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Abstract
The purpose of this study is to review the cases of postcolonoscopy appendicitis (PCA) reported in the literature. A comprehensive search using PubMed, EMBASE, Scopus, and Google Scholar identified 57 cases. The median age at presentations of PCA was 55 years. PCAs typically occurred during the first 24 hours after colonoscopy, and the majority developed after diagnostic colonoscopy. Clinical presentations were similar to those with common acute appendicitis, though with a high perforation rate. Most patients were correctly diagnosed using ultrasound or computed tomography scan. Treatment included open appendicectomy, laparoscopic appendicectomy or cecotomy, radiologic drainage of the abscess, nonoperative treatment with antibiotics. In addition to barotrauma, fecalith impaction into the appendiceal lumen, direct trauma to the appendiceal orifice, and underlying ulcerative colitis, a pre-existing subclinical disease of the appendix seems to play an important role in the pathogenesis. For PCA, timely diagnosis and management are crucial to attain a satisfactory outcome.
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Chaudhry RI, Chopra T, Fissell R, Golper TA. Strategies to Prevent Peritonitis after Procedures: Our Opinions. Perit Dial Int 2020; 39:315-319. [DOI: 10.3747/pdi.2018.00148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/28/2018] [Indexed: 12/24/2022] Open
Abstract
Peritoneal Dialysis (PD) patients are at increased risk of peritonitis following elective colonoscopy and other potentially invasive dental or gynecological procedures. The increased risk of iatrogenic peritonitis is attributed to procedure-related factors such as instrumentation, biopsies, tissue injury, and peri-procedural bacterial contamination. Also contributory are patient-related factors such as the effect of the immunocompromised status of end-stage renal disease and the presence of intraperitoneal dialysate on the disruption of natural host defense mechanisms. We propose the use of standard peri-procedure protocols, including procedure-specific prophylactic antibiotics, and discuss the enhanced defense rationale for a dry abdomen during and sometimes after procedures. Depending on the procedure and its inherent risk of causing peritonitis, as well as the patient's ability to withhold PD for up to 3 days, we sometimes increase the intensity of PD before the procedure. We conclude that it is imperative that proceduralists and nephrologists be aware of and proactive about how to mitigate postprocedure PD complications.
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Affiliation(s)
- Rafia I. Chaudhry
- Division of Nephrology and Hypertension, Albany Medical College, Albany, NY, USA
| | - Tushar Chopra
- Division of Nephrology, University of Virginia Health Systems, Charlottesville, VA, USA
| | - Rachel Fissell
- Division of Nephrology, Vanderbilt University Medical Center, Nashville TN, USA
| | - Thomas A. Golper
- Division of Nephrology, Vanderbilt University Medical Center, Nashville TN, USA
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53
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Chen HC, Shieh CC, Sung JM. IncreasingStaphylococcusSpecies Resistance in Peritoneal Dialysis-Related Peritonitis Over a 10-Year Period in a Single Taiwanese Center. Perit Dial Int 2020; 38:266-270. [DOI: 10.3747/pdi.2017.00226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/01/2018] [Indexed: 01/31/2023] Open
Abstract
BackgroundPeritonitis is a major complication of peritoneal dialysis (PD). Staphylococcus species are gram-positive bacteria that are most commonly associated with peritoneal peritonitis. The increasing antimicrobial resistance rate is a severe burden when considering the initial choice of antibiotics. This investigation examined the trends of staphylococcal infection as well as the resistance rate and clinical outcomes from 2006 to 2015 in southern Taiwan.MethodsWe retrospectively investigated all PD-related peritonitis episodes in southern Taiwan between January 2006 and December 2015 and evaluated the clinical characteristics of peritonitis, microbiological prevalence and resistance of Staphylococcus species, and outcomes in patients.ResultsAmong 244 episodes of peritonitis, Staphylococcus species accounted for approximately 65% of the gram-positive bacteria that caused the infection. The methicillin resistance rate among Staphylococcus species substantially increased to 64% by 2015 in both Staphylococcus aureus and coagulase-negative staphylococci in southern Taiwan. Notably, patients with methicillin-resistant staphylococcal infection exhibited a significantly higher hospitalization rate than those with methicillin-sensitive staphylococcal infection. However, the catheter removal rate and transfer to hemodialysis exhibited no differences between the 2 groups.ConclusionPeritonitis is the most serious complication in patients on PD, and microbiological trends have changed over the past 10 years at a single center in southern Taiwan. The number of methicillin-resistant Staphylococcus species has substantially increased. Empirical initial antibiotic therapy should be adapted on the basis of the growing microbiological resistance.
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Affiliation(s)
- Ho-Ching Chen
- Renal Division, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Chang Shieh
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Junne-Ming Sung
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Renal Division, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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54
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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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55
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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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56
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Ljungman S, Jensen JE, Paulsen D, Petersons A, Ots-Rosenberg M, Saha H, Struijk DG, Wilkie M, Heimbürger O, Stegmayr B, Elung-Jensen T, Johansson AC, Rydström M, Gudmundsdottir H, Petzold M. Retraining for prevention of peritonitis in peritoneal dialysis patients: A randomized controlled trial. Perit Dial Int 2020; 40:141-152. [PMID: 32063220 DOI: 10.1177/0896860819887626] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Peritonitis is more common in peritoneal dialysis (PD) patients nonadherent to the PD exchange protocol procedures than in compliant patients. We therefore investigated whether regular testing of PD knowledge with focus on infection prophylaxis could increase the time to first peritonitis (primary outcome) and reduce the peritonitis rate in new PD patients. METHODS This physician-initiated, open-label, parallel group trial took place at 57 centers in Sweden, Denmark, Norway, Finland, Estonia, Latvia, the Netherlands, and the United Kingdom from 2010 to 2015. New peritonitis-free PD patients were randomized using computer-generated numbers 1 month after the start of PD either to a control group (n = 331) treated according to center routines or to a retraining group (n = 340), which underwent testing of PD knowledge and skills at 1, 3, 6, 12, 18, 24, 30, and 36 months after PD start, followed by retraining if the goals were not achieved. RESULTS In all, 74% of the controls and 80% of the retraining patients discontinued the study. The groups did not differ significantly regarding cumulative incidence of first peritonitis adjusted for competing risks (kidney transplantation, transfer to hemodialysis and death; hazard ratio 0.84; 95% confidence interval (CI) 0.65-1.09) nor regarding peritonitis rate per patient year (relative risk 0.93; 95% CI 0.75-1.16). CONCLUSIONS In this randomized controlled trial, we were unable to demonstrate that regular, targeted testing and retraining of new PD patients increased the time to first peritonitis or reduced the rate of peritonitis, as the study comprised patients with a low risk of peritonitis, was underpowered, open to type 1 statistical error, and contamination between groups.
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Affiliation(s)
- Susanne Ljungman
- Department of Nephrology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jørgen E Jensen
- Department of Nephrology, Odense University Hospital, Denmark
| | - Dag Paulsen
- Department of Medicine, Innlandet Hospital HF, Lillehammer, Norway
| | - Aivars Petersons
- Nephrology Center, Department of Medicine, P. Stradins Clinical University Hospital, Riga, Latvia
| | - Mai Ots-Rosenberg
- Department of Internal Medicine, University Hospital of Tartu, Estonia
| | - Heikki Saha
- Department of Internal Medicine, Tampere University Hospital, Finland
| | - Dirk G Struijk
- Medisch Centrum, University of Amsterdam, the Netherlands
| | - Martin Wilkie
- Renal Unit, Department of Nephrology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Olof Heimbürger
- Patient Area Endocrinology and Nephrology, Karolinska University Hospital and Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
| | - Bernd Stegmayr
- Department of Nephrology, Public Health, and Clinical Medicine, Umeå University, Sweden
| | - Thomas Elung-Jensen
- Department of Nephrology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | | | | | | | - Max Petzold
- Health Metrics Unit, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
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57
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Lew SQ, Khan AA, Rieders B, Agrawal ST. Successful use of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) on a pancreatic lesion in a peritoneal dialysis patient without interrupting treatment. Perit Dial Int 2020; 40:230-232. [PMID: 32063184 DOI: 10.1177/0896860819893579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), a well-established minimally invasive gastrointestinal procedure, has been used to diagnose and stage cancers of the pancreas. We describe the successful use of EUS-FNA in a peritoneal dialysis (PD) patient to evaluate a pancreatic cyst. The patient continued on PD immediately after the procedure without using hemodialysis. The patient did not experience any complication such as infection, bleeding, or peritoneal fluid leakage.
