Steiner GZ, Tomlins M, Voss D, Chow J. Teaching peritoneal dialysis in Australia: An opportunity for improvement. Nephrology (Carlton) 2018; 23:259-263. [DOI: 10.1111/nep.12992] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/03/2016] [Accepted: 12/27/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Neil Boudville
- School of Medicine and Pharmacology; University of Western Australia; Perth Queensland Australia
- Australasian Kidney Trials Network, Diamantina Institute; University of Queensland; Brisbane Queensland Australia
| | - Yeoungjee Cho
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Queensland Australia
- Australasian Kidney Trials Network, Diamantina Institute; University of Queensland; Brisbane Queensland Australia
- Translational Research Institute; Brisbane Queensland Australia
| | | | - Ana Elizabeth Figueiredo
- School of Nursing; Nutrition and Physiotherapy at Pontifícia Universidade Católica do Rio Grande do Sul; Porto Alegre Brazil
| | - Carmel M Hawley
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Queensland Australia
- Australasian Kidney Trials Network, Diamantina Institute; University of Queensland; Brisbane Queensland Australia
- Translational Research Institute; Brisbane Queensland Australia
| | - Kirsten Howard
- School of Public Health; University of Sydney; Sydney Australia
| | - David W Johnson
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Queensland Australia
- Australasian Kidney Trials Network, Diamantina Institute; University of Queensland; Brisbane Queensland Australia
- Translational Research Institute; Brisbane Queensland Australia
| | - Matthew Jose
- School of Medicine; University of Tasmania; Melbourne New South Wales Australia
| | - Anna Lee
- Department of Nephrology; Illawarra Shoalhaven Local Health District; Melbourne New South Wales Australia
| | - Moira Alison Maley
- School of Medicine and Pharmacology; University of Western Australia; Perth Queensland Australia
- Australasian Kidney Trials Network, Diamantina Institute; University of Queensland; Brisbane Queensland Australia
| | | | - Elaine M Pascoe
- Australasian Kidney Trials Network, Diamantina Institute; University of Queensland; Brisbane Queensland Australia
| | - Genevieve Z Steiner
- National Institute of Complementary Medicine (NICM), Western Sydney University; Penrith New South Wales Australia
| | - Melinda Tomlins
- John Hunter Hospital; Hunter New England Local Health District; Melbourne New South Wales Australia
| | - David Voss
- Middlemore Hospital; Auckland New Zealand
| | - Josephine Chow
- University of Sydney; Sydney Australia
- University of Tasmania; Australia
- South Western Sydney Local Health District, NSW; Melbourne New South Wales Australia
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83
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Ribera-Sánchez R, Pérez-Fontán M, López-Iglesias A, García-Enríquez A, Rodríguez-Carmona A. Comprehensive Approach to Peritoneal Dialysis-Related Peritonitis by Enteric Microorganisms. Comparison Between Single Organism and Polymicrobial Infections. Perit Dial Int 2018; 38:139-146. [PMID: 29386310 DOI: 10.3747/pdi.2017.00184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/08/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Peritoneal infections of enteric origin (EntP) have been classically investigated using partial strategies, focused on particular subgroups of microorganisms. A more comprehensive approach may facilitate the definition of the nomenclature and clinical presentation of these infections. OBJECTIVES To investigate the clinical presentation and outcomes of a full spectrum of EntP, with a particular interest in the comparison between single-organism and polymicrobial infections. METHOD Following an observational design, we investigated 165 single-organism and 83 polymicrobial peritonitis episodes with isolation of at least 1 enteric bacteria (Enterobacteriaceae, Enterococcus spp. and/or intestinal anaerobics). We compared the risk of treatment failure for these 2 types of infection and explored the significance of the isolation of specific microorganisms and of their antibacterial susceptibility patterns. RESULTS Polymicrobial EntP was associated with higher rates of hospitalization, more changes to initial antibiotic therapy, more surgical explorations, and higher mortality and treatment failure rates than monobacterial EntP. However, stratified and multivariate analyses revealed that the burden of these differences rested on the isolation of intestinal anaerobics (odds ratio [OR] 12.05, 95% confidence interval [CI] 2.53-31.09, p < 0.001) and/or Enterococcus faecium (OR 3.37, 95% CI 1.02-11.30, p = 0.046), while other polymicrobial infections were more comparable with single-organism peritonitis, except for even higher mortality rates in the former group. Lower antibiotic susceptibility of the isolations (OR 1.18, 95% CI 0.51-2.70, p = 0.70) did not perform as a predictor of treatment failure. CONCLUSION A comprehensive approach to peritoneal infections by intestinal microorganisms may provide a focused perspective of the clinical presentation and outcomes of these complications of peritoneal dialysis.
