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Warady BA, Same R, Borzych-Duzalka D, Neu AM, El Mikati I, Mustafa RA, Begin B, Nourse P, Bakkaloglu SA, Chadha V, Cano F, Yap HK, Shen Q, Newland J, Verrina E, Wirtz AL, Smith V, Schaefer F. Clinical practice guideline for the prevention and management of peritoneal dialysis associated infections in children: 2024 update. Perit Dial Int 2024; 44:303-364. [PMID: 39313225 DOI: 10.1177/08968608241274096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
Infection-related complications remain the most significant cause for morbidity and technique failure in infants, children and adolescents who receive maintenance peritoneal dialysis (PD). The 2024 update of the Clinical Practice Guideline for the Prevention and Management of Peritoneal Dialysis Associated Infection in Children builds upon previous such guidelines published in 2000 and 2012 and provides comprehensive treatment guidance as recommended by an international group of pediatric PD experts based upon a review of published literature and pediatric PD registry data. The workgroup prioritized updating key clinical issues contained in the 2012 guidelines, in addition to addressing additional questions developed using the PICO format. A variety of new guideline statements, highlighted by those pertaining to antibiotic therapy of peritonitis as a result of the evolution of antibiotic susceptibilities, antibiotic stewardship and clinical registry data, as well as new clinical benchmarks, are included. Recommendations for future research designed to fill important knowledge gaps are also provided.
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Affiliation(s)
- Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Rebecca Same
- Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Dagmara Borzych-Duzalka
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdańsk, Poland
| | - Alicia M Neu
- Division of Pediatric Nephrology, Johns Hopkins Children's Hospital, Baltimore, Maryland, USA
| | - Ibrahim El Mikati
- Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Brandy Begin
- Doernbecher Children's Hospital at Oregon Health & Science University, Portland, Oregon, USA
| | - Peter Nourse
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | | | - Vimal Chadha
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Francisco Cano
- Luis Calvo Mackenna Children's Hospital, Santiago, Chile
| | - Hui Kim Yap
- Division of Pediatric Nephrology, National University Hospital, Singapore, Singapore
| | - Qian Shen
- Children's Hospital of Fudan University, Shanghai, China
| | - Jason Newland
- Division of Pediatric Infectious Diseases, St. Louis Children's Hospital, St Louis, Missouri, USA
| | - Enrico Verrina
- Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini Children's, Genoa, Italy
| | - Ann L Wirtz
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Valerie Smith
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Franz Schaefer
- Heidelberg University Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
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Zheng S, Bargman JM. Unusual and complicated peritonitis: Your questions answered. Perit Dial Int 2024:8968608241237400. [PMID: 38532707 DOI: 10.1177/08968608241237400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
Effective treatment of infections is a growing challenge owing to antimicrobial resistance. Peritoneal dialysis (PD) patients experience more frequent hospitalisations than the general population and have greater exposure to antibiotics, making them particularly vulnerable to this threat. Over the last decade, we have noted a surge in cases of complicated peritoneal dialysis-associated peritonitis (PD peritonitis) caused by antimicrobial-resistant organisms, including extended-spectrum beta-lactamase (ESBL), AmpC beta-lactamase-producing Enterobacterales, Pseudomonas aeruginosa and fungi. Practitioners must be alert to these organisms, seek early recognition of these resistance patterns and make timely adjustments in order to avoid delay in treatment that may increase risk of PD catheter removal and technique failure. We present a case of successful treatment of ESBL peritonitis, highlight its challenges, while providing guidance on management of other unusual and complicated PD peritonitis.
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Affiliation(s)
- Sijia Zheng
- Division of Nephrology, University of Toronto, University Health Network/Toronto General Hospital, Toronto, ON, Canada
| | - Joanne M Bargman
- Division of Nephrology, University of Toronto, University Health Network/Toronto General Hospital, Toronto, ON, Canada
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Wang AH, Sawyer K, Shah AD. Persistent peritonitis in peritoneal dialysis: a comphrenesive review of recurrent, relapsing, refractory, and repeat peritonitis. Int Urol Nephrol 2024; 56:583-595. [PMID: 37563501 DOI: 10.1007/s11255-023-03731-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
Peritonitis is a major cause of morbidity and technique failure in patients receiving peritoneal dialysis. Complicated peritonitis that manifests as multiple or unresolving episodes is classified as refractory, recurrent, relapsing, or repeat peritonitis, and often possesses higher risk of technique failure and mortality as well as lower complete cure rates than primary or uncomplicated episodes. While these peritonitis subtypes affect a considerable portion of PD patients, details regarding their epidemiology, pathogenesis, diagnosis, clinical sequelae, and management have not yet been fully elucidated. Improved clinical awareness and understanding of complicated peritonitis subtypes is crucial to ensure optimal management for these patients; thus, we consolidate and report the pertinent findings of recent literature on these four entities.
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Affiliation(s)
- Aaron H Wang
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Kelsey Sawyer
- Health and Biomedical Library Services, Brown University, Providence, RI, USA
| | - Ankur D Shah
- Warren Alpert Medical School, Brown University, Providence, RI, USA.