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Affiliation(s)
- Susie Q Lew
- Division of Renal Diseases and Hypertension, George Washington University, DC, USA
| | - Ali A Khan
- Department of Medicine, George Washington University, DC, USA
| | - Brandon Rieders
- Division of Gastroenterology, George Washington University, DC, USA
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58
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Silverstein WK, Teshima C, Jolly S, Perl J. Don't Interrupt! A Case Report of Continuing Peritoneal Dialysis After Endoscopic Gastric Tumor Resection. Can J Kidney Health Dis 2019; 6:2054358119887147. [PMID: 31723433 PMCID: PMC6836299 DOI: 10.1177/2054358119887147] [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] [Received: 07/08/2019] [Accepted: 09/27/2019] [Indexed: 01/13/2023] Open
Abstract
Rationale: The evidence supporting the safety of restarting peritoneal dialysis (PD) immediately after abdominal surgery and interventions is scant. In particular, there are no reported cases characterizing periprocedural management of PD for patients undergoing endoscopic submucosal dissection for gastric intramucosal tumor removal. Presenting concerns of the patient: A 66-year-old female with end-stage kidney disease secondary to diabetic nephropathy, currently on nocturnal automatic PD, presented with new iron-deficiency anemia. Workup revealed an intramucosal gastric lesion proximal to the pylorus, without surrounding lymph node involvement. Endoscopic submucosal dissection was performed with en bloc endoscopic resection of a 5-cm, partially flat, partially sessile mass along the posterior wall and lesser curvature of the gastric antrum. Pathology revealed low-grade dysplasia without features of malignancy. There was no evidence of hemorrhage or leak post-dissection. Diagnoses: The clinical presentation was consistent with an uncomplicated endoscopic submucosal dissection. Interventions: Peritoneal dialysis was held for 48 hours and restarted thereafter with no complications. The patient did not require bridging with hemodialysis. Outcomes: The patient had an uncomplicated post-endoscopic course, with no subsequent episodes of PD-associated peritonitis after at least 6-month follow-up. Novel finding: This is the first reported case of PD reinitiation after endoscopic submucosal dissection of a gastric tumor.
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Affiliation(s)
| | - Christopher Teshima
- Department of Medicine, University of Toronto, ON, Canada.,Division of Gastroenterology, St. Michael's Hospital, Toronto, ON, Canada
| | - Simran Jolly
- Clinical Research Solutions, Miamisburg, OH, USA
| | - Jeffrey Perl
- Department of Medicine, University of Toronto, ON, Canada.,Division of Nephrology, St. Michael's Hospital, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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59
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Lanot A, Bechade C, Verger C, Fabre E, Vernier I, Lobbedez T. Patterns of peritoneal dialysis catheter practices and technique failure in peritoneal dialysis: A nationwide cohort study. PLoS One 2019; 14:e0218677. [PMID: 31220171 PMCID: PMC6586404 DOI: 10.1371/journal.pone.0218677] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/06/2019] [Indexed: 11/27/2022] Open
Abstract
Introduction Our objective was to assess whether clusters of centers with similar peritoneal dialysis (PD) catheter related practices were associated with differences in the risk of technique failure. Methods Patients on incident PD in French centers contributing to the French Language PD Registry from 2012 to 2016 were included in a retrospective analysis of prospectively collected data. Centers with similar catheter cares practices were gathered in clusters in a hierarchical analysis. Clusters of centers associated with technique failure were evaluated using Cox and Fine and Gray models. A mixed effect Cox model was used to assess the influence of a center effect, as explained by the clusters. Results Data from 2727 catheters placed in 64 centers in France were analyzed. Five clusters of centers were identified. After adjustment for patient-level characteristics, the fourth cluster was associated with a lower risk of technique failure (cause specific-HR 0.70, 95%CI 0.54–0.90. The variance of the center effect decreased by 5% after adjusting for patient characteristics and by 26% after adjusting for patient characteristics and clusters of centers in the mixed effect Cox model. Favorable outcomes were observed in clusters with a greater proportion of community hospitals, where catheters were placed via open surgery, first dressing done 6 to 15 days after catheter placement, and local prophylactic antibiotics was applied on exit-site. Conclusion Several patterns of PD catheter related practices have been identified in France, associated with differences in the risk of technique failure. Combinations of favorable practices are suggested in this study.
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Affiliation(s)
- Antoine Lanot
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, CAEN, France
- Normandie université, Unicaen, UFR de médecine, Caen, France
- * E-mail:
| | - Clemence Bechade
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, CAEN, France
| | | | | | - Isabelle Vernier
- RDPLF, Pontoise, France
- Néphrologie, polyclinique le Languedoc, Narbonne, France
| | - Thierry Lobbedez
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, CAEN, France
- Normandie université, Unicaen, UFR de médecine, Caen, France
- RDPLF, Pontoise, France
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60
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Pottanat ND, Brook AC, Bartosova M, Cortado H, Gupta S, Li B, Jackson AR, Vonau M, Cohen S, Ferrara M, Ching CB, Spencer JD, Brauner A, Fraser DJ, Schmitt CP, Eberl M, Ayoob R, Becknell B. Analysis of the Ribonuclease A Superfamily of Antimicrobial Peptides in Patients Undergoing Chronic Peritoneal Dialysis. Sci Rep 2019; 9:7753. [PMID: 31123272 PMCID: PMC6533318 DOI: 10.1038/s41598-019-44219-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/09/2019] [Indexed: 02/03/2023] Open
Abstract
Infectious peritonitis is a common complication in patients undergoing chronic peritoneal dialysis (PD), limiting the duration of PD as a modality for renal replacement therapy and increasing patient morbidity and mortality. Antimicrobial peptides (AMPs) serve critical roles in mucosal defense, but their expression and activity during peritonitis are poorly understood. We hypothesized that AMPs belonging to the Ribonuclease (RNase) A Superfamily are present in peritoneal fluid and increase during peritonitis in patients undergoing chronic PD. In the absence of peritonitis, we detected RNase 3, RNase 6, and RNase 7 in cell-free supernatants and viable cells obtained from peritoneal fluid of chronic PD patients. The cellular sources of these RNases were eosinophils (RNase 3), macrophages (RNase 6), and mesothelial cells (RNase 7). During peritonitis, RNase 3 increased 55-fold and RNase 7 levels increased 3-fold on average, whereas RNase 6 levels were unchanged. The areas under the receiver-operating characteristic curves for RNase 3 and RNase 7 were 0.99 (95% confidence interval (CI): 0.96-1.0) and 0.79 (95% CI: 0.64-0.93), respectively, indicating their potential as biomarkers of peritonitis. Discrete omental reservoirs of these RNases were evident in patients with end stage kidney disease prior to PD initiation, and omental RNase 3 reactive cells increased in patients undergoing PD with a history of peritonitis. We propose that constitutive and inducible pools of antimicrobial RNases form a network to shield the peritoneal cavity from microbial invasion in patients undergoing chronic PD.
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Affiliation(s)
- Neha Dhingra Pottanat
- Division of Nephrology, Department of Pediatrics, Riley Children's Hospital and Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amy C Brook
- Division of Infection and Immunity, School of Medicine and Systems Immunity Research Institute, Cardiff University, Cardiff, CF14 4XN, United Kingdom
| | - Maria Bartosova
- Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Hanna Cortado
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Sudipti Gupta
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Birong Li
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Ashley R Jackson
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Martin Vonau
- Department of Pediatrics and Internal Medicine, Ohio State University College of Medicine, Columbus, OH, USA
| | - Shira Cohen
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Maria Ferrara
- Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christina B Ching
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Division of Pediatric Urology, Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - John David Spencer
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Division of Nephrology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Annelie Brauner
- Department of Microbiology, Tumor and Cell Biology, Division of Clinical Microbiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Donald J Fraser
- Division of Infection and Immunity, School of Medicine and Systems Immunity Research Institute, Cardiff University, Cardiff, CF14 4XN, United Kingdom
- Wales Kidney Research Unit, Cardiff University, Cardiff, United Kingdom
| | - Claus Peter Schmitt
- Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Matthias Eberl
- Division of Infection and Immunity, School of Medicine and Systems Immunity Research Institute, Cardiff University, Cardiff, CF14 4XN, United Kingdom
| | - Rose Ayoob
- Division of Nephrology, Department of Pediatrics, Charleston, WV, USA.
| | - Brian Becknell
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
- Division of Nephrology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.