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Affiliation(s)
| | - Miguel Pérez-Fontán
- Division of Nephrology, University Hospital A Coruña, Spain .,Department of Medicine, Health Sciences Faculty, University of A Coruña, Spain
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84
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Htay H, Cho Y, Pascoe EM, Darssan D, Nadeau-Fredette AC, Hawley C, Clayton PA, Borlace M, Badve SV, Sud K, Boudville N, McDonald SP, Johnson DW. Center Effects and Peritoneal Dialysis Peritonitis Outcomes: Analysis of a National Registry. Am J Kidney Dis 2017; 71:814-821. [PMID: 29289475 DOI: 10.1053/j.ajkd.2017.10.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/11/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Peritonitis is a common cause of technique failure in peritoneal dialysis (PD). Dialysis center-level characteristics may influence PD peritonitis outcomes independent of patient-level characteristics. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS Using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data, all incident Australian PD patients who had peritonitis from 2004 through 2014 were included. PREDICTORS Patient- (including demographic data, causal organisms, and comorbid conditions) and center- (including center size, proportion of patients treated with PD, and summary measures related to type, cause, and outcome of peritonitis episodes) level predictors. OUTCOMES & MEASUREMENT The primary outcome was cure of peritonitis with antibiotics. Secondary outcomes were peritonitis-related catheter removal, hemodialysis therapy transfer, peritonitis relapse/recurrence, hospitalization, and mortality. Outcomes were analyzed using multilevel mixed logistic regression. RESULTS The study included 9,100 episodes of peritonitis among 4,428 patients across 51 centers. Cure with antibiotics was achieved in 6,285 (69%) peritonitis episodes and varied between 38% and 86% across centers. Centers with higher proportions of dialysis patients treated with PD (>29%) had significantly higher odds of peritonitis cure (adjusted OR, 1.21; 95% CI, 1.04-1.40) and lower odds of catheter removal (OR, 0.78; 95% CI, 0.62-0.97), hemodialysis therapy transfer (OR, 0.78; 95% CI, 0.62-0.97), and peritonitis relapse/recurrence (OR, 0.68; 95% CI, 0.48-0.98). Centers with higher proportions of peritonitis episodes receiving empirical antibiotics covering both Gram-positive and Gram-negative organisms had higher odds of cure with antibiotics (OR, 1.22; 95% CI, 1.06-1.42). Patient-level characteristics associated with higher odds of cure were younger age and less virulent causative organisms (coagulase-negative staphylococci, streptococci, and culture negative). The variation in odds of cure across centers was 9% higher after adjustment for patient-level characteristics, but 66% lower after adjustment for center-level characteristics. LIMITATIONS Retrospective study design using registry data. CONCLUSIONS These results suggest that center effects contribute substantially to the appreciable variation in PD peritonitis outcomes that exist across PD centers within Australia.
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Affiliation(s)
- Htay Htay
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia; Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Yeoungjee Cho
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia
| | - Darsy Darssan
- Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia
| | | | - Carmel Hawley
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Central Northern Adelaide Renal and Transplantation Service; Royal Adelaide Hospital, Adelaide, Australia; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Monique Borlace
- Central Northern Adelaide Renal and Transplantation Service; Royal Adelaide Hospital, Adelaide, Australia
| | - Sunil V Badve
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Nephrology, St George Hospital, Sydney, Australia
| | - Kamal Sud
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Renal Medicine, Nepean Hospital, Sydney, Australia; Department of Renal Medicine, Westmead Hospital, Sydney, Australia; University of Sydney Medical School, Sydney, Australia
| | - Neil Boudville
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Stephen P McDonald
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Central Northern Adelaide Renal and Transplantation Service; Royal Adelaide Hospital, Adelaide, Australia; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - David W Johnson
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia.
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85
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Ponce D, de Moraes TP, Pecoits-Filho R, Figueiredo AE, Barretti P. Peritonitis in Children on Chronic Peritoneal Dialysis: The Experience of a Large National Pediatric Cohort. Blood Purif 2017; 45:118-125. [PMID: 29241184 DOI: 10.1159/000484344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/17/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND We performed this study to evaluate the incidence, risk factors, microbiology, treatment, and outcome of peritonitis in pediatric Peritoneal dialysis (PD) patients at a nationwide prospective study. METHODOLOGY Patients younger than 18 years recruited in the BRAZPD II study from 2004 to 2011, who presented their first peritonitis episode, were included in the study. RESULTS We found 125 first episodes of peritonitis in 491 children PD patients (0.43 episodes/patient-year). Patients free of peritonitis episode constituted 75.6% in 1 year. Culture-negative episodes were very high (59.2%) and gram-positive (GP) bacteria were the most commonly found organisms (58.8%). First-generation cephalosporin was the initial choice to cover GP (40.5%) and aminoglycosides was the most prescribed antibiotics used for gram-negative agents (27.5%). Treatment failure was 26.4%. Technique failure (TF) occurred in 12.1% and peritonitis was the main cause (65.1%). Pseudomonas (p = 0.04) and negative cultures (p < 0.001) were identified as predictors of TF. CONCLUSION Peritonitis remains a common complication of PD in children and negative cultures and pseudomonas had a negative impact on TF.
