1
|
Motta Guimarães MG, Pinheiro Martin Tapioca F, Costa Neves F, Nunes Freitas Teixeira S, Santana Passos LC. The efficacy of fluconazole for anti-fungal prophylaxis in peritoneal dialysis patients: A systematic review and meta-analysis. Nefrologia 2024; 44:173-179. [PMID: 38697695 DOI: 10.1016/j.nefroe.2024.04.002] [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: 04/26/2023] [Accepted: 07/24/2023] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES The efficacy of fluconazole as a prophylactic strategy in patients with chronic kidney disease (CKD) on peritoneal dialysis (PD) with prior antibiotic exposure is controversial in the current literature. This study aimed to compare a strategy of fluconazole prophylaxis versus no-prophylaxis for patients in PD on antibiotics for previous episodes of peritonitis. MATERIALS AND METHODS We performed a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs) comparing fluconazole prophylaxis with no prophylaxis for PD-related peritonitis. The search was conducted on PubMed, EMBASE, and Cochrane Central in January 23, 2023. The outcome of interest was the occurrence of fungal peritonitis (FP). RESULTS We included six studies (1 RCT, 5 observational) with 4515 occurrences of peritonitis, of which 1098 (24.8%) received fluconazole prophylaxis in variable doses, whereas 3417 (75.6%) did not receive prophylaxis during peritonitis episodes. Overall, fluconazole prophylaxis was associated with a lower incidence of FP (OR 0.22; 95% CI 0.12-0.41; p<0.001; I2=0%). Subgroup analysis of studies that administered daily doses of fluconazole also demonstrated a reduced incidence of FP in patients who received antifungal prophylaxis (OR 0.31; CI 0.14-0.69; p=0.004; I2=0%). CONCLUSIONS In this meta-analysis of 4515 episodes of PD-related peritonitis, prophylaxis with fluconazole significantly reduced episodes of FP as compared with no antifungal prophylaxis.
Collapse
Affiliation(s)
| | - Fernanda Pinheiro Martin Tapioca
- Division of Nephrology, Ana Nery Hospital, Salvador, Bahia, Brazil; Bahiana School of Medicine, Salvador, Bahia, Brazil; Medicine and Health Program, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Felipe Costa Neves
- Division of Nephrology, Ana Nery Hospital, Salvador, Bahia, Brazil; Bahiana School of Medicine, Salvador, Bahia, Brazil
| | | | - Luiz Carlos Santana Passos
- Medicine and Health Program, Federal University of Bahia, Salvador, Bahia, Brazil; Division of Cardiology, Ana Nery Hospital, Salvador, Bahia, Brazil
| |
Collapse
|
2
|
Li PKT, Chow KM, Cho Y, Fan S, Figueiredo AE, Harris T, Kanjanabuch T, Kim YL, Madero M, Malyszko J, Mehrotra R, Okpechi IG, Perl J, Piraino B, Runnegar N, Teitelbaum I, Wong JKW, Yu X, Johnson DW. ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Perit Dial Int 2022; 42:110-153. [PMID: 35264029 DOI: 10.1177/08968608221080586] [Citation(s) in RCA: 174] [Impact Index Per Article: 87.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Peritoneal dialysis (PD)-associated peritonitis is a serious complication of PD and prevention and treatment of such is important in reducing patient morbidity and mortality. The ISPD 2022 updated recommendations have revised and clarified definitions for refractory peritonitis, relapsing peritonitis, peritonitis-associated catheter removal, PD-associated haemodialysis transfer, peritonitis-associated death and peritonitis-associated hospitalisation. New peritonitis categories and outcomes including pre-PD peritonitis, enteric peritonitis, catheter-related peritonitis and medical cure are defined. The new targets recommended for overall peritonitis rate should be no more than 0.40 episodes per year at risk and the percentage of patients free of peritonitis per unit time should be targeted at >80% per year. Revised recommendations regarding management of contamination of PD systems, antibiotic prophylaxis for invasive procedures and PD training and reassessment are included. New recommendations regarding management of modifiable peritonitis risk factors like domestic pets, hypokalaemia and histamine-2 receptor antagonists are highlighted. Updated recommendations regarding empirical antibiotic selection and dosage of antibiotics and also treatment of peritonitis due to specific microorganisms are made with new recommendation regarding adjunctive oral N-acetylcysteine therapy for mitigating aminoglycoside ototoxicity. Areas for future research in prevention and treatment of PD-related peritonitis are suggested.
Collapse
Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Kai Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yeoungjee Cho
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Stanley Fan
- Translational Medicine and Therapeutic, William Harvey Research Institute, Queen Mary University, London, UK
| | - Ana E Figueiredo
- Nursing School Escola de Ciências da Saúde e da Vida Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tess Harris
- Polycystic Kidney Disease Charity, London, UK
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Magdalena Madero
- Division of Nephrology, Department of Medicine, National Heart Institute, Mexico City, Mexico
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Diseases, The Medical University of Warsaw, Poland
| | - Rajnish Mehrotra
- Division of Nephrology, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, DC, USA
| | - Ikechi G Okpechi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, South Africa
| | - Jeff Perl
- St Michael's Hospital, University of Toronto, ON, Canada
| | - Beth Piraino
- Department of Medicine, Renal Electrolyte Division, University of Pittsburgh, PA, USA
| | - Naomi Runnegar
- Infectious Management Services, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Isaac Teitelbaum
- Division of Nephrology, Department of Medicine, University of Colorado, Aurora, CO, USA
| | | | - Xueqing Yu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangzhou, China
- Guangdong Academy of Medical Sciences, Guangzhou, China
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| |
Collapse
|
3
|
Wong SS, Chu KH, Cheuk A, Tsang WK, Fung SK, Chan HW, Tong MK. Prophylaxis against Gram-Positive Organisms Causing Exit-Site Infection and Peritonitis in Continuous Ambulatory Peritoneal Dialysis Patients by Applying Mupirocin Ointment at the Catheter Exit Site. Perit Dial Int 2020. [DOI: 10.1177/089686080302302s32] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective We evaluated the effectiveness of local application of mupirocin ointment at the catheter exit site in preventing exit-site infection and peritonitis attributable to gram-positive organisms in continuous ambulatory peritoneal dialysis patients. Methods This prospective randomized controlled trial included 154 patients. They were randomly allocated to a mupirocin-treated group (group M) and a control group (group C). Group M included 73 patients (47.4%) who were instructed to apply mupirocin ointment to the catheter exit site once daily after the routine daily exit-site dressing. Group C included 81 patients (52.6%) who continued their usual daily exit-site care without applying mupirocin. The two groups were followed to see whether there would be any difference in the frequency of exit-site infection and peritonitis or in the infecting organisms. Results Interim data were collected at 5 months after the start of the study. Those data showed a significantly lower incidence of exit-site infection and peritonitis attributable to gram-positive organisms in group M as compared with group C. The incidence of gram-positive exit-site infection in group C was 1 episode per 36.8 patient–months; in group M, the incidence was 1 episode per ∞ patient–months (0 incidence in 5 months, p < 0.05). The incidence of gram-positive peritonitis in group C was 1 episode per 40.5 patient–months; in group M, the incidence was 1 episode per 365 patient–months ( p < 0.05). Mupirocin treatment had no significant effect on the incidence of exit-site infection and peritonitis attributable to other organisms. Before mupirocin treatment, we saw a trend toward higher infection rates in diabetic patients and nasal carriers of Staphylococcus aureus as compared with non diabetic patients and nasal non carriers, although the differences were not statistically significant. Mupirocin brought the infection rate attributable to gram-positive organisms to an equally low level in diabetic and non-diabetic patients, and in nasal carriers and nasal non carriers of S. aureus. No adverse effect of local application of mupirocin was reported. Conclusion Local application of mupirocin ointment at the catheter exit site is a safe and effective method of preventing exit-site infection and peritonitis involving gram-positive organisms.