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61
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Abstract
Peritonitis is a common and severe complication in peritoneal dialysis (PD). Detailed recommendations on the prevention and treatment of PD-associated peritonitis have been published by the International Society for Peritoneal Dialysis (ISPD), but there is a substantial variation in clinical practice among dialysis units. Prophylactic antibiotics administered before PD catheter insertion, colonoscopy, or invasive gynecologic procedures, daily topical application of antibiotic cream or ointment to the catheter exit site, and prompt treatment of exit site or catheter infection are key measures to prevent PD-associated peritonitis. When a patient on PD presents with clinical features compatible with PD-associated peritonitis, empirical antibiotic therapy, with coverage of both Gram-positive and Gram-negative organisms (including Pseudomonas species), should be started once the appropriate microbiologic specimens have been obtained. Intraperitoneal is the preferred route of administration. Antifungal prophylaxis, preferably oral nystatin, should be added to prevent secondary fungal peritonitis. Once the PD effluent Gram stain or culture and sensitivity results are available, antibiotic therapy can be adjusted accordingly. A detailed description on the dosage of individual antibiotic can be found in the latest recommendations by the ISPD. The duration of antibiotics is usually 2-3 weeks, depending on the specific organisms identified. Catheter removal and temporary hemodialysis support is recommended for refractory, relapsing, or fungal peritonitis. In some patients, a new PD catheter could be inserted after complete resolution of the peritonitis. PD catheter removal should also be considered for refractory exit site or tunnel infections. After the improvement in clinical practice, there is a worldwide trend of reduction in PD-associated peritonitis rate, supporting the use of PD as a first-line dialysis modality.
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Affiliation(s)
- Cheuk-Chun Szeto
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Milan Manani S, Virzì GM, Giuliani A, Crepaldi C, Ronco C. Catheter-related infections in peritoneal dialysis: comparison of a single center results and the literature data. J Nephrol 2019; 32:837-841. [PMID: 30955154 DOI: 10.1007/s40620-019-00604-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/26/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Catheter-related infections are important causes of morbidity in patients undergoing peritoneal dialysis (PD). There are different protocols of exit site care for the prevention of catheter-related infections. The aim of this study was to evaluate the incidence of catheter-related infections and their complications in our PD center. METHODS We performed a retrospective, observational study for all patients receiving PD in our center. We observed prevalent patients every year for 5 years. The patients performed the exit-site care three times a week, cleaning the exit site with 10% sodium hypochlorite. From 2017, update of ISPD recommendations suggests the application of antibiotic creams. We recorded the incidence rate of ESI and TI, gentamicin resistance, catheter lost, related post-ESI peritonitis and fungal infections, and we compared our results with the data in the literature. RESULTS Prevalent patients per year were 117.6 ± 5.5. The "time at risk" was 356.46 years. The median values of TESI (tunnel and exit site infections), TI, gentamicin resistance, related post-ESI peritonitis and fungal infection rate were similar in our results and the literature data. The ESI and the catheter lost caused by infection were significantly lower in our patients. No significant adverse effects, such as skin allergy or intolerance, were reported. CONCLUSIONS Our results confirm the utility and the safety of routinely exit site care using 10% sodium hypochlorite. This protocol resulted similar to the data reported in the literature. Our analysis of the literature highlighted the wide variation in the infection rate of ESI and TI.
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Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV, International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy. .,IRRIV, International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy.
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV, International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Carlo Crepaldi
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV, International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV, International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy.,Department of Medicine, University of Padua, Padua, Italy
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63
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Kim HJ, Park HS, Bae E, Kim HW, Kim B, Moon KH, Lee DY. A Case of Peritoneal Dialysis-related Peritonitis Caused by Aeromonas Hydrophila in the Patient Receiving Automated Peritoneal Dialysis. Electrolyte Blood Press 2019; 16:27-29. [PMID: 30899312 PMCID: PMC6414316 DOI: 10.5049/ebp.2018.16.2.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 02/25/2019] [Indexed: 11/26/2022] Open
Abstract
Peritoneal dialysis (PD)-related peritonitis is a major cause of injury and technique failure in patients undergoing PD. Aeromonas hydrophila is ubiquitous in the environment, and is a Gram-negative rod associated with infections in fish and amphibians in most cases; however, it can also cause opportunistic infections in immunocompromised patients. We report a case of A. hydrophila peritonitis in a 56-year-old male on automated PD. Peritonitis may have been caused by contamination of the Set Plus, a component of the automated peritoneal dialysis device. Although Set Plus is disposable, the patient reused the product by cleansing with tap water. He was successfully treated with intraperitoneally-administered ceftazidime and has been well without recurrence for more than 2 years.
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Affiliation(s)
- Hyun Jin Kim
- Internal Medicine, Veterans Healthcare System Medical Center, Seoul, Korea
| | - Hyun Sun Park
- Internal Medicine, Veterans Healthcare System Medical Center, Seoul, Korea
| | - Eunsin Bae
- Department of Laboratory Medicine, Veterans Healthcare System Medical Center, Seoul, Korea
| | - Hae Won Kim
- Internal Medicine, Veterans Healthcare System Medical Center, Seoul, Korea
| | - Beom Kim
- Internal Medicine, Veterans Healthcare System Medical Center, Seoul, Korea
| | - Kyoung Hyoub Moon
- Internal Medicine, Veterans Healthcare System Medical Center, Seoul, Korea
| | - Dong-Young Lee
- Internal Medicine, Veterans Healthcare System Medical Center, Seoul, Korea
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64
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Szeto CC, Lo WK, Li PK. Clinical practice guidelines for the provision of renal service in Hong Kong: Peritoneal Dialysis. Nephrology (Carlton) 2019; 24 Suppl 1:27-40. [PMID: 30900337 DOI: 10.1111/nep.13505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Cheuk Chun Szeto
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and TherapeuticsPrince of Wales Hospital, The Chinese University of Hong Kong Shatin Hong Kong SAR, China
| | - Wai Kei Lo
- Department of MedicineTung Wah Hospital Hong Kong SAR, China
- Dialysis CentreGleneagles Hospital Hong Kong SAR, China
| | - Philip Kam‐Tao Li
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and TherapeuticsPrince of Wales Hospital, The Chinese University of Hong Kong Shatin Hong Kong SAR, China
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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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66
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Einbinder Y, Cohen-Hagai K, Shitrit P, Zitman-Gal T, Erez D, Benchetrit S, Korzets Z, Kotliroff A. ISPD guideline-driven retraining, exit site care and decreased peritonitis: a single-center experience in Israel. Int Urol Nephrol 2019; 51:723-727. [PMID: 30834483 DOI: 10.1007/s11255-019-02100-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 02/08/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE Evaluate the efficacy of retraining and catheter exit site care in reducing peritonitis rates. METHODS This interventional study included all prevalent PD patients from 1/2009 to 12/2017 from a single center. Peritonitis rates and causative organisms were assessed and compared in three periods: (1) Before intervention (01/2009-12/2014), (2) after educational intervention: assessment of training process by infection control nurse and repeat training every 3 months, after each peritonitis episode and after hospitalizations > 2 weeks (01/2015-02/2016), and (3) in addition to the measures in period 2, an exit site care protocol including postoperative care, topical antibacterial therapy and nasal Staph aureus screening and eradication was implemented (03/2016-12/2017). RESULTS The study included 201 patients (149 men, 52 women), mean age was 65.1 ± 12.6 years. After both interventions, including educational and exit site care strategies, peritonitis decreased significantly from 1.05 episodes per patient-year (n = 113) to 0.67 (n = 54); P = 0.017 between periods 1 and 3. The percentage of peritonitis-free patients increased from 27.4 to 52.4 and 55.6%, respectively (P = 0.001 between period 1 vs. 2 and period 1 vs. 3.). Coagulase-negative staph was the most common pathogen, causing 7.56 peritonitis episodes per year, followed by pseudomonas at 4.33 episodes annually and staph aureus at 3.44 episodes per year. CONCLUSIONS Enforcement of an educational program and strict adherence to an exit site care protocol was associated with a significant decrease in peritonitis rates.