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Affiliation(s)
- Daniela Ponce
- Department of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | | | | | - Ana Elizabeth Figueiredo
- Programa de Pós-Graduação em Medicina e Ciências da Saúde (Nefrologia), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Pasqual Barretti
- Department of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
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86
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Nataatmadja M, Cho Y, Johnson DW. Continuous Quality Improvement Initiatives to Sustainably Reduce Peritoneal Dialysis-Related Infections in Australia and New Zealand. Perit Dial Int 2017; 36:472-7. [PMID: 27659926 DOI: 10.3747/pdi.2016.00114] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia Translational Research Institute, Brisbane, Australia Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia Translational Research Institute, Brisbane, Australia Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
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87
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Phui VE, Tan CHH, Chen CK, Lai KH, Chew KF, Chua HH, Ngu LLS, Hii LWS. Causative organisms and outcomes of peritoneal dialysis-related peritonitis in Sarawak General Hospital, Kuching, Malaysia: a 3-year analysis. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-017-0117-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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88
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Lanot A, Bechade C, Verger C, Fabre E, Vernier I, Lobbedez T. Clusters of Practice in Peritoneal Dialysis in France: Data from the Catheter Section of the RDPLF. Perit Dial Int 2017; 38:89-97. [PMID: 29162681 DOI: 10.3747/pdi.2017.00135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 09/03/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Peritonitis is a major cause of peritoneal dialysis (PD) failure. Recommendations for the prevention of peritonitis are available, but wide variations exist in the peritonitis rate among countries and PD units. The objective of this study was to describe the different pattern of practices in France. METHODS This was a retrospective, multicenter study based on data from the French Language Peritoneal Dialysis Registry. Center practices were described and mapped. Clusters of practices were sought in a hierarchical analysis and centers belonging to the same clusters of practices were mapped. RESULTS Data from 2,770 catheters placed in 64 centers in France between 1 February 2012 and 31 December 2016 were considered. A median of 34 (ranging from 5 to 133) catheters was reported in each center. Twenty-eight (43.8%) centers routinely administered a prophylactic antibiotic prior to catheter placement, and 8 (12.5%) centers applied a local prophylactic antibiotic at the exit site, as recommended by International guidelines. The presence of a PD nurse specialized in PD or PD referent nephrologist was not associated with better adherence to guidelines. Practices were heterogeneous across centers. We identified 5 clusters of centers according to practice. Geographical proximity was not associated with homogeneity in practices. CONCLUSION Peritoneal dialysis practices are heterogeneous in France, even those that are subject to International guidelines. Studies to identify associations between center-specific practices and PD patient outcomes remain mandatory. Efforts should be made to standardize the PD standards of care in France.
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Affiliation(s)
- Antoine Lanot
- Néphrologie, CUMR, CHU de Caen, Caen, France.,Université Normandie, Unicaen, UFR de médecine, Caen, France
| | | | | | | | - Isabelle Vernier
- RDPLF, Pontoise, France.,Néphrologie, Polyclinique le Languedoc, Narbonne, France
| | - Thierry Lobbedez
- Néphrologie, CUMR, CHU de Caen, Caen, France .,Université Normandie, Unicaen, UFR de médecine, Caen, France.,RDPLF, Pontoise, France
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89
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McGuire AL, Mulroney KT, Carson CF, Ram R, Morahan G, Chakera A. Analysis of early mesothelial cell responses to Staphylococcus epidermidis isolated from patients with peritoneal dialysis-associated peritonitis. PLoS One 2017; 12:e0178151. [PMID: 28542390 PMCID: PMC5443531 DOI: 10.1371/journal.pone.0178151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 05/08/2017] [Indexed: 02/06/2023] Open
Abstract
The major complication of peritoneal dialysis (PD) is the development of peritonitis, an infection within the abdominal cavity, primarily caused by bacteria. PD peritonitis is associated with significant morbidity, mortality and health care costs. Staphylococcus epidermidis is the most frequently isolated cause of PD-associated peritonitis. Mesothelial cells are integral to the host response to peritonitis, and subsequent clinical outcomes, yet the effects of infection on mesothelial cells are not well characterised. We systematically investigated the early mesothelial cell response to clinical and reference isolates of S. epidermidis using primary mesothelial cells and the mesothelial cell line Met-5A. Using an unbiased whole genome microarray, followed by a targeted panel of genes known to be involved in the human antibacterial response, we identified 38 differentially regulated genes (adj. p-value < 0.05) representing 35 canonical pathways after 1 hour exposure to S. epidermidis. The top 3 canonical pathways were TNFR2 signaling, IL-17A signaling, and TNFR1 signaling (adj. p-values of 0.0012, 0.0012 and 0.0019, respectively). Subsequent qPCR validation confirmed significant differences in gene expression in a number of genes not previously described in mesothelial cell responses to infection, with heterogeneity observed between clinical isolates of S. epidermidis, and between Met-5A and primary mesothelial cells. Heterogeneity between different S. epidermidis isolates suggests that specific virulence factors may play critical roles in influencing outcomes from peritonitis. This study provides new insights into early mesothelial cell responses to infection with S. epidermidis, and confirms the importance of validating findings in primary mesothelial cells.