Collapse
Affiliation(s)
- Sunny S.H. Wong
- Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China
| | - Kwok Hong Chu
- Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China
| | - Au Cheuk
- Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China
| | - Wai Kay Tsang
- Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China
| | - Samuel K.S. Fung
- Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China
| | - Hilda W.H. Chan
- Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China
| | - Matthew K.L. Tong
- Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China
| |
Collapse
|
4
|
Abstract
Peritonitis is one of the most frequent complications of peritoneal dialysis (PD) and 1% – 15% of episodes are caused by fungal infections. The mortality rate of fungal peritonitis (FP) varies from 5% to 53%; failure to resume PD occurs in up to 40% of patients. The majority of these FP episodes are caused by Candida species. Candida albicans has historically been reported to be a more common cause than non-albicans Candida species, but in recent reports a shift has been observed and non-albicans Candida may now be more common. Unusual, often “nonpathogenic,” fungi are being increasingly reported as etiologic agents in FP. Clinical features of FP are not different from those of bacterial peritonitis. Phenotypic identification of fungi in clinical microbiology laboratories is often difficult and delayed. New molecular diagnostic techniques ( e.g., polymerase chain reaction) are being developed and evaluated, and may improve diagnosis and so facilitate early treatment of infected patients. Abdominal pain, abdominal pain with fever, and catheter left in situ are risk factors for mortality and technique failure in FP. In programs with high baseline rates of FP, nystatin prophylaxis may be beneficial. Each program must examine its own history of FP to decide whether prophylaxis would be beneficial. Catheter removal is indicated immediately after fungi are identified by Gram stain or culture in all patients with FP. Prolonged treatment with antifungal agents to determine response and attempt clearance is not encouraged. Antifungals should be continued for 10 days to 2 weeks after catheter removal. Attempts at reinsertion should be made only after waiting for 4 – 6 weeks.
Collapse
Affiliation(s)
- Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Amit Gupta
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
5
|
Troidle LK, Kliger AS, Finkelstein FO. Challenges of Managing Chronic Peritoneal Dialysis-Associated Peritonitis. Perit Dial Int 2020. [DOI: 10.1177/089686089901900406] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Laura K. Troidle
- New Haven CAPD, Renal Research Institute Yale University School of Medicine New Haven, Connecticut, U.S.A
| | - Alan S. Kliger
- New Haven CAPD, Renal Research Institute Yale University School of Medicine New Haven, Connecticut, U.S.A
| | - Fredric O. Finkelstein
- New Haven CAPD, Renal Research Institute Yale University School of Medicine New Haven, Connecticut, U.S.A
| |
Collapse
|
6
|
Ritzau J, Hoffman RM, Tzamaloukas AH. Effect of Preventing Staphylococcus Aureus Carriage on Rates of Peritoneal Catheter-Related Staphylococcal Infections. Literature Synthesis. Perit Dial Int 2020. [DOI: 10.1177/089686080102100508] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To determine whether specific preventive measures reduce the rate of peritoneal catheter-related infections and peritoneal catheter loss due to Staphylococcus aureus. Design Structured literature synthesis. Methods Relevant studies were identified by medline search, from personal files, and from the reference lists of retrieved articles. We analyzed English-language studies on treatment targeted at S. aureus, with at least 10 subjects and at least 3 months of follow-up, and data on staphylococcal peritoneal dialysis catheter infections. We excluded noncontrolled studies. Two investigators abstracted data using a structured form. Results W e evaluated six studies with concurrent controls and eight studies with historical controls. In one randomized, placebo-controlled, blinded study, periodic nasal mupirocin ointment reduced the rate of staphylococcal exit-site infection from 0.42 to 0.12 episodes/patient-year ( p = 0.006), but had no effect on the rates of staphylococcal tunnel infection, peritonitis, or catheter loss. In one randomized study without placebo control, periodic oral rifampin reduced the rate of staphylococcal exit-site infection from 0.65 to 0.22 epi/pt-yr ( p = 0.011), but had no effect on the rate of staphylococcal peritonitis. In another nonblinded, randomized, controlled study, the use of either rifampin or mupirocin was associated with low rates of staphylococcal catheter infections and catheter loss. In one study with historical controls, the rate of staphylococcal exit-site infection and peritonitis was lower after oral rifampin prophylaxis. In seven other studies comparing nasal or exit-site mupirocin to historical controls, the rate of staphylococcal exit-site infection decreased from 0.17 to 0.05 epi/pt-yr, the rate of staphylococcal peritonitis decreased from 0.18 to 0.06 epi/pt-yr, and the rate of catheter loss decreased from 0.09 to 0.05 epi/pt-yr during the mupirocin period. Conclusion The literature provides strong evidence that staphylococcal carriage prophylaxis using either oral rifampin or mupirocin ointment in the nares or exit site reduces significantly the rate of exit-site infection due to Staphylococcus aureus. Weaker evidence based on studies with historical controls suggests that rifampin or mupirocin prophylaxis also reduces the rate of staphylococcal peritonitis and peritoneal catheter loss. Studies with a stronger level of evidence are needed to verify this last point.