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Affiliation(s)
- Yael Einbinder
- Department of Nephrology and Hypertension, Meir Medical Center, 44281, Kfar Saba, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, 44281, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pnina Shitrit
- Infection Control Unit, Meir Medical Center, 44281, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Zitman-Gal
- Department of Nephrology and Hypertension, Meir Medical Center, 44281, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Erez
- Department of Nephrology and Hypertension, Meir Medical Center, 44281, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sydney Benchetrit
- Department of Nephrology and Hypertension, Meir Medical Center, 44281, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ze'ev Korzets
- Department of Nephrology and Hypertension, Meir Medical Center, 44281, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andy Kotliroff
- Department of Nephrology and Hypertension, Meir Medical Center, 44281, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lui SL, Yap D, Cheng V, Chan TM, Yuen KY. Clinical practice guidelines for the provision of renal service in Hong Kong: Infection Control in Renal Service. Nephrology (Carlton) 2019; 24 Suppl 1:98-129. [PMID: 30900339 PMCID: PMC7167703 DOI: 10.1111/nep.13497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
| | - Desmond Yap
- Department of MedicineThe University of Hong KongHong Kong
| | - Vincent Cheng
- Department of MicrobiologyQueen Mary HospitalHong Kong
| | - Tak Mao Chan
- Department of MedicineThe University of Hong KongHong Kong
| | - Kwok Yung Yuen
- Department of MicrobiologyThe University of Hong KongHong Kong
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68
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Parthasarathy R, Kashem T, NicFhogartaigh C, Melzer M, Fan SL. Clinical Value of Screening Peritoneal Dialysis Patients for Bacterial Colonization or Contamination. Perit Dial Int 2019; 39:126-133. [PMID: 30739095 DOI: 10.3747/pdi.2018.00082] [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: 04/24/2018] [Accepted: 10/08/2018] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The adoption of the International Society for Peritoneal Dialysis guideline of using mupirocin ointment has been limited by fear of developing mupirocin-resistant organisms. We performed a surveillance program of a large peritoneal dialysis (PD) unit. METHODS We performed 1,175 surveillance swabs from anterior nares, PD catheter exit site, groin, and axilla, from 240 patients. The mean interval between swabs was 3.3 months. RESULTS Colonization by Staphylococcus aureus (S. aureus) or Pseudomonas species was 9.5% and 10.9%, respectively. Despite adopting a universal policy of applying mupirocin to PD catheter exit sites in 2001, no instances of mupirocin-resistant S. aureus were identified. Moreover, patients who grew S. aureus from surveillance swabs did not experience higher peritonitis rates than those with "no growth." This was in contrast to patients who grew Pseudomonas or enteric organisms. There were no differences in patient demographics for those who grew S. aureus, Pseudomonas, or enteric organisms (compared with "no-growth" patients). CONCLUSION Our results suggest that the application of mupirocin ointment appeared to minimize peritonitis of patients colonized with S. aureus. The use of mupirocin in this patient cohort has not led to mupirocin resistance. The increased peritonitis rate of patients who grew Pseudomonas or enteric organisms is of interest. We propose that greater attention to hygiene and catheter care in these patients is warranted. The increasing use of paid healthcare workers attending patients daily to help perform PD (assisted PD) gives an opportunity for us to address these wider issues.
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Affiliation(s)
| | - Tasnuva Kashem
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
| | | | - Mark Melzer
- Department of Microbiology, Barts Health NHS Trust, London, UK
| | - Stanley L Fan
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
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Chow JSF, Cho Y, Equinox KL, Figueiredo A, Frasca S, Hawley C, Howard K, Johnson DW, Jose M, Lee A, Maley M, Moodie JA, Brent PA, Pascoe E, Reidinger D, Steiner GZ, Tomlins M, Voss D, Woodward P, Boudville N. An Intervention Design: Supporting Skills Development for Peritoneal Dialysis Trainers. Perit Dial Int 2019; 39:134-141. [PMID: 30661004 DOI: 10.3747/pdi.2018.00159] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 09/11/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is a home-based therapy where nurses train patients in its use. There has been no published randomized controlled trial (RCT) evaluating any specific protocol for nurses delivering PD training. A standardized education package based upon the best available evidence and utilizing modern educational practices may lead to improved patient outcomes. The aim is to develop a standardized, evidence-based curriculum for PD trainers and patients aligned with guidelines from the International Society for Peritoneal Dialysis (ISPD), using best practice pedagogy. METHODS A literature search and clinical audit were conducted to identify current practice patterns and best practice. Results were reviewed by a focus group of practitioners comprising PD nurses, nephrologists, consumers, a medical education expert, and an eLearning expert. From this, a training curriculum and modules were developed. RESULTS A comprehensive PD training curriculum has been developed, which includes modules for training PD nurses (trainers) and patient training manuals. The package comprises 2 introductory modules and 2 clinical case modules. The curriculum is designed for both interactive digital media (trainers) and traditional paper-based teaching with practical demonstrations (patients). Assessment is also addressed. CONCLUSION The need for the development of a comprehensive and standardized curriculum for PD nurse trainers and their patients was confirmed. This paper outlines the process of the development of this curriculum. Pilot testing of the modules was launched in late 2017 to examine feasibility, and planning has commenced for a RCT in 2019 to investigate the effect of the modules on clinical outcomes, and their wider application across Australia and New Zealand.
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Affiliation(s)
- Josephine S F Chow
- Clinical Innovation & Business Unit, South Western Sydney Local Health District, Sydney, Australia .,Faculty of Nursing, University of Sydney, Sydney, Australia.,School of Health Science, University of Tasmania, Tasmania, Australia
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Translational Research Instittue, Brisbane, Australia
| | - Keri-Lu Equinox
- Department of Renal Medicine, Cairns Hospital, Sydney, Australia
| | - Ana Figueiredo
- School of Health Sciences, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Serena Frasca
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, Australia
| | - Carmel Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Translational Research Instittue, Brisbane, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Translational Research Instittue, Brisbane, Australia
| | - Matthew Jose
- School of Medicine, University of Tasmania, Tasmania, Australia
| | - Anna Lee
- Department of Renal Medicine, Illawarra Shoalhaven Local Health District, NSW, Australia
| | - Moira Maley
- Medical School, University of Western Australia, Perth, Australia
| | - Jo-Anne Moodie
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia
| | - Peta-Anne Brent
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Elaine Pascoe
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Donna Reidinger
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Genevieve Z Steiner
- NICM Health Research Institute and Translational Health Research Institute (THRI), Western Sydney University, Penrith, Australia
| | - Melinda Tomlins
- Department of Renal Medicine, Hunter New England Local Health District, New Lambton, Australia
| | - David Voss
- Renal Medicine, Middlemore Hospital, Auckland, New Zealand
| | - Paula Woodward
- The Med Collective (Medical Education and Communications), Sydney, Australia
| | - Neil Boudville
- Medical School, University of Western Australia, Perth, Australia
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Kim SY, Kim HS, Park HJ. Adverse events related to colonoscopy: Global trends and future challenges. World J Gastroenterol 2019; 25:190-204. [PMID: 30670909 PMCID: PMC6337013 DOI: 10.3748/wjg.v25.i2.190] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/22/2018] [Accepted: 12/01/2018] [Indexed: 02/06/2023] Open
Abstract
Colonoscopy is a widely used method for diagnosing and treating colonic disease. The number of colonoscopies is increasing worldwide, and concerns about associated adverse events are growing. Large-scale studies using big data for post-colonoscopy complications have been reported. A colon perforation is a severe complication with a relatively high mortality rate. The perforation rate, as reported in large studies (≥ 50,000 colonoscopies) published since 2000, ranges from 0.005-0.085%. The trend in the overall perforation rate in the past 15 years has not changed significantly. Bleeding is a more common adverse event than perforation. Recent large studies (≥ 50,000 colonoscopies) have reported post-colonoscopy bleeding occurring in 0.001-0.687% of cases. Most studies about adverse events related to colonoscopy were performed in the West, and relatively few studies have been conducted in the East. The incidence of post-colonoscopy complications increases in elderly patients or patients with inflammatory bowel diseases. It is important to use a unified definition and refined data to overcome the limitations of previous studies. In addition, a structured training program for endoscopists and a systematic national management program are needed to reduce post-colonoscopy complications. In this review, we discuss the current trends in colonoscopy related to adverse events, as well as the challenges to be addressed through future research.
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Affiliation(s)
- Su Young Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, South Korea
| | - Hyun-Soo Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, South Korea
| | - Hong Jun Park
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, South Korea
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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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Oka H, Yamada S, Kamimura T, Aihara S, Hyodo M, Terakado N, Harada A, Nakano T, Tsuruya K, Kitazono T. Better Oral Hygiene Habits Are Associated With a Lower Incidence of Peritoneal Dialysis‐Related Peritonitis. Ther Apher Dial 2018; 23:187-194. [DOI: 10.1111/1744-9987.12757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Hideaki Oka
- Division of Kidney CenterMatsuyama Red Cross Hospital Matsuyama Japan
- Department of Medicine and Clinical Science, Graduate School of Medical SciencesKyushu University Fukuoka Japan
| | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical SciencesKyushu University Fukuoka Japan
| | - Taro Kamimura
- Division of Kidney CenterMatsuyama Red Cross Hospital Matsuyama Japan
| | - Seishi Aihara
- Division of Kidney CenterMatsuyama Red Cross Hospital Matsuyama Japan
- Department of Medicine and Clinical Science, Graduate School of Medical SciencesKyushu University Fukuoka Japan
| | - Masahide Hyodo
- Department of Dentistry and Oral SurgeryMatsuyama Red Cross Hospital Matsuyama Japan
| | - Nagaaki Terakado
- Department of Dentistry and Oral SurgeryMatsuyama Red Cross Hospital Matsuyama Japan
| | - Atsumi Harada
- Division of Kidney CenterMatsuyama Red Cross Hospital Matsuyama Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical SciencesKyushu University Fukuoka Japan
- Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical SciencesKyushu University Fukuoka Japan
| | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medical SciencesKyushu University Fukuoka Japan
- Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical SciencesKyushu University Fukuoka Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical SciencesKyushu University Fukuoka Japan
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Yao Q, Dong J, Feng T, Lindholm B. What PD Research in China Tells Us. Perit Dial Int 2018; 38:S19-S24. [PMID: 30315043 DOI: 10.3747/pdi.2018.00027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/12/2018] [Indexed: 12/17/2022] Open
Abstract
Peritoneal dialysis (PD) was introduced in China later than in most Western countries, and PD research activity was quite limited until the 1990s. However, in the 2000s, and even more so during the last decade, there has been an unsurpassed increase in the number of PD patients, paralleled by a substantial increase in PD research activity reflected by an increasing number of PD papers from China. In this brief review, we describe some of the factors that may explain the dramatic developments in PD research in mainland China, such as the focus on basic research using scientific approaches that subsequently could be applied also in clinical studies. Another important factor was the growing interactions with international PD research centers in Hong Kong and in Western countries. Thanks to strong support from Chinese national and regional funding sources, a growing number of young Chinese researchers went to key international PD centers to learn about novel advanced research techniques. This paved the way for long-lasting, productive collaborations with benefits also for the foreign host institutions. Finally, we present some current research projects, including basic research that may contribute to the understanding of mechanisms behind complications such as peritonitis, and clinical projects aiming at improving PD management guidelines and better understanding of the potential of PD in China. Because of the size of the PD population, now the largest in the world, and the increasing number, and quality, of researchers in the PD field, PD research in China is destined to be a major contributor to advancements in PD in the near future.