- Division of Kidney Disease and Hypertension, Rhode Island Hospital, Warren Alpert Medical School at Brown University, 593 Eddy St, Providence, RI, 02903, USA.
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Hu KY, Chao CT, Chen SI, Shu CC, Hung KY. Mycobacterium mageritense related peritoneal dialysis peritonitis: An antibiogram summary and successful treatment experiences. Nephrology (Carlton) 2023; 28:690-692. [PMID: 37632407 DOI: 10.1111/nep.14234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/21/2023] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Kai-Yu Hu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Ter Chao
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan
- Nephrology Division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital Beihu branch, Taipei, Taiwan
| | - Shih-I Chen
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital Beihu branch, Taipei, Taiwan
| | - Chin-Chung Shu
- Chest Medicine Division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuan-Yu Hung
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Nephrology Division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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Hashimoto N, Kani N, Makino S, Naka T, Miyakawa H, Okamoto K, Uwatoko R, Bessho S, Iio R, Ueda Y, Hayashi T. Fatal peritoneal dialysis-associated peritonitis caused by Mycobacterium mageritense: a case report with review. RENAL REPLACEMENT THERAPY 2023. [DOI: 10.1186/s41100-023-00457-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Background
Peritonitis is a serious and potentially fatal complication of peritoneal dialysis. We report a case of fatal peritonitis caused by Mycobacterium mageritense that was detected for the first time in peritonitis.
Case presentation
A male patient in his 60 s undergoing peritoneal dialysis was admitted for catheter diversion with exit-site renewal. The patient had a refractory exit-site infection. Mycobacterial culture was not performed at the exit site prior to admission. After the surgery, the patient developed a fever, and a cloudy effluent was observed. Various antibiotics, including anti-tuberculosis drugs, were administered; however, his symptoms did not improve. The catheter was removed on the thirty-seventh day of admission. Bacteria positive for Ziehl–Neelsen staining were found in the peritoneal sample collected during the surgery. Since nontuberculous mycobacteria were considered the cause of peritonitis, the patient was administered imipenem/cilastatin, amikacin, and clarithromycin. However, he died of septic shock on the fifty-first day after admission. Mycobacterium mageritense was detected in the ascites culture after death.
Conclusion
This is, to our knowledge, the first report of peritonitis caused by Mycobacterium mageritense. In patients undergoing peritoneal dialysis, when a refractory exit-site infection is observed, mycobacterial culture is necessary to prevent the development of peritonitis.
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Fung WWS, Chow KM, Ng JKC, Chan GCK, Li PKT, Szeto CC. The Clinical Utility of the Neutrophil-to-Lymphocyte Ratio as a Discriminatory Test among Bacterial, Mycobacterium Tuberculosis, and Nontuberculous Mycobacterium Peritoneal Dialysis-Related Peritonitis. KIDNEY360 2022; 3:1031-1038. [PMID: 35845333 PMCID: PMC9255867 DOI: 10.34067/kid.0000842022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/21/2022] [Indexed: 01/10/2023]
Abstract
Background Distinguishing Mycobacterium tuberculosis (TB) and nontuberculous Mycobacterium (NTM) from bacterial peritoneal dialysis (PD)-related peritonitis (peritonitis) is often very challenging and can lead to a significant delay in diagnosis and treatment. The neutrophil-to-lymphocyte ratio (NLR) is readily calculable and has been shown to be useful in differentiating pulmonary TB from bacterial pneumonia. We are the first group to demonstrate the predictive efficacy of peritoneal dialysate (PDE) NLR in distinguishing TB/NTM peritonitis from bacterial causes in the PD population. Methods We retrospectively reviewed the clinical and laboratory characteristics of all patients with TB/NTM peritonitis, methicillin-sensitive Staphylococcus aureus (MSSA) peritonitis, and culture-negative peritonitis in our tertiary center between July 2000 and July 2020. The diagnostic ability of the blood and PDE NLR for differential diagnosis was evaluated. Results In total, 258 episodes, 38 episodes, and 27 episodes were caused by MSSA, TB, and NTM species, respectively; 364 episodes were culture negative. The PDE NLR level taken at presentation were lowest in the TB peritonitis, followed by the NTM, culture-negative, and MSSA groups, (9.44±13.01, 16.99±23.96, 36.63±32.33, 48.51±36.01; P<0.001, respectively). The area under the receiver operating characteristic curve for the NLR taken at presentation was 0.83 (95% confidence interval, 0.77 to 0.89; P<0.001). A PDE NLR <15 was an optimal cut-off value with sensitivity, specificity, positive predictive value, and negative predictive values of 81%, 70%, 97%, and 22%, respectively. Conclusions The PDE NLR obtained at presentation is a useful and easily accessible marker to discriminate TB/NTM peritonitis from bacterial peritonitis, especially in areas with intermediate TB/NTM burden. The NLR may enable early prompting of TB/NTM peritonitis, allowing specific investigation and treatment to be instigated earlier.
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Affiliation(s)
| | - Kai-Ming Chow
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Jack Kit-Chung Ng
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Gordon Chun-Kau Chan
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Philip Kam-Tao Li
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Cheuk-Chun Szeto
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China,Division of Nephrology, Li Ka Shing Institute of Health Sciences, Hong Kong, China
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