Collapse
Affiliation(s)
- Jennifer Ritzau
- General Internal Medicine Section, and Renal Section, New Mexico VA Health Care System, and Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.A
| | - Richard M. Hoffman
- General Internal Medicine Section, and Renal Section, New Mexico VA Health Care System, and Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.A
| | - Antonios H. Tzamaloukas
- General Internal Medicine Section, and Renal Section, New Mexico VA Health Care System, and Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.A
| |
Collapse
|
7
|
Annigeri R, Conly J, Vas SI, Dedier H, Prakashan KP, Bargman JM, Jassal V, Oreopoulos D. Emergence of Mupirocin-ResistantStaphylococcus Aureusin Chronic Peritoneal Dialysis Patients using Mupirocin Prophylaxis to Prevent Exit-Site Infection. Perit Dial Int 2020. [DOI: 10.1177/089686080102100604] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ObjectiveTo determine the prevalence of the carriage of Staphylococcus aureus (SA), methicillin-resistant Staphylococcus aureus (MRSA), and mupirocin-resistant Staphylococcus aureus (MuRSA) in chronic peritoneal dialysis (CPD) patients after 4 years of prophylactic mupirocin application to the exit site, in a peritoneal dialysis unit.MethodsThree swabs were collected from the nares, axillae/groin, and exit site, respectively, from 149 patients on CPD between May and July 2001. All swabs were cultured on solid selective agar (mannitol salt agar) and in mannitol salt broth. Staphylococcus aureus isolates were tested for methicillin resistance using oxacillin screening plates, and mupirocin resistance using E-test strips. Low-level MuRSA was defined as minimum inhibitory concentration (MIC) of 4 mg/mL or more, and high-level MuRSA as MIC of 256 mg/mL or more.ResultsStaphylococcus aureus was isolated from 26 (17%) patients (25 from nares/axilla/groin, and 1 from the exit site). High-level MuRSA was isolated from 4 patients (3% of the total study population; 15% of total SA isolates). No MRSA was detected. One patient with high-level MuRSA had peritonitis due to SA, resulting in treatment failure and catheter loss, soon after the swabs were collected for the study.ConclusionWe report the emergence of high-level MuRSA in CPD patients after a 4-year practice of continuous use of mupirocin in a small number of patients in our unit. Our results may have significant implications for the future practice of prophylactic use of mupirocin by CPD patients to prevent exit-site infection.
Collapse
Affiliation(s)
- Rajeev Annigeri
- Division of Nephrology University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - John Conly
- Division of Infectious Diseases, Department of Medicine University Health Network and University of Toronto, Toronto, Ontario, Canada
- Infection Prevention and Control Unit, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Stephen I. Vas
- Division of Nephrology University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Helen Dedier
- Infection Prevention and Control Unit, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Kannam P. Prakashan
- Division of Nephrology University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Joanne M. Bargman
- Division of Nephrology University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Vanita Jassal
- Division of Nephrology University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Dimitrios Oreopoulos
- Division of Nephrology University Health Network and University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Danguilan RA, Evangelista LP, Abrenica MS, Rondilla SMS. Comparative Study of Mupirocin and Sodium Fucidate in the Prophylaxis of Exit-Site Infections in CAPD Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080302300614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Romina A. Danguilan
- Department of Nephrology, National Kidney and Transplant Institute Quezon City, Philippines
| | - Liezl P. Evangelista
- Department of Nursing National Kidney and Transplant Institute Quezon City, Philippines
| | - Mildred S. Abrenica
- Department of Nursing National Kidney and Transplant Institute Quezon City, Philippines
| | | |
Collapse
|
9
|
Prakashan K, Annigeri R, Chu M, Bargman J, Vas S, Oreopoulos D. Local Application of Mupirocin at the Peritoneal Catheter Exit Site Prevents Early Postoperative Infections and Should Become Standard Practice. Perit Dial Int 2020. [DOI: 10.1177/089686080102100519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- K.P. Prakashan
- Division of Nephrology University Health Network University of Toronto Toronto, Ontario, Canada
| | - R.A. Annigeri
- Division of Nephrology University Health Network University of Toronto Toronto, Ontario, Canada
| | - M. Chu
- Division of Nephrology University Health Network University of Toronto Toronto, Ontario, Canada
| | - J.M. Bargman
- Division of Nephrology University Health Network University of Toronto Toronto, Ontario, Canada
| | - S.I. Vas
- Division of Nephrology University Health Network University of Toronto Toronto, Ontario, Canada
| | - D.G. Oreopoulos
- Division of Nephrology University Health Network University of Toronto Toronto, Ontario, Canada
| |
Collapse
|
10
|
Piraino B, Bailie GR, Bernardini J, Boeschoten E, Gupta A, Holmes C, Kuijper EJ, Li PKT, Lye WC, Mujais S, Paterson DL, Fontan MP, Ramos A, Schaefer F, Uttley L. Peritoneal Dialysis-Related Infections Recommendations: 2005 Update. Perit Dial Int 2020. [DOI: 10.1177/089686080502500203] [Citation(s) in RCA: 516] [Impact Index Per Article: 129.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Beth Piraino
- Renal Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Judith Bernardini
- Renal Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Amit Gupta
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Clifford Holmes
- Renal Division, Baxter Healthcare Corporation, McGaw Park, Illinois, USA
| | - Ed J. Kuijper
- Department of Medical Microbiology, University Medical Center, Leiden, The Netherlands
| | - Philip Kam-Tao Li
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | - Wai-Choong Lye
- Centre for Kidney Diseases, Mount Elizabeth Medical Centre, Singapore
| | - Salim Mujais
- Renal Division, Baxter Healthcare Corporation, McGaw Park, Illinois, USA
| | - David L. Paterson
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Alfonso Ramos
- Division of Nephrology, Hospital General de Zona #2, Instituto Mexicano del Seguro Social, Hermosillo, Mexico
| | - Franz Schaefer
- Pediatric Nephrology Division, University Children's Hospital, Heidelberg, Germany
| | - Linda Uttley
- Renal Dialysis Treatment, Manchester Royal Infirmary, Manchester, United Kingdom
| |
Collapse
|
11
|
Peacock SJ, Howe PA, Day NP, Crook DW, Winearls CG, Berendt AR. Outcome following Staphylococcal Peritonitis. Perit Dial Int 2020. [DOI: 10.1177/089686080002000209] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Staphylococcus spp predominate as the causative pathogen of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis. This study evaluated the difference in morbidity and mortality between peritonitis caused by S. aureus and coagulase-negative staphylococci (CoNS). Design Prospective observational study. Setting A single regional dialysis unit in a teaching hospital. Patients Thirty-seven patients had S. aureus peritonitis and 65 patients had CoNS peritonitis between July 1990 and November 1995. Main Outcome Measures Using the first recorded episode of peritonitis, survival analysis was performed for time to ( 1 ) death, ( 2 ) removal of peritoneal dialysis catheter, and ( 3 ) change to hemodialysis. Abdominal complications were recorded for the first and subsequent episodes. Results No difference in time to death was demonstrated for the two groups ( p = 0.79), although two deaths that occurred during therapy for peritonitis were attributable to S. aureus infection. In addition, 5 patients developed serious abdominal complications related to an episode of S. aureus peritonitis. Patients with S. aureus peritonitis had a shorter time to both peritoneal dialysis catheter removal ( p = 0.004) and change to hemodialysis ( p = 0.014). The change in mode of dialysis was independent of catheter loss. Conclusion This study highlights the serious nature of S. aureus peritonitis and confirms the need for effective preventive measures against infection by this pathogen.