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Affiliation(s)
- Qiang Yao
- Medical Affairs, Baxter China, Shanghai, PR China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing, PR China.,Key Laboratory of Renal Disease, National Health and Family Planning Commission of the People's Republic of China, Beijing, PR China
| | - Tao Feng
- Medical Affairs, Baxter China, Shanghai, PR China
| | - Bengt Lindholm
- Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Huddinge, Sweden
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Chang JH, Oh J, Park SK, Lee J, Kim SG, Kim SJ, Shin DH, Hwang YH, Chung W, Kim H, Oh KH. Frequent patient retraining at home reduces the risks of peritoneal dialysis-related infections: A randomised study. Sci Rep 2018; 8:12919. [PMID: 30150627 PMCID: PMC6110747 DOI: 10.1038/s41598-018-30785-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 08/06/2018] [Indexed: 12/05/2022] Open
Abstract
The present study, entitled Trial on Education And Clinical outcomes for Home PD patients (TEACH), investigated the effect of frequent retraining at home on the outcomes of peritoneal dialysis (PD). TEACH is a multicentre, open-label, randomised, controlled trial with parallel arms. Patients starting PD were randomized into either the conventional retraining group (CG) or the frequent retraining group (FG). Patients in the FG were given more frequent home visits for retraining. The primary endpoint was exit site infection (ESI). Secondary endpoints were peritonitis, any PD-related infections, hospitalization, technique failure, and patient survival. A generalised estimating equations (GEE) approach was employed for the adjusted effect of training level on the outcomes. Cox regression was employed for peritonitis and other secondary outcomes. The subjects were randomised to either the FG (n = 51) or the CG (n = 53). Although the time of initial training did not differ between the 2 groups, the total time of training was longer and the frequency of training visits was higher in the FG. In the GEE model, the p-values for interactions between groups and time were significant for both ESI and any PD-related infections, suggesting that the event rates of the two groups significantly changed over time. The event rates for the FG decreased over time, and the event rates for the CG increased after month 12. In the older subgroup (age ≥ 60), frequent retraining had a significant effect in the risk reduction of the first episode of peritonitis (adjusted HR 0.01 [0.001–0.35], p = 0.01). Frequent retraining at home reduced the risk of PD-related infections.
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Affiliation(s)
- Jae Hyun Chang
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University School of Medicine, Namdong Gu, Incheon, 21565, Korea
| | - Jieun Oh
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym Kidney Research Institute, Hallym University, Kangdong Gu, Seoul, 05355, Korea
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Chongno Gu, Seoul, 03080, Korea
| | - Juyeon Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Chongno Gu, Seoul, 03080, Korea
| | - Sung Gyun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Dongan Gu, Anyang, Gyeonggi-do, 14068, Korea
| | - Soo Jin Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym Kidney Research Institute, Hallym University, Kangdong Gu, Seoul, 05355, Korea
| | - Dong Ho Shin
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym Kidney Research Institute, Hallym University, Kangdong Gu, Seoul, 05355, Korea
| | - Young-Hwan Hwang
- Department of Internal Medicine, Eulji University College of Medicine, Hangeul Biseok Ro, Seoul, 01830, Korea
| | - Wookyung Chung
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University School of Medicine, Namdong Gu, Incheon, 21565, Korea
| | - Hyunwook Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Kangnam Gu, Seoul, 06273, Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea.
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76
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Peikani FA, Shahgholian N, Kazemi A. The Effect of Health-belief-model-Based Training on Behaviors Preventing Peritonitis in Patients on Peritoneal Dialysis. Int J Prev Med 2018; 9:72. [PMID: 30167102 PMCID: PMC6106128 DOI: 10.4103/ijpvm.ijpvm_566_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/01/2018] [Indexed: 01/03/2023] Open
Abstract
Background: Peritonitis is one of the important complications of peritoneal dialysis and one of the reasons for failure of this therapeutic technique. As one of the important reasons for development of peritonitis is disregard for health behaviors, this study aims to investigate the effect of education based on health belief model (HBM) on behaviors preventing peritonitis in peritoneal dialysis patients. Methods: This double-blind clinical trial study conducted on 60 patients with peritoneal dialysis in Isfahan, Iran. A researcher-made questionnaire was used to evaluate knowledge, HBM constructs, and peritonitis preventive behaviors in three stages (before, immediately after and 2-month after intervention). The intervention group received four HBM-based educational sessions and the control group received a lecture session. Data were analyzed using Chi-square, Mann–Whitney, Fisher's exact test, independent t-test, and repeated measures ANOVA. Results: There was no significant difference between the two groups’ background variables and level of knowledge, perceived, sensitivity, severity, benefits, arriers, self-efficacy, personal and environmental hygiene behaviors and fluid-replacement technique before the intervention. Immediately after the intervention, all of the variables, except perceived barriers, personal, and environmental hygiene, were significantly higher in the intervention group than the control group (P < 0.05); 2 months after the intervention, all of the variables, except personal hygiene and perceived barriers, were significantly higher in the intervention group (P < 0.05); in three stages, personal hygiene was not significantly different between the two groups; and 2 months after the intervention, the variable of perceived barriers decreased significantly in the intervention group (P < 0.05). Conclusions: Education based on HBM is effective on promoting behaviors preventing peritonitis. Education based on HBM is suggested in peritoneal dialysis patients to prevent peritonitis.
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Affiliation(s)
- Fatemeh Attari Peikani
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nahid Shahgholian
- Department of Critical Care Nursing, Isfahan Kidney Diseases Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ashraf Kazemi
- Nursing and Midwifry Care Resarch Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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77
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Auricchio S, Giovenzana ME, Pozzi M, Galassi A, Santorelli G, Dozio B, Scanziani R. Fungal peritonitis in peritoneal dialysis: a 34-year single centre evaluation. Clin Kidney J 2018; 11:874-880. [PMID: 30524723 PMCID: PMC6275450 DOI: 10.1093/ckj/sfy045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/02/2018] [Indexed: 12/11/2022] Open
Abstract
Backgound Fungal peritonitis (FP) is one of the most important causes of peritoneal dialysis (PD) failure, often burdened by increased morbility and mortality. This study evaluates the clinical course of FP cases that arose between 1983 and 2016 in a single PD unit. Methods We conducted a retrospective observational analysis of FP episodes recorded in the Baxter POET (Peritonitis Organism Exit sites Tunnel infections) registry and clinical records. FP incidence rate, PD and patients’ survival and clinical characteristics of the study population were analysed, taking into account the evolution of clinical practice during the study period as a result of technical innovation, scientific evidence and guideline history. Results Fourteen FP cases (2.8%) were detected. The overall incidence of PD peritonitis was one episode/27 patient-months. Candida parapsilosis was the most frequently (50%) detected yeast. Seventy-five per cent of cases were considered secondary FP. This group experienced 2.6±1.7 bacterial peritonitis before FP, most frequently due to Staphylococcus and Enterococcus species. Most patients were treated with fluconazole for ≥8 days. All subjects were hospitalized for a median time of 25 days. Tenckhoff catheter removal occurred in all cases of FP and all patients were transferred to haemodialysis. Two patients died. From December 2010 to December 2016, no FP episodes were recorded. Conclusions FP is confirmed as a significant cause of PD drop out and increases patients’ mortality risk. Prompt diagnosis of FP, targeted antifugal therapy and rapid PD catheter removal are essential strategies for improved patient and PD survival.