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Affiliation(s)
- Amanda L. McGuire
- Translational Renal Research Group, Harry Perkins Institute of Medical Research, Nedlands, Western Australia, Australia
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
- * E-mail:
| | - Kieran T. Mulroney
- Translational Renal Research Group, Harry Perkins Institute of Medical Research, Nedlands, Western Australia, Australia
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
| | - Christine F. Carson
- Translational Renal Research Group, Harry Perkins Institute of Medical Research, Nedlands, Western Australia, Australia
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
| | - Ramesh Ram
- Centre for Diabetes Research, Harry Perkins Institute of Medical Research, Nedlands, Western Australia, Australia
| | - Grant Morahan
- Centre for Diabetes Research, Harry Perkins Institute of Medical Research, Nedlands, Western Australia, Australia
| | - Aron Chakera
- Translational Renal Research Group, Harry Perkins Institute of Medical Research, Nedlands, Western Australia, Australia
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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90
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Campbell D, Mudge DW, Craig JC, Johnson DW, Tong A, Strippoli GF. Antimicrobial agents for preventing peritonitis in peritoneal dialysis patients. Cochrane Database Syst Rev 2017; 4:CD004679. [PMID: 28390069 PMCID: PMC6478113 DOI: 10.1002/14651858.cd004679.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) is an important therapy for patients with end-stage kidney disease and is used in more than 200,000 such patients globally. However, its value is often limited by the development of infections such as peritonitis and exit-site and tunnel infections. Multiple strategies have been developed to reduce the risk of peritonitis including antibiotics, topical disinfectants to the exit site and antifungal agents. However, the effectiveness of these strategies has been variable and are based on a small number of randomised controlled trials (RCTs). The optimal preventive strategies to reduce the occurrence of peritonitis remain unclear.This is an update of a Cochrane review first published in 2004. OBJECTIVES To evaluate the benefits and harms of antimicrobial strategies used to prevent peritonitis in PD patients. SEARCH METHODS We searched the Cochrane Kidney and Transplant's Specialised Register to 4 October 2016 through contact with the Information Specialist using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE, and EMBASE; handsearching conference proceedings; and searching the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA RCTs or quasi-RCTs in patients receiving chronic PD, which evaluated any antimicrobial agents used systemically or locally to prevent peritonitis or exit-site/tunnel infection were included. DATA COLLECTION AND ANALYSIS Two authors independently assessed risk of bias and extracted data. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratio (RR) with 95% confidence intervals (CI). MAIN RESULTS Thirty-nine studies, randomising 4435 patients, were included. Twenty additional studies have been included in this update. The risk of bias domains were often unclear or high; risk of bias was judged to be low in 19 (49%) studies for random sequence generation, 12 (31%) studies for allocation concealment, 22 (56%) studies for incomplete outcome reporting, and in 12 (31%) studies for selective outcome reporting. Blinding of participants and personnel was considered to be at low risk of bias in 8 (21%) and 10 studies (26%) for blinding of outcome assessors. It should be noted that blinding of participants and personnel was not possible in many of the studies because of the nature of the intervention or control treatment.The use of oral or topical antibiotic compared with placebo/no treatment, had uncertain effects on the risk of exit-site/tunnel infection (3 studies, 191 patients, low quality evidence: RR 0.45, 95% CI 0.19 to 1.04) and the risk of peritonitis (5 studies, 395 patients, low quality evidence: RR 0.82, 95% CI 0.57 to 1.19).The use of nasal antibiotic compared with placebo/no treatment had uncertain effects on the risk of exit-site/tunnel infection (3 studies, 338 patients, low quality evidence: RR 1.34, 95% CI 0.62 to 2.87) and the risk of peritonitis (3 studies, 338 patients, low quality evidence: RR 0.94, 95% CI 0.67 to 1.31).Pre/perioperative intravenous vancomycin compared with no treatment may reduce the risk of early peritonitis (1 study, 177 patients, low quality evidence: RR 0.08, 95% CI 0.01 to 0.61) but has an uncertain effect on the risk of exit-site/tunnel infection (1 study, 177 patients, low quality evidence: RR 0.36, 95% CI 0.10 to 1.32).The use of topical disinfectant compared with standard care or other active treatment (antibiotic or other disinfectant) had uncertain effects on the risk of exit-site/tunnel infection (8 studies, 973 patients, low quality evidence, RR 1.00, 95% CI 0.75 to 1.33) and the risk of peritonitis (6 studies, 853 patients, low quality evidence: RR 0.83, 95% CI 0.65 to 1.06).Antifungal prophylaxis with oral nystatin/fluconazole compared with placebo/no treatment may reduce the risk of fungal peritonitis occurring after a patient has had an antibiotic course (2 studies, 817 patients, low quality evidence: RR 0.28, 95% CI 0.12 to 0.63).No intervention reduced the risk of catheter removal or replacement. Most of the available studies were small and of suboptimal quality. Only six studies enrolled 200 or more patients. AUTHORS' CONCLUSIONS In this update, we identified limited data from RCTs and quasi-RCTs which evaluated strategies to prevent peritonitis and exit-site/tunnel infections. This review demonstrates that pre/peri-operative intravenous vancomycin may reduce the risk of early peritonitis and that antifungal prophylaxis with oral nystatin or fluconazole reduces the risk of fungal peritonitis following an antibiotic course. However, no other antimicrobial interventions have proven efficacy. In particular, the use of nasal antibiotic to eradicate Staphylococcus aureus, had an uncertain effect on the risk of peritonitis and raises questions about the usefulness of this approach. Given the large number of patients on PD and the importance of peritonitis, the lack of adequately powered and high quality RCTs to inform decision making about strategies to prevent peritonitis is striking.