Collapse
Affiliation(s)
- Sharon J. Peacock
- Nuffield Department of Pathology and Bacteriology, The John Radcliffe
| | | | | | | | | | - Anthony R. Berendt
- Bone Infection Unit, Nuffield Orthopedic Hospital, Oxford, United Kingdom
| |
Collapse
|
12
|
Mahajan S, Tiwari SC, Kalra V, Bhowmik DM, Agarwal SK, Dash SC, Kumar P. Effect of Local Mupirocin Application on Exit-Site Infection and Peritonitis in an Indian Peritoneal Dialysis Population. Perit Dial Int 2020. [DOI: 10.1177/089686080502500512] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Staphylococcus aureus-associated peritonitis and catheter exit-site infections (ESIs) are important causes of hospitalization and catheter loss in patients undergoing chronic peritoneal dialysis. Intranasal and topical use of mupirocin has been found to be an effective strategy in decreasing S. aureus-related infectious complications in persons who are carriers of S. aureus; however, there is no consensus regarding the prophylactic use of mupirocin irrespective of carrier status. We aimed to determine the potential effectiveness of application of mupirocin cream at the catheter exit site in preventing ESI and peritonitis irrespective of carrier status in a tropical country such as India. Methods This prospective historically controlled study was done in a total of 40 patients. From August 2003, all patients, incident and prevalent, were instructed to apply 2% mupirocin cream daily to the exit site instead of the older practice of povidone-iodine and gauze dressing. Patients were not screened to determine whether they were S. aureus carriers. The infection-related data for 1 year, until July 2004, were compared with the historical control, which was infection-related data for the year preceding the year of mupirocin application. Results Mean age of the study population was 62 years, with 61.8% being male and 64.3% being diabetic. Local application of mupirocin led to a significant reduction in the incidence density per patient-month of both ESI and peritonitis compared to controls (0.15 vs 0.37 and 0.37 vs 0.67, p = 0.01 for both). This amounted to a relative reduction of 60.5% and 55% respectively. ESI and peritonitis due to S. aureus were also significantly lower in the study group compared to controls (incidence density per patient-month 0.05 vs 0.13 and zero vs 0.17 respectively, p < 0.01 for both). There occurred no catheter removal due to infection-related complications during the study period compared to two during the control period. None of the patients reported a mupirocin-related adverse effect. Conclusions Daily application of mupirocin at the exit site is a well-tolerated and effective strategy in reducing the incidence of ESI and peritonitis in a tropical country such as India. It can thus significantly reduce morbidity, catheter loss, and transfer to hemodialysis in peritoneal dialysis patients.
Collapse
Affiliation(s)
- Sandeep Mahajan
- Department of Nephrology, All India Institute of Medical Sciences, Ansari Nagar
| | - Suresh C. Tiwari
- Department of Nephrology, All India Institute of Medical Sciences, Ansari Nagar
| | - Vikram Kalra
- Department of Nephrology, All India Institute of Medical Sciences, Ansari Nagar
| | - Dipankar M. Bhowmik
- Department of Nephrology, All India Institute of Medical Sciences, Ansari Nagar
| | - Sanjay K. Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, Ansari Nagar
| | - Suresh C. Dash
- Department of Nephrology, All India Institute of Medical Sciences, Ansari Nagar
| | - Parveen Kumar
- Directorate of Health Services, Delhi Government, DHS Headquarters, New Delhi, India
| |
Collapse
|
13
|
Affiliation(s)
- Ram Gokal
- Manchester RoyalInfirmary, Department of Renal Medicine, Manchester, England
| |
Collapse
|
14
|
Casey M, Taylor J, Clinard P, Graham A, Mauck V, Spainhour L, Brown P, Burkart J. Application of Mupirocin Cream at the Catheter Exit Site Reduces Exit-Site Infections and Peritonitis in Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080002000512] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Michael Casey
- Section on Nephrology Wake Forest University School of Medicine and Piedmont Dialysis Center, Inc. Winston–Salem, North Carolina, U.S.A
| | - Janet Taylor
- Section on Nephrology Wake Forest University School of Medicine and Piedmont Dialysis Center, Inc. Winston–Salem, North Carolina, U.S.A
| | - Patricia Clinard
- Section on Nephrology Wake Forest University School of Medicine and Piedmont Dialysis Center, Inc. Winston–Salem, North Carolina, U.S.A
| | - Angie Graham
- Section on Nephrology Wake Forest University School of Medicine and Piedmont Dialysis Center, Inc. Winston–Salem, North Carolina, U.S.A
| | - Vicki Mauck
- Section on Nephrology Wake Forest University School of Medicine and Piedmont Dialysis Center, Inc. Winston–Salem, North Carolina, U.S.A
| | - Linda Spainhour
- Section on Nephrology Wake Forest University School of Medicine and Piedmont Dialysis Center, Inc. Winston–Salem, North Carolina, U.S.A
| | - Page Brown
- Section on Nephrology Wake Forest University School of Medicine and Piedmont Dialysis Center, Inc. Winston–Salem, North Carolina, U.S.A
| | - John Burkart
- Section on Nephrology Wake Forest University School of Medicine and Piedmont Dialysis Center, Inc. Winston–Salem, North Carolina, U.S.A
| |
Collapse
|
15
|
Williams P, Moncrieff N, Marriott J. No Benefit in using Nystatin Prophylaxis against Fungal Peritonitis in Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080002000319] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- P.F. Williams
- Ipswich Hospital NHS Trust, Ipswich Addenbrooke's NHS Trust, Cambridge United Kingdom
| | - N. Moncrieff
- Ipswich Hospital NHS Trust, Ipswich Addenbrooke's NHS Trust, Cambridge United Kingdom
| | - J. Marriott
- Ipswich Hospital NHS Trust, Ipswich Addenbrooke's NHS Trust, Cambridge United Kingdom
| |
Collapse
|
16
|