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Affiliation(s)
- Sara Auricchio
- Department of Nephrology and Dialysis, Azienda Socio Sanitaria Territoriale di Monza, Desio, Italy
| | - Maria Enrica Giovenzana
- Department of Nephrology and Dialysis, Azienda Socio Sanitaria Territoriale di Monza, Desio, Italy
| | - Marco Pozzi
- Department of Nephrology and Dialysis, Azienda Socio Sanitaria Territoriale di Monza, Desio, Italy
| | - Andrea Galassi
- Department of Health Sciences, Renal Division, San Paolo Hospital, University of Milan, Milan, Italy
| | - Gennaro Santorelli
- Department of Nephrology and Dialysis, Azienda Socio Sanitaria Territoriale di Monza, Desio, Italy
| | - Beatrice Dozio
- Department of Nephrology and Dialysis, Azienda Socio Sanitaria Territoriale di Monza, Desio, Italy
| | - Renzo Scanziani
- Department of Nephrology and Dialysis, Azienda Socio Sanitaria Territoriale di Monza, Desio, Italy
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78
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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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Molnar AO, Moist L, Klarenbach S, Lafrance JP, Kim SJ, Tennankore K, Perl J, Kappel J, Terner M, Gill J, Sood MM. Hospitalizations in Dialysis Patients in Canada: A National Cohort Study. Can J Kidney Health Dis 2018; 5:2054358118780372. [PMID: 29900002 PMCID: PMC5985541 DOI: 10.1177/2054358118780372] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/14/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Hospitalizations of chronic dialysis patients have not been previously studied at a
national level in Canada. Understanding the scope and variables associated with
hospitalizations will inform measures for improvement. Objective: To describe the risk of all-cause and infection-related hospitalizations in patients on
dialysis. Design: Retrospective cohort study using health care administrative databases. Setting: Provinces and territories across Canada (excluding Manitoba and Quebec). Patients: Incident chronic dialysis patients with a dialysis start date between January 1, 2005,
and March 31, 2014. Patients with a prior history of kidney transplantation were
excluded. Measurements: Patient characteristics were recorded at baseline. Dialysis modality was treated as a
time-varying covariate. The primary outcomes of interest were all-cause and
dialysis-specific infection-related hospitalizations. Methods: Crude rates for all-cause hospitalization and infection-related hospitalization were
determined per patient year (PPY) at 7 and 30 days, and at 3, 6, and 12 months
postdialysis initiation. A stratified, gamma-distributed frailty model was used to
assess repeat hospital admissions and to determine the inter-recurrence dependence of
hospitalizations within individuals, as well as the hazard ratio (HR) attributed to each
covariate of interest. Results: A total of 38 369 incident chronic dialysis patients were included: 38 088 adults and
281 pediatric patients (age less than 18 years). There were 112 374 hospitalizations, of
which 11.5% were infection-related hospitalizations. The all-cause hospitalization rate
was similar for all adult age groups (age 65 years and older: 1.40, 1.35, and 1.18
admissions PPY at 7 days, 30 days, and 6 months, respectively). The all-cause
hospitalization rate was higher for pediatric patients (1.67, 2.48, and 2.47 admissions
PPY at 7 days, 30 days, and 6 months, respectively; adjusted HR: 2.73, 95% confidence
interval [CI]: 2.37-3.15, referent age group: 45-64 years). Within the first 7 days
after dialysis initiation, patients on peritoneal dialysis had a higher risk of
all-cause hospitalization (HR: 1.27, 95% CI: 1.07-1.50) and infection-related
hospitalization (HR: 2.05, 95% CI: 1.19-3.55) compared with patients on hemodialysis.
Beyond 7 days, the risk did not differ significantly by dialysis modality. Female sex
and Indigenous race were significant risk factors for all-cause hospitalization. Limitations: The cohort had too few home hemodialysis patients to examine this subgroup. The outcome
of infection-related hospitalization was determined using diagnostic codes. Dialysis
patients from Manitoba and Quebec were not included. Conclusions: In Canada, the rates of hospitalization were not influenced by dialysis modality beyond
the initial 7-day period following dialysis initiation; however, the rate of
hospitalization in pediatric patients was higher than in adults at every time frame
examined.
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Affiliation(s)
- Amber O Molnar
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Louise Moist
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
| | - Scott Klarenbach
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - S Joseph Kim
- Division of Nephrology, University Health Network, Department of Medicine, University of Toronto, Ontario, Canada
| | - Karthik Tennankore
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital, Department of Medicine, University of Toronto, Ontario, Canada
| | - Joanne Kappel
- Division of Nephrology, Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Michael Terner
- Canadian Institute of Health Information, Toronto, Ontario, Canada
| | - Jagbir Gill
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Manish M Sood
- Division of Nephrology, Department of Medicine, University of Ottawa, Ontario, Canada
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80
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Gorbatkin C, Bass J, Finkelstein FO, Gorbatkin SM. Peritoneal Dialysis in Austere Environments: An Emergent Approach to Renal Failure Management. West J Emerg Med 2018; 19:548-556. [PMID: 29760854 PMCID: PMC5942023 DOI: 10.5811/westjem.2018.3.36762] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 02/16/2018] [Accepted: 03/09/2018] [Indexed: 12/26/2022] Open
Abstract
Peritoneal dialysis (PD) is a means of renal replacement therapy (RRT) that can be performed in remote settings with limited resources, including regions that lack electrical power. PD is a mainstay of end-stage renal disease (ESRD) therapy worldwide, and the ease of initiation and maintenance has enabled it to flourish in both resource-limited and resource-abundant settings. In natural disaster scenarios, military conflicts, and other austere areas, PD may be the only available life-saving measure for acute kidney injury (AKI) or ESRD. PD in austere environments is not without challenges, including catheter placement, availability of dialysate, and medical complications related to the procedure itself. However, when hemodialysis is unavailable, PD can be performed using generally available medical supplies including sterile tubing and intravenous fluids. Amidst the ever-increasing global burden of ESRD and AKI, the ability to perform PD is essential for many medical facilities.
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Affiliation(s)
- Chad Gorbatkin
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
| | - John Bass
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
| | | | - Steven M. Gorbatkin
- Atlanta VA Medical Center, Emory University, Department of Nephrology, Atlanta, Georgia
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81
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Fang P, Lu J, Liu YH, Deng HM, Zhang L, Zhang HQ. Benefit of an operating vehicle preventing peritonitis in peritoneal dialysis patients: a retrospective, case-controlled study. Int Urol Nephrol 2018; 50:1163-1170. [PMID: 29508173 DOI: 10.1007/s11255-018-1823-z] [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: 10/25/2017] [Accepted: 02/10/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Peritonitis, which is one of the leading complications of peritoneal dialysis (PD) worldwide, severely affected morbidity and mortality of the PD patients. Although many efforts have been made to prevent PD-related peritonitis, it seems impossible to prevent it completely. Many causes have been reported to lead to peritonitis, and contamination during bag exchange is one of the important risk factors for peritonitis. METHODS Here, we introduce an operating vehicle, which we invented to provide a sterile and safe space for bag exchange. A single-center, retrospective, case-control study was undertaken to determine whether this operating vehicle has a protective role in preventing peritonitis. In total, 462 continuous ambulatory peritoneal dialysis patients were included in this study from October 2014 to March 2017. According to their personal will, these patients chose to use operating vehicle or traditional method during their bag exchange. The demographic, clinical and laboratory data of these patients in the two groups were collected, analyzed and compared. RESULTS Of 462 patients with home dialysis, operating vehicle group consisted of 61 patients, and control group consisted of 401 patients. In the control group, over 677 patient-years, peritonitis occurred in 69 of 401 patients (17.2%), while in the operating vehicle group, over 60 patient-years, only 4 of 61 patients (6.6%) had episodes of peritonitis. The number of patients suffered from peritonitis was significantly decreased in the operating vehicle group (P = 0.034). Besides, there were a total of 99 episodes of peritonitis, and the rate was 1 episode every 7.2 patient-years in control group and 1 episode every 12 patient-years in the operating vehicle group. There was significant difference between the two groups (0.013). Positive dialysate cultures were obtained in majority of the peritonitis episodes (60.6%). CONCLUSION Operating vehicle might help to reduce PD-related peritonitis by preventing contamination during bag exchange. Further studies are still needed to demonstrate the protective role of the operating vehicle in preventing peritonitis.
