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Dizdar OS, Ozer O, Erdem S, Gunal AI. Subcutaneous gentamicin injection around the cuff in treatment of resistant exit site infection in peritoneal dialysis patients: a pilot study. Ther Clin Risk Manag 2017; 13:909-914. [PMID: 28790835 PMCID: PMC5530059 DOI: 10.2147/tcrm.s140894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background/purpose One of the most common complications of the peritoneal dialysis (PD) is the infection of the exit site of the peritoneal catheter. The aim of the present study was to evaluate the efficacy of the subcutaneous gentamicin injection around the cuff as a part of routine treatment of the resistant exit site infection (ESI). Methods If the exit site remains infected after a 2-week systemic antibiotics treatment, it is defined as resistant ESI. In these cases, systemic antibiotics were discontinued and a subcutaneous 40-mg gentamicin injection was administered around the external cuff of the PD catheter every 3 days. A total of three or four injections were given to each patient. Results A subcutaneous gentamicin injection was administered around the cuff in thirteen patients for the treatment of resistant ESI over a 2-year period. The median follow-up time in cured patients was 12 months. Eleven of the thirteen patients had been apparently cured of their resistant ESI, with no recurrence. None of the patients had a gentamicin-resistant species. Subcutaneous gentamicin-related adverse effect was not observed in any patient. Conclusion Subcutaneous gentamicin injection around the cuff is a well-tolerated and effective strategy for treating resistant ESI. To gain widespread approval of this therapy and reach a consensus about ESI management, additional studies are needed.
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Affiliation(s)
- Oguzhan Sıtkı Dizdar
- Department of Internal Medicine and Clinical Nutrition, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Ozerhan Ozer
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Selahattin Erdem
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Ali Ihsan Gunal
- Department of Internal Medicine Division of Nephrology, Kayseri Training and Research Hospital, Kayseri, Turkey
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Hsieh YP, Wang SC, Chang CC, Wen YK, Chiu PF, Yang Y. The negative impact of early peritonitis on continuous ambulatory peritoneal dialysis patients. Perit Dial Int 2014; 34:627-35. [PMID: 24497590 DOI: 10.3747/pdi.2013.00024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Peritonitis rate has been reported to be associated with technique failure and overall mortality in previous literatures. However, information on the impact of the timing of the first peritonitis episode on continuous ambulatory peritoneal dialysis (CAPD) patients is sparse. The aim of this research is to study the influence of time to first peritonitis on clinical outcomes, including technique failure, patient mortality and dropout from peritoneal dialysis (PD). METHODS A retrospective observational cohort study was conducted over 10 years at a single PD unit in Taiwan. A total of 124 patients on CAPD with at least one peritonitis episode comprised the study subjects, which were dichotomized by the median of time to first peritonitis into either early peritonitis patients or late peritonitis patients. Cox proportional hazard model was used to analyze the correlation of the timing of first peritonitis with clinical outcomes. RESULTS Early peritonitis patients were older, more diabetic and had lower serum levels of creatinine than the late peritonitis patients. Early peritonitis patients were associated with worse technique survival, patient survival and stay on PD than late peritonitis patients, as indicated by Kaplan-Meier analysis (log-rank test, p = 0.04, p < 0.001, p < 0.001, respectively). In the multivariate Cox regression model, early peritonitis was still a significant predictor for technique failure (hazard ratio (HR), 0.54; 95% confidence interval (CI), 0.30 - 0.98), patient mortality (HR, 0.34; 95% CI, 0.13 - 0.92) and dropout from PD (HR, 0.50; 95% CI, 0.30 - 0.82). In continuous analyses, a 1-month increase in the time to the first peritonitis episode was associated with a 2% decreased risk of technique failure (HR, 0.98; 95% CI, 0.97 - 0.99), a 3% decreased risk of patient mortality (HR, 0.97; 95% CI, 0.95 - 0.99), and a 2% decreased risk of dropout from PD (HR, 98%; 95% CI, 0.97 - 0.99). Peritonitis rate was inversely correlated with time to first peritonitis according to the Spearman analysis (r = -0.64, p < 0.001). CONCLUSIONS Time to first peritonitis is significantly correlated with clinical outcomes of peritonitis patients with early peritonitis patients having poor prognosis. Patients with shorter time to first peritonitis were prone to having a higher peritonitis rate.
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Affiliation(s)
- Yao-Peng Hsieh
- Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan; and School of Medicine, Chung Shan Medical University, Taichung, Taiwan Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan; and School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shu-Chuan Wang
- Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan; and School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chia-Chu Chang
- Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan; and School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yao-Ko Wen
- Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan; and School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ping-Fang Chiu
- Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan; and School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yu Yang
- Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan; and School of Medicine, Chung Shan Medical University, Taichung, Taiwan Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan; and School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Increased peritoneal dialysis exit site infections using topical antiseptic polyhexamethylene biguanide compared to mupirocin: results of a safety interim analysis of an open-label prospective randomized study. Antimicrob Agents Chemother 2013; 57:2026-8. [PMID: 23403425 DOI: 10.1128/aac.02079-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Prophylactic mupirocin for peritoneal catheter exit sites reduces exit site infection (ESI) risk but engenders antibiotic resistance. We present early interim safety analysis of an open-label randomized study comparing polyhexamethylene biguanide (PHMB) and mupirocin. A total of 106 patients randomized to 53 in each group were followed up for a mean of 12.68 months per patient. On safety analysis, the PHMB group had a significantly greater ESI rate than the mupirocin group (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.09 to 0.80), leading to discontinuation of the trial.
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Kalil AC, Mattei J, Florescu DF, Sun J, Kalil RS. Recommendations for the assessment and reporting of multivariable logistic regression in transplantation literature. Am J Transplant 2010; 10:1686-94. [PMID: 20642690 PMCID: PMC2909008 DOI: 10.1111/j.1600-6143.2010.03141.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Multivariable logistic regression is an important method to evaluate risk factors and prognosis in solid organ transplant literature. We aimed to assess the quality of this method in six major transplantation journals. Eleven analytical criteria and four documentation criteria were analyzed for each selected article that used logistic regression. A total of 106 studies (6%) out of 1,701 original articles used logistic regression analyses from January 1, 2005 to January 1, 2006. The analytical criteria and their respective reporting percentage among the six journals were: Linearity (25%); Beta coefficient (48%); Interaction tests (19%); Main estimates (98%); Ovefitting prevention (84%); Goodness-of-fit (3.8%); Multicolinearity (4.7%); Internal validation (3.8%); External validation (8.5%). The documentation criteria were reported as follows: Selection of independent variables (73%); Coding of variables (9%); Fitting procedures (49%); Statistical program (65%). No significant differences were found among different journals or between general versus subspecialty journals with respect to reporting quality. We found that the report of logistic regression is unsatisfactory in transplantation journals. Because our findings may have major consequences for the care of transplant patients and for the design of transplant clinical trials, we recommend a practical solution for the use and reporting of logistic regression in transplantation journals.
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Affiliation(s)
- Andre C. Kalil
- Infectious Diseases Division, University of Nebraska Medical Center, Omaha, NE
| | - Jane Mattei
- Hospital Nossa Senhora da Conceicao, Porto Alegre, Brazil
| | - Diana F. Florescu
- Infectious Diseases Division, University of Nebraska Medical Center, Omaha, NE
| | - Junfeng Sun
- Critical Care Medicine Department, National Institutes of Health, Bethesda, MD
| | - Roberto S. Kalil
- Nephrology Division, University of Iowa Hospitals and Clinics, Iowa City, IA
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