Thodis E, Passadakis P, Vargemezis V, Oreopoulos DG. Peritoneal Dialysis: Better than, Equal to, or Worse than Hemodialysis? Data Worth Knowing before Choosing a Dialysis Modality. Perit Dial Int 2020. [DOI: 10.1177/089686080102100105] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Technological advances such as those that allow the delivery of an adequate dialysis dose to a larger percentage of patients, minimization of peritoneal membrane damage with more biocompatible solutions, and lower peritonitis rates will undoubtedly improve retention of patients on peritoneal dialysis (PD) for longer periods. Currently, only 15% of the world dialysis population is managed by PD. Peritoneal dialysis has many advantages over hemodialysis, and if end-stage renal disease (ESRD) patients are fully informed about them, the proportion of patients who would prefer this treatment would rise to 25% – 30%. An integrated approach to the treatment of ESRD could start with PD in a large percentage of patients, especially those who will receive a kidney transplant within 2 – 3 years. With the present epidemic of ESRD, this approach could lead to a significant saving, relieve the pressure on dialysis units, and allow a larger number of ESRD patients to be treated.
Collapse
Affiliation(s)
- Elias Thodis
- Department of Nephrology, Medical School Democritus University of Thrace, Alexandroupolis, Greece
| | - Ploumis Passadakis
- Department of Nephrology, Medical School Democritus University of Thrace, Alexandroupolis, Greece
| | - Vassilis Vargemezis
- Department of Nephrology, Medical School Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios G. Oreopoulos
- The Toronto Western Hospital-University Health Network and University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
17
|
Montenegro J, Saracho R, Aguirre R, Martínez I, Iribar I, Ocharán J. Exit-Site Care with Ciprofloxacin Otologic Solution Prevents Polyurethane Catheter Infection in Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080002000208] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Mupirocin ointment and antiseptics are standard cleansing agents in routine exit-site care of peritoneal dialysis (PD) catheters, but these agents have a deleterious effect on polyurethane devices. We assessed the effectiveness of topical use of ciprofloxacin otologic solution for preventing exit-site infection (ESI) in PD patients with polyurethane catheters. Design Prospective study. Setting Service of Nephrology of an acute-care teaching hospital in Galdácano, Bizkaia, Spain. Patients A total of 164 patients with polyurethane catheters inserted was studied from start of continuous ambulatory PD to the end of a 24-month period. Patients were divided into two groups according to exit-site treatment protocols. Intervention Patients in group 1 ( n = 86) were instructed on daily exit-site care with soap and water only; whereas patients in group 2 ( n = 78) cleansed with soap and water, followed by application of a single-dose vial of 0.5 mL ciprofloxacin (1 mg) for application around the insertion site. Main Outcome Measures Episodes of ESI and peritonitis. Results There were 67 episodes of ESI among patients in group 1 versus 9 episodes among patients in group 2 ( p < 0.05), resulting in a rate of 0.41 and 0.06 episodes per patient-year of exposure, respectively ( p < 0.001). Staphylococcus aureus ESI rate was 0.34 in group 1 versus 0.06 in group 2 ( p = 0.001). Infections caused by Pseudomonas aeruginosa and other pathogens occurred in 11 patients in group 1 and in no patients in group 2 ( p = 0.05). Peritonitis due to S. aureus ESI was significantly less frequent among patients treated with ciprofloxacin (1 vs 9 cases, p = 0.001). Removal of the catheter was necessary in 5 patients in group 1 and in no patients in group 2 ( p < 0.05). Conclusion Daily application of ciprofloxacin otologic solution at the exit site of PD patients with polyurethane catheters inserted significantly reduces the rate of ESI caused by S. aureus and other organisms, particularly P. aeruginosa.
Collapse
Affiliation(s)
- Jesús Montenegro
- Service of Nephrology, Hospital de Galdakao, Galdácano, Bizkaia, Spain
| | - Ramón Saracho
- Service of Nephrology, Hospital de Galdakao, Galdácano, Bizkaia, Spain
| | - Román Aguirre
- Service of Nephrology, Hospital de Galdakao, Galdácano, Bizkaia, Spain
| | - Isabel Martínez
- Service of Nephrology, Hospital de Galdakao, Galdácano, Bizkaia, Spain
| | - Izakun Iribar
- Service of Nephrology, Hospital de Galdakao, Galdácano, Bizkaia, Spain
| | - Julián Ocharán
- Service of Nephrology, Hospital de Galdakao, Galdácano, Bizkaia, Spain
| |
Collapse
|
18
|
Herwaldt LA, Boyken LD, Coffman S, Hochstetler L, Flanigan MJ. Sources of Staphylococcus Aureus for Patients on Continuous Ambulatory Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080302300304] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
← Objective This study was designed to determine whether family members and health care workers are a source of Staphylococcus aureus for patients on peritoneal dialysis. ← Design Over 36 months, cultures were obtained from the nares of patients, family members that cared for the patients’ catheters, and health care workers in a dialysis unit. Pulsed-field gel electrophoresis was performed on all S. aureus isolates. ← Setting A university-based peritoneal dialysis program. ← Participants 74 patients, 32 family members, and 17 health care workers. ← Interventions None. ← Main Outcome Measures The number of patients that acquired S. aureusstrains during the study period. ← Results Of the 48 patients whose initial nares cultures were negative, 7 (15%) acquired S. aureus strains. Overall, 24 of 53 (45%) patients that had 2 or more cultures obtained during the study gained strains. Potential sources were not identified for strains gained by 11 (46%) patients. Five patients appeared to acquire their strains from family members; however, other patients also shared related strains; 8 patients acquired strains shared by other patients. ← Conclusions Family members and other patients appeared to be important sources of S. aureus for patients on peritoneal dialysis. Health care workers that carry S. aureus transiently may be important intermediaries. Good hand hygiene is essential to prevent transmission of S. aureus to these susceptible patients.