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Affiliation(s)
- Pan Fang
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China.,Institute of Nephrology, Central South University, Changsha, 410011, Hunan, China
| | - Jia Lu
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China.,Institute of Nephrology, Central South University, Changsha, 410011, Hunan, China
| | - Ying-Hong Liu
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China.,Institute of Nephrology, Central South University, Changsha, 410011, Hunan, China
| | - Hong-Mei Deng
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China.,Institute of Nephrology, Central South University, Changsha, 410011, Hunan, China
| | - Lei Zhang
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China.,Institute of Nephrology, Central South University, Changsha, 410011, Hunan, China
| | - Hong-Qing Zhang
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China. .,Institute of Nephrology, Central South University, Changsha, 410011, Hunan, China.
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82
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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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Wilkie M. The 2016 ISPD Update on Prevention and Treatment of Peritonitis-Grading the Evidence. Perit Dial Int 2017; 36:469-70. [PMID: 27659924 DOI: 10.3747/pdi.2016.00118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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84
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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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85
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Nakai K, Saito K, Fujii H, Nishi S. Impact of hypokalemia on peritonitis in peritoneal dialysis patients: a systematic review. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-017-0128-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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86
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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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87
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Woodrow G, Fan SL, Reid C, Denning J, Pyrah AN. Renal Association Clinical Practice Guideline on peritoneal dialysis in adults and children. BMC Nephrol 2017; 18:333. [PMID: 29145808 PMCID: PMC5691857 DOI: 10.1186/s12882-017-0687-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 08/09/2017] [Indexed: 12/15/2022] Open
Abstract
These guidelines cover all aspects of the care of patients who are treated with peritoneal dialysis. This includes equipment and resources, preparation for peritoneal dialysis, and adequacy of dialysis (both in terms of removing waste products and fluid), preventing and treating infections. There is also a section on diagnosis and treatment of encapsulating peritoneal sclerosis, a rare but serious complication of peritoneal dialysis where fibrotic (scar) tissue forms around the intestine. The guidelines include recommendations for infants and children, for whom peritoneal dialysis is recommended over haemodialysis.Immediately after the introduction there is a statement of all the recommendations. These recommendations are written in a language that we think should be understandable by many patients, relatives, carers and other interested people. Consequently we have not reworded or restated them in this lay summary. They are graded 1 or 2 depending on the strength of the recommendation by the authors, and A-D depending on the quality of the evidence that the recommendation is based on.
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Affiliation(s)
- Graham Woodrow
- St James's University Hospital Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | | | - Christopher Reid
- Evelina Children's Hospital, Guy's and St Thomas' NHS Trust, London, UK
| | - Jeannette Denning
- Peritoneal Dialysis Unit, St James's University Hospital Leeds Teaching Hospitals NHS Trust, London, UK
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88
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Wang HH, Hung SY, Chang MY, Lee YC, Lin HF, Lin TM, Yang SP, Lin HH, Yang SC, Wang JL. Bacterial colonization patterns in daily chlorhexidine care at the exit site in peritoneal dialysis patients-A prospective, randomized controlled trial. PLoS One 2017; 12:e0184859. [PMID: 28981543 PMCID: PMC5628800 DOI: 10.1371/journal.pone.0184859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 08/07/2017] [Indexed: 11/18/2022] Open
Abstract
Bacterial colonization patterns in daily chlorhexidine care at the exit site in peritoneal dialysis (PD) patients were not known. We performed a prospective, randomized controlled trial enrolling 89 PD patients. After stratification by initial Staphylococcus aureus (SA) carrier status, patients were randomly assigned to receive daily 4% chlorhexidine care (intervention group) or normal saline (control group) at the exit site. Monthly, we cultured bacteria from the exit site and nasal swabs for 1 year. The SA colonization rates at exit site at 6 and 12 months were significantly lower in the intervention group than the control group (5.0% vs. 22.9%, p = 0.023 and 8.6% vs. 28.1%, p = 0.037 for 6 and 12 months, respectively). The Methicillin-resistant SA (MRSA) colonization rate at exit site at 6 months was similar (5.7% vs. 2.5%,p = 0.596) in control and intervention group, but significantly lower in the intervention group than the control group at exit site at 12months (0% vs. 12.5%, p = 0.047). The gram-negative bacilli (GNB) colonization rates were similar between the intervention and control groups at 6 and 12 months. Genotyping of all MRSA isolates showed ST (sequence type) 59 was the most predominant clone. In conclusion, chlorhexidine care at the exit site in PD patients may be a good strategy for SA and MRSA decolonization. TRIAL REGISTRATION ClinicalTrials.gov NCT02446158.
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Affiliation(s)
- Hsi-Hao Wang
- Internal Medicine Department, E-DA Hospital, Kaohsiung, Taiwan
- School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Shih-Yuan Hung
- Internal Medicine Department, E-DA Hospital, Kaohsiung, Taiwan
- School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Min-Yu Chang
- Internal Medicine Department, E-DA Hospital, Kaohsiung, Taiwan
- School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yi-Che Lee
- Internal Medicine Department, E-DA Hospital, Kaohsiung, Taiwan
- School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Hsiu-Fang Lin
- Department of Laboratory Medicine, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Tsun-Mei Lin
- Department of Laboratory Medicine, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Su-Pen Yang
- Internal Medicine Department, E-DA Hospital, Kaohsiung, Taiwan
- School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Hsi-Hsun Lin
- Internal Medicine Department, E-DA Hospital, Kaohsiung, Taiwan
- School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Su-Ching Yang
- Department of Nursing, National Tainan Institute of Nursing, Tainan, Taiwan
| | - Jiun-Ling Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail:
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89
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Lonappan V, Al Ali F, Amin M, Hamdy H, Ismail S. ISQUA17-2026MULTIDISCIPLINARY INTERVENTIONS TO REDUCE PERITONITIS INFECTION IN PERITONITIS INFECTION IN PERITONEAL DIALYSIS UNIT, QATAR. Int J Qual Health Care 2017. [DOI: 10.1093/intqhc/mzx125.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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90
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Baillie J, Gill P, Courtenay M. Knowledge, understanding and experiences of peritonitis amongst patients, and their families, undertaking peritoneal dialysis: A mixed methods study protocol. J Adv Nurs 2017; 74:201-210. [DOI: 10.1111/jan.13400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | - Paul Gill
- School of Healthcare Sciences; Cardiff University; UK
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91
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Colonoscopy in automated peritoneal dialysis patients: value of prophylactic antibiotics: a prospective study on a single antibiotic. Int J Artif Organs 2017; 40:550-557. [PMID: 28708216 DOI: 10.5301/ijao.5000612] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the need for prophylactic antibiotics in automated peritoneal dialysis (APD) patients undergoing flexible colonoscopy. PATIENTS AND METHODS A total of 93 patients on automated peritoneal dialysis (APD) undergoing diagnostic colonoscopy were enrolled in a prospective, randomized study. Patients were randomized into 2 age- and sex-matched groups; group A (46 patients) with intraperitoneal (IP) ceftazidime prior to colonoscopy and group B (47 patients) without prophylactic antibiotics. The relations between peritonitis and different parameters were analyzed. RESULTS Of all colonoscopies, 60.2% showed normal findings, 17.2% with colonic polyps at different sites, 12.9% with angiodysplastic-like lesions, 5.4% with colonic ulcer(s), 3.2% with diverticulae without diverticulitis and 1.1% had transverse colon stricture. Post-colonoscopy peritonitis was documented in 3 (6.5%) and 4 (8.5%) patients in groups A and B, respectively (p = 0.2742); the causative organisms were mainly gram negative bacteria. Polypectomy was not associated with increased peritonitis episodes. By multiple logistic regression analysis, diabetes mellitus was the only independent variable that entered into the best predictive equation over the development of post-colonoscopy peritonitis but not antibiotic use. CONCLUSIONS The relation between prophylactic antibiotic use prior to colonoscopy in APD patients and the risk of peritonitis was lacking. Only diabetes mellitus appears to be of significance. Polypectomy did not increase peritonitis episodes.
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92
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Sanghvi Y, Somers D. Blastomyces dermatitidis peritonitis complicating peritoneal dialysis. Semin Dial 2017. [DOI: 10.1111/sdi.12614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yogesh Sanghvi
- E300 GH; Division of Nephrology; Department of Internal Medicine; University of Iowa Hospital & Clinics; Iowa City IA USA
| | - Douglas Somers
- E300 GH; Division of Nephrology; Department of Internal Medicine; University of Iowa Hospital & Clinics; Iowa City IA USA
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93
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Liakopoulos V, Nikitidou O, Kalathas T, Roumeliotis S, Salmas M, Eleftheriadis T. Peritoneal dialysis-related infections recommendations: 2016 update. What is new? Int Urol Nephrol 2017; 49:2177-2184. [PMID: 28573488 DOI: 10.1007/s11255-017-1632-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 05/25/2017] [Indexed: 12/17/2022]
Abstract
In 2016, the International Society of Peritoneal Dialysis (ISPD) published guidelines that focus on the importance of both prevention and treatment of peritonitis. For once more, the need for annual reporting of peritonitis rates and recording of peritonitis and exit-site infections, isolated microorganism and antimicrobial susceptibilities as a central component of a quality improvement program is highlighted. Data on new antibiotic regimens, techniques for microorganism isolation and peritoneal dialysis solutions are included. Training of both peritoneal dialysis nurses and patients seems to be crucial, while the modifiable risk factors for peritonitis seem to be of great interest. In this article, we record the changes in the last ISPD (2016) guidelines compared to the previous ones published in 2010.