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Affiliation(s)
- Denise Campbell
- Centre for Kidney Research, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, Australia, 2145
| | - David W Mudge
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Level 2, ARTS Building, Ipswich Rd, Woolloongabba, Queensland, Australia, 4102
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW, Australia, 2006
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia, 2145
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Queensland, Australia, 4102
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, Australia, 2145
- Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW, Australia, 2006
| | - Giovanni Fm Strippoli
- Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW, Australia, 2006
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia, 2145
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- Medical Scientific Office, Diaverum, Lund, Sweden
- Diaverum Academy, Bari, Italy
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91
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Ndlovu KCZ, Sibanda W, Assounga A. Peritonitis outcomes in patients with HIV and end-stage renal failure on peritoneal dialysis: a prospective cohort study. BMC Nephrol 2017; 18:48. [PMID: 28158991 PMCID: PMC5291961 DOI: 10.1186/s12882-017-0466-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have investigated the management of human immunodeficiency virus (HIV)-associated end-stage renal failure particularly in low-resource settings with limited access to renal replacement therapy. We aimed to evaluate the effects of HIV infection on continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis outcomes and technique failure in highly active antiretroviral therapy (HAART)-treated HIV-positive CAPD populations. METHODS We conducted a single-center prospective cohort study of consecutive incident CAPD patients recruited from two hospitals in Durban, South Africa from September 2012-February 2015. Seventy HIV-negative and 70 HIV-positive end-stage renal failure patients were followed monthly for 18 months at a central renal clinic. Primary outcomes of peritonitis and catheter failure were assessed for the first 18 months of CAPD therapy. We assessed risk factors for peritonitis and catheter failure using Cox regression survival analysis. RESULTS The HIV-positive cohort had a significantly increased rate of peritonitis compared to the HIV-negative cohort (1.86 vs. 0.76 episodes/person-years, respectively; hazard ratio [HR], 2.41; 95% confidence interval [CI], 1.69-3.45, P < 0.001). When the baseline CD4 count was below 200 cells/μL, the peritonitis rate rose to 3.69 episodes/person-years (HR 4.54, 95% CI 2.35-8.76, P < 0.001), while a baseline CD4 count above 350 cells/μL was associated with a peritonitis rate of 1.60 episodes/person-years (HR 2.10, CI 1.39-3.15, P = 0.001). HIV was associated with increased hazards of peritonitis relapse (HR, 3.88; CI, 1.37-10.94; P = 0.010). Independent predictors associated with increased peritonitis risk were HIV (HR, 1.84; CI, 1.07-3.16; P = 0.027), diabetes (HR, 2.09; CI, 1.09-4.03; P = 0.027) and a baseline CD4 count < 200 cells/μL (HR, 3.28; CI, 1.42-7.61; P = 0.006). Catheter failure rates were 0.34 (HIV-positive cohort) and 0.24 (HIV-negative cohort) episodes/person-years (HR, 1.42; 95% CI, 0.73-2.73; P = 0.299). Peritonitis (HR, 14.47; CI, 2.79-75.00; P = 0.001), average hemoglobin concentrations (HR, 0.75; CI, 0.59-0.95; P = 0.016), and average serum C-reactive protein levels were independent predictors of catheter failure. CONCLUSIONS HIV infection in end-stage renal disease patients managed by CAPD was associated with increased peritonitis risk; however, HIV infection did not increase the risk for CAPD catheter failure rate at 18 months.
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Affiliation(s)
- Kwazi C Z Ndlovu
- Inkosi Albert Luthuli Central Hospital, Durban, South Africa. .,Department of Nephrology, University of KwaZulu-Natal, P/Bag X7, Congella, Durban, 4013, South Africa.
| | - Wilbert Sibanda
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Alain Assounga
- Inkosi Albert Luthuli Central Hospital, Durban, South Africa.,Department of Nephrology, University of KwaZulu-Natal, P/Bag X7, Congella, Durban, 4013, South Africa
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92
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Piraino B. Innovations in Treatment Delivery, Risk of Peritonitis, and Patient Retention on Peritoneal Dialysis. Semin Dial 2017; 30:158-163. [PMID: 28066919 DOI: 10.1111/sdi.12571] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Early innovations in the delivery of peritoneal dialysis (PD) markedly improved its acceptability and lowered peritonitis rates. The standard osmotic agent was, and continues to be dextrose, an agent that is not ideal as it is readily absorbed. The development of icodextrin-containing dialysis fluid has allowed a long dwell time to provide more effective ultrafiltration. The development of a smaller, more easily used automated cycler, led to an increase in the proportion of patients on the cycler as opposed to CAPD. Recently, new cyclers with better teaching tools and ease of use and communication with the training team have come on the market; data on outcomes using these cyclers are not yet available. Peritonitis continues to be a serious complication of PD although improvements in connectology and research on Staphylococcus aureus carriage have decreased peritonitis risk. Peritonitis rates continue to vary tremendously from one program to another, which may be in part due to failure to follow best demonstrated practices in training, care of the l catheter exit site, and prevention of peritonitis. Peritonitis rates should be expressed as episodes per year at risk and as organism-specific rates to allow comparisons from one program to another, from one period to another and from a program to the published literature. The term technique failure is misused in PD. Patients leave PD for a host of reasons including transplantation. Transfer from PD to hemodialysis can be planned and have an excellent outcome or can be delayed or done emergently and have a less optimal outcome. The life plan of the patient with ESRD needs to be not only considered but also periodically revised as circumstances and patient wishes change.
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Affiliation(s)
- Beth Piraino
- Renal Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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93
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Wearne N, Kilonzo K, Effa E, Davidson B, Nourse P, Ekrikpo U, Okpechi IG. Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries. Int J Nephrol Renovasc Dis 2017; 10:1-9. [PMID: 28115864 PMCID: PMC5221809 DOI: 10.2147/ijnrd.s104208] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Chronic kidney disease is a major public health problem that continues to show an unrelenting global increase in prevalence. The prevalence of chronic kidney disease has been predicted to grow the fastest in low- to middle-income countries (LMICs). There is evidence that people living in LMICs have the highest need for renal replacement therapy (RRT) despite the lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD) does not require advanced technologies, much infrastructure, or need for dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. However, CAPD is scarcely available in many LMICs, and even where available, there are several hurdles to be confronted regarding patient selection for this modality. High cost of CAPD due to unavailability of fluids, low patient education and motivation, low remuneration for nephrologists, lack of expertise/experience for catheter insertion and management of complications, presence of associated comorbid diseases, and various socio-demographic factors contribute significantly toward reduced patient selection for CAPD. Cost of CAPD fluids seems to be a major constraint given that many countries do not have the capacity to manufacture fluids but instead rely heavily on fluids imported from developed countries. There is need to invest in fluid manufacturing (either nationally or regionally) in LMICs to improve uptake of patients treated with CAPD. Workforce training and retraining will be necessary to ensure that there is coordination of CAPD programs and increase the use of protocols designed to improve CAPD outcomes such as insertion of catheters, treatment of peritonitis, and treatment of complications associated with CAPD. Training of nephrology workforce in CAPD will increase workforce experience and make CAPD a more acceptable RRT modality with improved outcomes.