Collapse
Affiliation(s)
- Loreen A. Herwaldt
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa, USA
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Linda D. Boyken
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa, USA
| | - Stacy Coffman
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa, USA
| | - Linda Hochstetler
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa, USA
| | - Michael J. Flanigan
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa, USA
| |
Collapse
|
19
|
Al-Hilali N, Nampoory MR, Ninan TV, Ali JH, Gawish A, Johny KV. Viability of Home Peritoneal Dialysis: Experience with 100 Patients from an Arab Population. Perit Dial Int 2020. [DOI: 10.1177/089686080302302s34] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BackgroundThe viability of home peritoneal dialysis (HPD) is being debated in Arab countries. We therefore undertook the present study to assess the viability of HPD in the Arab culture.Patients and MethodsA total of 100 patients with end-stage renal failure were treated with HPD during the period January 1996 to October 2001.ResultsContinuous ambulatory peritoneal dialysis (CAPD) was performed in 81 patients (81%), and nightly intermittent peritoneal dialysis (NIPD) in 19 patients (19%). The patient group included 54 men (54%) and 46 women (46%) with a mean age of 54.94 ± 14.58 years. They were followed for a total of 2118.3 patient–treatment months and had a mean dialysis duration of 21.2 ± 9.97 months. Peritonitis occurred at the rates of 1 episode every 18.5 patient–treatment months (Bieffe L3 double-bag system: Bieffe Medital, Grosotto, Italy), 1 episode every 22.5 patient–treatment months (ANDY Plus system: Fresenius Medical Care, Bad Homburg, Germany), and 1 episode every 23.7 patient–treatment months (NIPD system Fresenius PD-Night: Fresenius Medical Care, Bad Homburg, Germany). Recurrent peritonitis was the main reason (70.6%) for transfer to hemodialysis. A good level of social well-being and rehabilitation was achieved in 49 patients on CAPD (60.5%) and 13 patients on NIPD (68.4%).ConclusionsWe conclude that HPD is a viable modality of renal replacement therapy in Arab countries. By adopting a strict training model, the peritoneal dialysis team can train even patients or caregivers with limited education, preventing peritonitis and promoting the general well-being of patients.
Collapse
Affiliation(s)
- Nabieh Al-Hilali
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait
| | | | - Thomas V. Ninan
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait
| | - Jaber H. Ali
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait
| | - Alaa Gawish
- Mubarak Al-Kabeer Hospital; and Hamed Al-Essa Organ Transplant Center Faculty of Medicine, Kuwait University, Kuwait
| | - Kaivilayil V. Johny
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait
| |
Collapse
|
20
|
Lo W, Cheng I. Who is Going to Benefit from Nystatin Prophylaxis for Fungal Peritonitis Complicating Capd? Perit Dial Int 2020. [DOI: 10.1177/089686089901900225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- W.–K. Lo
- Division of Nephrology Tung Wah Hospital The University of Hong Kong 12 Po Yan Street Sheung Wan, Hong Kong
| | - I.K.P. Cheng
- Division of Nephrology Tung Wah Hospital The University of Hong Kong 12 Po Yan Street Sheung Wan, Hong Kong
| |
Collapse
|
21
|
Al-Hilali N, Ninan V, Al-Humoud H, Nampoory M, Johny K. Mupirocin Once Weekly Reduces the Incidence of Catheter Exit-Site Infection in Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080502500117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- N.A. Al-Hilali
- Nephrology Division Mubarak Al Kabeer Hospital, Hawally, Kuwait
| | - V.T. Ninan
- Nephrology Division Mubarak Al Kabeer Hospital, Hawally, Kuwait
| | - H.A. Al-Humoud
- Nephrology Division Mubarak Al Kabeer Hospital, Hawally, Kuwait
- Department of Medicine Faculty of Medicine, Kuwait University Jabriah, Hawally, Kuwait
| | - M.R.N. Nampoory
- Nephrology Division Mubarak Al Kabeer Hospital, Hawally, Kuwait
| | - K.V. Johny
- Nephrology Division Mubarak Al Kabeer Hospital, Hawally, Kuwait
- Department of Medicine Faculty of Medicine, Kuwait University Jabriah, Hawally, Kuwait
| |
Collapse
|
22
|
Warchol S, Ziolkowska H, Roszkowska–Blaim M. Exit-Site Infection in Children on Peritoneal Dialysis: Comparison of Two Types of Peritoneal Catheters. Perit Dial Int 2020. [DOI: 10.1177/089686080302300213] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To review our experience with two types of peritoneal catheters, the standard Tenckhoff catheter and the swan-neck presternal catheter (SNPC). Design A retrospective study was undertaken to compare exit-site infection (ESI) rates using two types of peritoneal catheters in children. Setting Medical University of Warsaw, Warsaw, Poland. Patients During the past 10 years, 60 peritoneal catheters were implanted in 50 children with end-stage renal failure: 46 straight, double-cuffed Tenckhoff in 37 children (mean age 11.8 ± 4.2 years, range 3.1 – 18.5 years), and 14 presternal in 13 children (mean age 10.6 ± 5 years, range 0.3 – 17.7 years). The SNPCs were used in special clinical situations such as recurrent ESI with previous abdominal peritoneal catheters, obesity, presence of ureterocutaneostomies, use of diapers, and young age. For the statistical analysis, only the first catheter placed in each child was chosen: 34 standard Tenckhoff catheters and 9 SNPCs. Intervention In all children, peritoneal catheters were implanted surgically under general anesthesia by one surgeon; uniform operative technique and perioperative management was used. Results The mean observation time for 46 standard Tenckhoff catheters was 23.8 ± 21.1 months, and for 14 SNPCs 25.1 ± 27.0 months. The ESI rate was 1/17.4 patient-months (0.69 episodes/year) for Tenckhoff catheters and 1/70.2 patient-months (0.17 episodes/year) for SNPCs. The observed differences in ESI rates between the groups reported did not achieve statistical significance. Conclusions The risk of ESI may be lower with presternal catheters. Confirmation of these findings requires further prospective clinical investigation in large numbers of patients.