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Affiliation(s)
- Vassilios Liakopoulos
- Peritoneal Dialysis Unit, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece.
| | - Olga Nikitidou
- Peritoneal Dialysis Unit, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Theofanis Kalathas
- Peritoneal Dialysis Unit, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Stefanos Roumeliotis
- Peritoneal Dialysis Unit, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Marios Salmas
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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94
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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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95
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Hoekstra BP, de Vries-Hoogsteen A, Winkels B, Zevenbergen-Osinga H, Thijssen-Broers I, Bellemakers T. Exit site care in the Netherlands: the use of guidelines in practice. J Ren Care 2017; 43:156-162. [DOI: 10.1111/jorc.12199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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96
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Tsai CC, Yang PS, Liu CL, Wu CJ, Hsu YC, Cheng SP. Comparison of topical mupirocin and gentamicin in the prevention of peritoneal dialysis-related infections: A systematic review and meta-analysis. Am J Surg 2017; 215:179-185. [PMID: 28341139 DOI: 10.1016/j.amjsurg.2017.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/03/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Topical antibiotics have been shown to reduce exit-site infection and peritonitis. The aim of this study was to compare infection rates between mupirocin and gentamicin. METHODS Multiple comprehensive databases were searched systematically to include relevant randomized controlled trials and observational studies. Pooled risk ratios (RRs) and 95% confidence intervals were calculated for the incidences of exit-site infection and peritonitis. RESULTS Seven studies (mupirocin group n = 458, gentamicin group n = 448) were analyzed for exit-site infection. The risk of gram-positive exit-site infection was similar between the groups. Gram-negative exit-site infection rate was higher in the mupirocin group (RR = 2.125, P = 0.037). Six studies were assessed the peritonitis risk. There was no difference in the gram-positive and -negative peritonitis rate. CONCLUSIONS Topical use of gentamicin is associated with fewer exit-site infections caused by gram-negative organisms. Gentamicin has comparable efficacy to mupirocin for peritonitis and gram-positive exit-site infection.
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Affiliation(s)
- Chia-Chi Tsai
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
| | - Po-Sheng Yang
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan; Graduate Institute of Medical Sciences and Department of Pharmacology, Taipei Medical University, Taipei, Taiwan
| | - Chien-Liang Liu
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
| | - Chih-Jen Wu
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan; Graduate Institute of Medical Sciences and Department of Pharmacology, Taipei Medical University, Taipei, Taiwan
| | - Yi-Chiung Hsu
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan City, Taiwan; Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Shih-Ping Cheng
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan; Graduate Institute of Medical Sciences and Department of Pharmacology, Taipei Medical University, Taipei, Taiwan.
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97
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Latich I, Luciano RL, Mian A. Image-Guided Approach to Peritoneal Dialysis Catheter Placement. Tech Vasc Interv Radiol 2017; 20:75-81. [DOI: 10.1053/j.tvir.2016.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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98
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Szeto CC, Li PKT, Johnson DW, Bernardini J, Dong J, Figueiredo AE, Ito Y, Kazancioglu R, Moraes T, Van Esch S, Brown EA. ISPD Catheter-Related Infection Recommendations: 2017 Update. Perit Dial Int 2017; 37:141-154. [DOI: 10.3747/pdi.2016.00120] [Citation(s) in RCA: 193] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 12/18/2022] Open
Affiliation(s)
- Cheuk-Chun Szeto
- Department of Medicine and Therapeutics, Hammersmith Hospital, London, UK
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Hammersmith Hospital, London, UK
| | - David W. Johnson
- Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Department of Nephrology, Hammersmith Hospital, London, UK
| | - Judith Bernardini
- University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Renal Electrolyte Division, Hammersmith Hospital, London, UK
| | - Jie Dong
- University of Pittsburgh School of Medicine Pittsburgh, PA, USA; Renal Division, Hammersmith Hospital, London, UK
| | - Ana E. Figueiredo
- Department of Medicine, Peking University First Hospital, Beijing, China; Pontifícia Universidade Católica do Rio Grande do Sul, Hammersmith Hospital, London, UK
| | - Yasuhiko Ito
- FAENFI, Porto Alegre, Brazil; Division of Nephrology, Hammersmith Hospital, London, UK
| | - Rumeyza Kazancioglu
- Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Nephrology, Hammersmith Hospital, London, UK
| | - Thyago Moraes
- Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey; Pontifícia Universidade Católica do Paraná, Hammersmith Hospital, London, UK
| | - Sadie Van Esch
- Curitiba, Brazil; Elisabeth Tweesteden Hospital, Hammersmith Hospital, London, UK
| | - Edwina A. Brown
- Nephrology Department and Internal Medicine, Tilburg, Netherlands; and Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
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99
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Mudge DW, Boudville N, Brown F, Clayton P, Duddington M, Holt S, Johnson DW, Jose M, Saweirs W, Sud K, Voss D, Walker R. Peritoneal dialysis practice in Australia and New Zealand: A call to sustain the action. Nephrology (Carlton) 2017; 21:535-46. [PMID: 26807739 DOI: 10.1111/nep.12731] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/09/2015] [Accepted: 01/19/2016] [Indexed: 01/08/2023]
Abstract
This paper updates a previous 'Call to Action' paper (Nephrology 2011; 16: 19-29) that reviewed key outcome data for Australian and New Zealand peritoneal dialysis patients and made recommendations to improve care. Since its publication, peritonitis rates have improved significantly, although they have plateaued more recently. Peritoneal dialysis patient and technique survival in Australian and New Zealand have also improved, with a reduction in the proportion of technique failures attributed to 'social reasons'. Despite these improvements, technique survival rates overall remain lower than in many other parts of the world. This update includes additional practical recommendations based on published evidence and emerging initiatives to further improve outcomes.
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Affiliation(s)
- David W Mudge
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Neil Boudville
- School of Medicine and Pharmacology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Fiona Brown
- Monash Medical Centre, Melbourne, Victoria, Australia
| | - Philip Clayton
- Department of Renal Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Stephen Holt
- Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Matthew Jose
- Department of Nephrology, Royal Hobart Hospital & Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Walaa Saweirs
- Renal Unit, Whangarei Hospital, Whangarei, New Zealand
| | - Kamal Sud
- Nepean Clinical School, and Department of Renal Medicine, Nepean Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - David Voss
- Renal Department, Middlemore Hospital, Auckland, New Zealand
| | - Rowan Walker
- Department of Renal Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
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Ashley J, Rasooly JA, Tran I, Yost LE, Chertow GM. Effect of UV Light on Disinfection of Peritoneal Dialysis Catheter Connections. Perit Dial Int 2017; 37:109-111. [PMID: 28153966 DOI: 10.3747/pdi.2016.00106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We evaluated the microbiological performance of an ultraviolet (UV) light-based peritoneal dialysis catheter connection system. The system includes a UV light-generating device combined with a UV transmissive window incorporated into the transfer set. Each UV transparent transfer set was inoculated with 10 μL of cultured inoculum consisting of either S. aureus, E. coli, or C. albicans After being inoculated, we attached a solution set connector to the transfer catheter, and exposed that connection to a UV light dose of approximately 340 mJoules/cm2 After exposure to UV light, we broke the seal of the solution set and opened the plunger valve on the UV transmissive transfer catheter. We then flushed 10 mL of dialysate through the connection. The flushed solution was collected, diluted, plated on agar medium, and incubated for 24 hours. Results were compared to positive controls collected in an identical manner without exposure to UV light. Thirty test samples and 3 positive controls were collected for each organism. All test samples exposed to UV light had complete kill of bacteria except 1 colony on a single plate in the S. aureus group. Mean log reduction was 4.03 for C. albicans, 4.73 for S. aureus, and 5.29 for E. coli All positive control samples had significant bacterial growth. Our results demonstrate that the application of UV light within a UV transmissive transfer catheter window produces a germicidal effect upon microorganisms known to be associated with peritonitis.
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Affiliation(s)
- John Ashley
- PuraCath Medical, Inc., San Francisco, CA, USA
| | | | - Ian Tran
- PuraCath Medical, Inc., San Francisco, CA, USA
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