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Affiliation(s)
- Nicola Wearne
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Kajiru Kilonzo
- Department of Medicine, Kilimanjaro Christian Medical College, Moshi, Tanzania
| | - Emmanuel Effa
- Department of Medicine, University of Calabar, Calabar, Nigeria
| | - Bianca Davidson
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Peter Nourse
- Division of Paediatric Nephrology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Udeme Ekrikpo
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa; Department of Internal Medicine, University of Uyo, Uyo, Nigeria
| | - Ikechi G Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
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94
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Li PKT, Chow KM, Van de Luijtgaarden MWM, Johnson DW, Jager KJ, Mehrotra R, Naicker S, Pecoits-Filho R, Yu XQ, Lameire N. Changes in the worldwide epidemiology of peritoneal dialysis. Nat Rev Nephrol 2016; 13:90-103. [PMID: 28029154 DOI: 10.1038/nrneph.2016.181] [Citation(s) in RCA: 334] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
As the global burden of chronic kidney disease continues to increase, so does the need for a cost-effective renal replacement therapy. In many countries, patient outcomes with peritoneal dialysis are comparable to or better than those with haemodialysis, and peritoneal dialysis is also more cost-effective. These benefits have not, however, always led to increased utilization of peritoneal dialysis. Use of this therapy is increasing in some countries, including China, the USA and Thailand, but has proportionally decreased in parts of Europe and in Japan. The variable trends in peritoneal dialysis use reflect the multiple challenges in prescribing this therapy to patients. Key strategies for facilitating peritoneal dialysis utilization include implementation of policies and incentives that favour this modality, enabling the appropriate production and supply of peritoneal dialysis fluid at a low cost, and appropriate training for nephrologists to enable increased utilization of the therapy and to ensure that rates of technique failure continue to decline. Further growth in peritoneal dialysis use is required to enable this modality to become an integral part of renal replacement therapy programmes worldwide.
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Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Carol &Richard Yu PD Research Centre, Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong
| | - Kai Ming Chow
- Department of Medicine and Therapeutics, Carol &Richard Yu PD Research Centre, Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong
| | - Moniek W M Van de Luijtgaarden
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, PO Box 22700, Amsterdam 1100 DE, Netherlands
| | - David W Johnson
- Department of Nephrology, Division of Medicine, ARTS Building, University of Queensland at Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, PO Box 22700, Amsterdam 1100 DE, Netherlands
| | - Rajnish Mehrotra
- Kidney Research Institute and Harborview Medical Center, Division of Nephrology, University of Washington, 325 9th Avenue, BOX 359606, Seattle, Washington 98104, USA
| | - Sarala Naicker
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | | | - Xue Qing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Norbert Lameire
- University Hospital Gent, 185, De Pintelaan, BE-9000 Gent, Belgium
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95
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Zhang L, Badve SV, Pascoe EM, Beller E, Cass A, Clark C, de Zoysa J, Isbel NM, Liu X, McTaggart S, Morrish AT, Playford G, Scaria A, Snelling P, Vergara LA, Hawley CM, Johnson DW. Representativeness of Honeypot Trial Participants to Australasian PD Patients. Perit Dial Int 2016; 37:516-522. [PMID: 27935534 DOI: 10.3747/pdi.2016.00065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 10/01/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The HONEYPOT trial failed to establish the superiority of exit-site application of Medihoney compared with nasal mupirocin prophylaxis for the prevention of peritonitis in peritoneal dialysis (PD) patients. This study aimed to assess the representativeness of the patients in the HONEYPOT trial to the Australian and New Zealand PD population. METHODS This study compared baseline characteristics of the 371 PD patients in the HONEYPOT trial with those of 6,085 PD patients recorded on the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. RESULTS Compared with the PD population, the HONEYPOT sample was older (standardized difference [d] = 0.19, p = 0.003), more likely to be treated with automated PD (d = 0.58, p < 0.001), had higher residual renal function (d = 0.26, p < 0.001) and a higher proportion of participants with end-stage kidney disease due to polycystic kidney disease (d = 0.17) and lower proportion due to diabetes (d = -0.17) and glomerulonephritis (d = -0.18) (p < 0.001), and lower proportions of indigenous people (d = -0.17, p < 0.001), current smokers (d = -0.10, p < 0.001), and people with prior histories of hemodialysis (d = -0.16, p < 0.001), diabetes mellitus (d = -0.18, p < 0.001), and coronary artery disease (d = -0.15, p < 0.001). CONCLUSIONS HONEYPOT trial participants tended to be healthier than the Australian and New Zealand PD patient population. Although the differences between the groups were generally modest, it is possible that their cumulative effect may have had some impact on external generalizability, which is not an uncommon occurrence in clinical trials.