Collapse
Affiliation(s)
- Stanislaw Warchol
- Department of Cardiac Surgery and General Pediatric Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Helena Ziolkowska
- Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | | |
Collapse
|
23
|
Abstract
Heavy bacterial colonization results in exit-site infection. Antiseptic and non antiseptic agents have both been used for exit-site cleansing. An ideal cleansing agent should not only reduce the number of microorganisms, but should also be harmless to the body's defenses and should not interfere with wound healing. In vitro studies using animal cells have demonstrated that some antiseptic agents have adverse effects on wound healing. Strong cytotoxic antiseptics should be discouraged in exit-site cleansing.In choosing an appropriate cleansing agent for exit-site care, the phase of wound healing, the condition of the exit site, and the goal of cleansing should be taken into consideration. Antimicrobial soap is recommended for cleansing a healed exit site, but biocompatible solution is preferred for the postoperative, infected, or traumatized exit site. In vivo studies on the effectiveness of some cleansing agents are still lacking, and clinical study of exit-site cleansing is needed to determine the most effective agents for the task.
Collapse
Affiliation(s)
- Flora S.Y. Wong
- Renal Dialysis Unit, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China
| |
Collapse
|
24
|
Verrina E, Honda M, Warady BA, Piraino B. Prevention of Peritonitis in Children on Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080002000608] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We reviewed methods of preventing peritonitis in children. A considerable body of evidence indicates that peritonitis rates are lowest with the use of a double-cuffed catheter, with a downward directed tunnel, placed by an experienced surgeon. Evidence in adults, but lacking in children, suggests that exit-site mupirocin will lower Staphylococcus aureus exit-site infections and thus peritonitis rates. The risk of peritonitis due to contamination can be diminished by the avoidance of spiking and by the provision of a long training period. Catheter removal and replacement for catheter-related peritonitis may be done simultaneously in certain circumstances and is useful in decreasing the risk of recurrent peritonitis. Antibiotic prophylaxis at the time of catheter insertion, for contamination, during dialysate leaks, and for invasive procedures appears to be useful in diminishing peritonitis risk.
Collapse
Affiliation(s)
| | | | | | - Beth Piraino
- University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| |
Collapse
|
25
|
Mehrotra R, Marwaha T, Berman N, Mason G, Appell M, Kopple JD. Reducing Peritonitis Rates in a Peritoneal Dialysis Program of Indigent Ethnic Minorities. Perit Dial Int 2020. [DOI: 10.1177/089686080302300113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Rajnish Mehrotra
- Division of Nephrology and Hypertension, California
- Medical Center Torrance, California
- David Geffen School of Medicine at UCLA, California, USA
| | | | - Nancy Berman
- Department of Pediatrics, California
- Medical Center Torrance, California
- UCLA School of Public Health Los Angeles, California, USA
| | - Greg Mason
- Division of Pulmonary and Critical Care Research and Education Institute at Harbor–UCLA, California
- Medical Center Torrance, California
- David Geffen School of Medicine at UCLA, California, USA
| | | | - Joel D. Kopple
- Division of Nephrology and Hypertension, California
- Medical Center Torrance, California
- David Geffen School of Medicine at UCLA, California, USA
- UCLA School of Public Health Los Angeles, California, USA
| |
Collapse
|
26
|
Conly JM, Vas S. Increasing Mupirocin Resistance of Staphylococcus Aureus in CAPD — Should it Continue to be Used as Prophylaxis? Perit Dial Int 2020. [DOI: 10.1177/089686080202200601] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This editorial summarizes the mechanisms of mupirocin resistance and the conditions that promote its development. While there is increasing evidence that high-level mupirocin resistance is developing during systematic use of mupirocin as prophylaxis against Staphylococcus aureus, the appearance of resistance does not preclude the beneficial effect of regular prophylaxis. Vigilance has to be exercised to notice larger-scale resistance that may require limiting the use of mupirocin.
Collapse
Affiliation(s)
- John M. Conly
- Centre for Antimicrobial Resistance Calgary Laboratory Services Division of Microbiology University of Calgary Calgary, Alberta Division of Nephrology Toronto Western Hospital Toronto, Ontario, Canada
| | - Stephen Vas
- Centre for Antimicrobial Resistance Calgary Laboratory Services Division of Microbiology University of Calgary Calgary, Alberta Division of Nephrology Toronto Western Hospital Toronto, Ontario, Canada
| |
Collapse
|
27
|
Piraino B, Bernardini J, Florio T, Fried L. Staphylococcus Aureus Prophylaxis and Trends in Gram-Negative Infections in Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080302300509] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To examine gram-negative exit-site infection and peritonitis rates before and after the implementation of Staphylococcus aureus prophylaxis in peritoneal dialysis (PD) patients. Design Prospective data collection with periodic implementation of protocols to decrease infection rates in two PD programs. Patients 663 incident patients on PD. Interventions Implementation of S. aureus prophylaxis, beginning in 1990. Main Outcome Measures Rates of S. aureus, gram-negative, and Pseudomonas aeruginosa exit-site infections and peritonitis. Results Staphylococcus aureus exit-site infection and peritonitis rates fluctuated without significant trends during the first decade (without prophylaxis), then began to decline during the 1990s subsequent to implementation of prophylaxis, reaching levels of 0.02/year at risk and zero in the year 2000. Gram-negative infections fell toward the end of the 1980s, due probably to the implementation of better connectology. However, there have been no significant changes for the past 6 years. There was little change in P. aeruginosa infections over the entire time period. Pseudomonas aeruginosa is now the most common cause of catheter infection and catheter-related peritonitis. Conclusions Prophylaxis against S. aureus is highly effective in reducing the rate of S. aureus infections but has no effect on gram-negative infections. Pseudomonas aeruginosa is now the most serious cause of catheter-related peritonitis.