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Affiliation(s)
| | - Lei Zhang
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Sunil V Badve
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Department of Nephrology, The St George Hospital, Sydney, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Elaine Beller
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Australia
| | - Alan Cass
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Menzies School of Health Research, Darwin, Australia
| | - Carolyn Clark
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Department of Nephrology, Nambour Hospital, Nambour, Australia
| | - Janak de Zoysa
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Department of Renal Medicine, North Shore Hospital, Auckland, New Zealand
| | - Nicole M Isbel
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Department of Nephrology, The St George Hospital, Sydney, Australia
| | - Xusheng Liu
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Steven McTaggart
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Child & Adolescent Renal Service, Lady Cilento Children's Hospital, Brisbane, Australia
| | - Alicia T Morrish
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Geoffrey Playford
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Anish Scaria
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Paul Snelling
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Department of Nephrology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Liza A Vergara
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia .,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
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96
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Tian Y, Xie X, Xiang S, Yang X, Zhang X, Shou Z, Chen J. Risk factors and outcomes of high peritonitis rate in continuous ambulatory peritoneal dialysis patients: A retrospective study. Medicine (Baltimore) 2016; 95:e5569. [PMID: 27930566 PMCID: PMC5266038 DOI: 10.1097/md.0000000000005569] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Peritonitis remains a major complication of peritoneal dialysis (PD). A high peritonitis rate (HPR) affects continuous ambulatory peritoneal dialysis (CAPD) patients' technique survival and mortality. Predictors and outcomes of HPR, rather than the first peritonitis episode, were rarely studied in the Chinese population. In this study, we examined the risk factors associated with HPR and its effects on clinical outcomes in CAPD patients.This is a single center, retrospective, observational cohort study. A total of 294 patients who developing at least 1 episode of peritonitis were followed up from March 1st, 2002, to July 31, 2014, in our PD center. Multivariate logistic regression was used to determine the factors associated with HPR, and the Cox proportional hazard model was conducted to assess the effects of HPR on clinical outcomes.During the study period of 2917.5 patient-years, 489 episodes of peritonitis were recorded, and the total peritonitis rate was 0.168 episodes per patient-year. The multivariate analysis showed that factors associated with HPR include a quick occurrence of peritonitis after CAPD initiation (shorter than 12 months), and a low serum albumin level at the start of CAPD. In the Cox proportional hazard model, HPR was a significant predictor of technique failure. There were no differences between HPR and low peritonitis rate (LPR) group for all-cause mortality. However, when the peritonitis rate was considered as a continuous variable, a positive correlation was observed between the peritonitis rate and mortality.We found the quick peritonitis occurrence after CAPD and the low serum albumin level before CAPD were strongly associated with an HPR. Also, our results verified that HPR was positively correlated with technique failure. More importantly, the increase in the peritonitis rate suggested a higher risk of all-cause mortality.These results may help to identify and target patients who are at higher risk of HPR at the start of CAPD and to take interventions to reduce peritonitis incidence and improve clinical outcomes.
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Affiliation(s)
- Yuanshi Tian
- Kidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
| | - Xishao Xie
- Kidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
| | - Shilong Xiang
- Kidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
| | - Xin Yang
- Kidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
| | - Xiaohui Zhang
- Kidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
| | - Zhangfei Shou
- Kidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Kidney Disease Center, Zhejiang University International Hospital, Shulan (Hangzhou) Hospital, Hangzhou, Zhejiang Province, P.R. China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
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97
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Abstract
Technical innovations in peritoneal dialysis (PD), now used widely for the long-term treatment of ESRD, have significantly reduced therapy-related complications, allowing patients to be maintained on PD for longer periods. Indeed, the survival rate for patients treated with PD is now equivalent to that with in-center hemodialysis. In parallel, changes in public policy have spurred an unprecedented expansion in the use of PD in many parts of the world. Meanwhile, our improved understanding of the molecular mechanisms involved in solute and water transport across the peritoneum and of the pathobiology of structural and functional changes in the peritoneum with long-term PD has provided new targets for improving efficiency and for intervention. As with hemodialysis, almost half of all deaths on PD occur because of cardiovascular events, and there is great interest in identifying modality-specific factors contributing to these events. Notably, tremendous progress has been made in developing interventions that substantially reduce the risk of PD-related peritonitis. Yet the gains have been unequal among individual centers, primarily because of unequal clinical application of knowledge gained from research. The work to date has further highlighted the areas in need of innovation as we continue to strive to improve the health and outcomes of patients treated with PD.
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Affiliation(s)
- Rajnish Mehrotra
- Kidney Research Institute and
- Harborview Medical Center, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Olivier Devuyst
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Division of Nephrology, Université Catholique de Louvain Medical School, Brussels, Belgium
| | - Simon J Davies
- Department of Nephrology, Keele University, Staffordshire, United Kingdom; and
| | - David W Johnson
- Department of Nephrology, Division of Medicine, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
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98
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Yeo SH, Kwak JH, Kim YU, Lee JS, Kim HJ, Park KH, Lee JS, Ha GY, Lee JH, Lee JY, Yoo KD. Peritoneal dialysis-related peritonitis due to Halomonas hamiltonii: A first case report. Medicine (Baltimore) 2016; 95:e5424. [PMID: 27893682 PMCID: PMC5134875 DOI: 10.1097/md.0000000000005424] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Halomonas hamiltonii is a Gram-negative, halophilic, motile, and nonspore-forming rod bacterium. Although most Halomonas sp. are commonly found in saline environments, it has rarely been implicated as a cause of human infection. Herein, the authors present a case report of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis attributed to H hamiltonii. CASE PRESENTATION An 82-year-old male patient who had been receiving CAPD therapy presented to an emergency department with complaints of abdominal pain and cloudy dialysate that had persisted for 2 days. The peritoneal dialysate was compatible with CAPD peritonitis, with white blood cell count of peritoneal effluent of 810/mm and neutrophils predominated (60%). Two days after culture on blood agar medium, nonhemolytic pink mucoid colonies showed, with cells showing Gram-negative, nonspore-forming rods with a few longer and larger bacilli than usual were found. We also performed biochemical tests and found negative responses in K/K on the triple sugar iron test and H2S and equivocal (very weak) response in the motility test, but positive responses to catalase, oxidase, and urease tests. The partial sequence of the 16S rRNA gene of a bacterium detected by peritoneal fluid culture was utilized for a Basic Local Alignment Search Tool search, which revealed that the organism was H hamiltonii. Intraperitoneal antibiotics were administered for 21 days, and the patient was discharged without clinical problems. CONCLUSION We present here the first case report of CAPD-related peritonitis caused by H hamiltonii, which was identified using molecular biological techniques. Although guidelines do not exist for the treatment of infections caused by this organism, conventional treatment for Gram-negative organisms could be effective.
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Affiliation(s)
- Se Hwan Yeo
- Department of Internal Medicine, Dongguk University
| | | | - Yeo Un Kim
- Department of Internal Medicine, Dongguk University
| | - Jin Suk Lee
- Department of Internal Medicine, Dongguk University
| | - Hyo Jin Kim
- Department of Internal Medicine, Dongguk University
| | | | - Jung Sook Lee
- Korean Collection for Type Cultures, Biological Resource Center, Korea Research Institute of Bioscience and Biotechnology, Jeongeup
| | - Gyoung Yim Ha
- Department of Laboratory Medicine, Dongguk University, Gyeongju
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99
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Kotera N, Tanaka M, Aoe M, Chikamori M, Honda T, Ikenouchi A, Miura R, Sugahara M, Furuse S, Saito K, Mise N. Age-Related Differences of Organism-Specific Peritonitis Rates: A Single-Center Experience. Ther Apher Dial 2016; 20:655-660. [PMID: 27500906 DOI: 10.1111/1744-9987.12449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 04/01/2016] [Accepted: 04/26/2016] [Indexed: 11/27/2022]
Abstract
Peritonitis remains an important cause of morbidity and mortality in peritoneal dialysis (PD) patients, but its incidence and the distribution of causative organisms vary widely between institutions and age groups. This study was performed to investigate the recent status and risk factors of PD-related peritonitis and to clarify differences between age groups. We retrospectively reviewed the medical records of 119 PD patients treated at our department between January 2002 and January 2013. We calculated both overall and organism-specific peritonitis rates and also analyzed risk factors. Sixty-three episodes of peritonitis occurred during 261.5 patient-years for an incident rate of 0.24 episodes/patient-year. Multivariate analysis showed that older age (≥65 years) and hypoalbuminemia (<3.0 g/dL) were associated with an increased risk of peritonitis (P = 0.035 and P = 0.029, respectively). In elderly patients (≥65 years old), the rate of peritonitis due to Gram-positive and Gram-negative bacteria was 0.17 and 0.08 episodes/patient-year, respectively, and Gram-positive peritonitis was markedly more frequent than in younger patients (<65 years old). In particular, there was a high frequency of Staphylococcus aureus peritonitis in elderly patients (0.09 episodes/patient-year) and it had a poor outcome. At our department, the risk of peritonitis was increased in older patients and patients with hypoalbuminemia. The distribution of causative organisms was markedly different between age groups and analysis of organism-specific peritonitis rates helped to identify current problems with our PD program.
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Affiliation(s)
- Nagaaki Kotera
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan.,Kugayama Kidney Clinic, Tokyo, Japan
| | - Mototsugu Tanaka
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan.,Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mari Aoe
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Masatomo Chikamori
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Tomoko Honda
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Ayako Ikenouchi
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Rika Miura
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Mai Sugahara
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Satoshi Furuse
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Katsunori Saito
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Naobumi Mise
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
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100
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El-Reshaid W, Al-Disawy H, Nassef H, Alhelaly U. Comparison of peritonitis rates and patient survival in automated and continuous ambulatory peritoneal dialysis: a 10-year single center experience. Ren Fail 2016; 38:1187-92. [PMID: 27435043 DOI: 10.1080/0886022x.2016.1209025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Peritonitis is a common complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). In this retrospective study, peritonitis rates and patient survival of 180 patients on CAPD and 128 patients on APD were compared in the period from January 2005 to December 2014 at Al-Nafisi Center in Kuwait. All patients had prophylactic topical mupirocin at catheter exit site. Patients on CAPD had twin bag system with Y transfer set. The peritonitis rates were 1 in 29 months in CAPD and 1 in 38 months in APD (p < 0.05). Percentage of peritonitis free patients over 10-year period in CAPD and APD were 49 and 60%, respectively (p < 0.05). Time to develop peritonitis was 10.25 ± 3.1 months in CAPD compared to 16.1 ± 4 months in APD (p < 0.001). Relapse and recurrence rates were similar in both groups. Median patient survival in CAPD and APD groups with peritonitis was 13.1 ± 1 and 14 ± 1.4 months respectively (p = 0.3) whereas in peritonitis free patients it was 15 ± 1.4 months in CAPD and 23 ± 3.1 months in APD (p = 0.025). APD had lower incidence rate of peritonitis than CAPD. Patient survival was better in APD than CAPD in peritonitis free patients but was similar in patients who had peritonitis.
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Affiliation(s)
- Wael El-Reshaid
- a Department of Medicine, Faculty of Medicine , Kuwait University , Kuwait , Kuwait
| | - Hanan Al-Disawy
- b Division of Nephrology , Al-Nafisi Renal Centre , Kuwait, Kuwait
| | | | - Usama Alhelaly
- b Division of Nephrology , Al-Nafisi Renal Centre , Kuwait, Kuwait
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