Collapse
Affiliation(s)
- Beth Piraino
- Department of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Tracey Florio
- Department of Medicine, Pittsburgh, Pennsylvania, USA
| | - Linda Fried
- Department of Medicine, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh School of Medicine; VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
28
|
Warady BA, Schaefer F, Holloway M, Alexander S, Kandert M, Piraino B, Salusky I, Tranæus A, Divino J, Honda M, Mujais S, Verrina E. Consensus Guidelines for the Treatment of Peritonitis in Pediatric Patients Receiving Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080002000607] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Beth Piraino
- University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | | | | | | | | | - Salim Mujais
- Renal Division, Baxter Healthcare Corporation, Deerfield, Illinois, U.S.A
| | | |
Collapse
|
29
|
Resistance to Mupirocin: No Indication of it to Date While Using Mupirocin Ointment for Prevention of Staphylococcus Aureus Exit-Site Infections in Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686089901900405] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
30
|
Lye WC. Article Commentary: Nystatin Prophylaxis for Fungal Peritonitis: To be or Not to be? Perit Dial Int 2020. [DOI: 10.1177/089686080702700506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Wai-Choong Lye
- Centre for Kidney Diseases Mount Elizabeth Medical Centre Singapore
| |
Collapse
|
31
|
Jassal SV, Lok CE. A Randomized Controlled Trial Comparing Mupirocin versus Polysporin Triple for the Prevention of Catheter-Related Infections in Peritoneal Dialysis Patients (The MP3 Study). Perit Dial Int 2020. [DOI: 10.1177/089686080802800112] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BackgroundPeritonitis remains the most serious complication of peritoneal dialysis (PD). Gram-positive organisms are among the most common causes of PD peritonitis; however, recent trends show increasing rates of gram-negative and fungal infections. Strategies to prevent peritonitis include the use of prophylactic topical mupirocin at the site where the PD catheter exits from the abdominal wall; however, mupirocin does not afford protection against gram-negative or fungal infections. The aim of this study is to determine if the incidence of catheter-related infections (exit-site infection, tunnel infection, or peritonitis) is significantly reduced by the routine application of Polysporin Triple antibiotic ointment (Pfizer Canada, Markham, Ontario, Canada) in comparison to mupirocin ointment.Methods and DesignThe Mupirocin Versus Polysporin Triple Study (MP3) is a multicenter, randomized, double-blinded controlled study comparing Polysporin Triple (P3) against the current standard of care. The aim of the study is to recruit 200 patients being treated with or starting on PD and randomize them to receive either mupirocin or P3 at the catheter exit site. Patients will be followed for 18 months or until death or transfer from PD to an alternate treatment modality. The primary outcome will be the time to first catheter-related infection. Catheter-related infections will be strictly defined using current guidelines and categorized into exit-site infections, infective peritonitis, or tunnel infections. The primary analysis will be an intention-to-treat analysis.DiscussionThe results of this study will help determine if the use of P3 is superior to mupirocin ointment in the prevention of catheter-related infections and will help guide evidence-based best practices.
Collapse
Affiliation(s)
- Sarbjit V. Jassal
- Department of Medicine, University of Toronto, and Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Charmaine E. Lok
- Department of Medicine, University of Toronto, and Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
32
|
Wong PN, Lo KY, Tong GM, Chan SF, Lo MW, Mak SK, Wong AK. Prevention of Fungal Peritonitis with Nystatin Prophylaxis in Patients Receiving CAPD. Perit Dial Int 2020. [DOI: 10.1177/089686080702700512] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Fungal peritonitis (FP) is a serious complication of continuous ambulatory peritoneal dialysis (CAPD), being associated with significant morbidity and mortality. The role of nystatin prophylaxis during antibiotic therapy in the prevention of FP remains controversial, especially in programs with a modest or low baseline FP rate. The aim of the present study was to evaluate the effect of nystatin prophylaxis on the occurrence of FP in programs with a relatively modest baseline FP rate. Patients and Methods Incident and prevalent patients receiving CAPD between April 1995 and April 2005 at our center were included and divided into 2 groups. The control group included 320 patients (total follow-up 8875 patient-months) being treated without nystatin before October 1999; the nystatin group included 481 patients (total follow-up 13725 patient-months) being treated after October 1999. Nystatin tablets (500000 units, 4 times per day) were given orally during whatever use of antibiotics to cover the whole course of antibiotic therapy. Occurrence of FP and antibiotic-related FP (AR-FP) in patients with and without nystatin prophylaxis was compared. Results The two groups were of similar age but the nystatin group had a significantly higher percentage of diabetics. In addition, the nystatin group had a higher proportion of patients using disconnecting twin-bag exchange systems and had a significantly lower peritonitis rate compared with the control. There were 13 and 14 episodes of FP in the nystatin and control groups respectively. The fungal peritonitis rate of the nystatin group was slightly lower than that of the control group (0.011 vs 0.019 per patient-year) but it did not reach statistical significance. There was, however, a significant decrease in the incidence and proportion of AR-FP in the nystatin group compared with the control group, which persisted even after adjustment for the peritonitis rate. Kaplan–Meier analysis further demonstrated significantly better AR-FP-free survival in the nystatin group compared with the control group. No significant side effects were observed for nystatin. Subgroup analyses in patients of the 2 different connecting systems revealed a similar but nonsignificant trend toward reduction of AR-FP in patients given nystatin prophylaxis. Conclusion Oral nystatin prophylaxis might prevent the occurrence of AR-FP in CAPD patients, resulting in a trend toward reduction in the incidence of FP even in programs with a modest baseline FP rate. A large scale, prospective, randomized controlled trial is needed to further examine this issue.
Collapse
Affiliation(s)
- Ping-Nam Wong
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Kin-Yee Lo
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Gensy M.W. Tong
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Shuk-Fan Chan
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Man-Wai Lo
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Siu-Ka Mak
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Andrew K.M. Wong
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| |
Collapse
|
33
|
Moreiras-Plaza M, Vello-Román A, Sampróm-Rodríguez M, Feijóo-Piñeiro D. Ten Years without Fungal Peritonitis: A Single Center's Experience. Perit Dial Int 2020. [DOI: 10.1177/089686080702700416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Arantxa Vello-Román
- Department of Nephrology Complexo Hospitalario Universitario Xeral-Cíes de Vigo Vigo, Spain
| | | | - Diana Feijóo-Piñeiro
- Department of Nephrology Complexo Hospitalario Universitario Xeral-Cíes de Vigo Vigo, Spain
| |
Collapse
|
34
|
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.
Collapse
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
| |
Collapse
|
35
|
Thodis E, Passadakis P, Vargemezis V, Oreopoulos D. Prevention of Catheter Related Infections in Patients on CAPD. Int J Artif Organs 2018. [DOI: 10.1177/039139880102401002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Catheter-related infections remain a serious problem for patients on peritoneal dialysis. Such infections can be reduced by careful patient selection and training, by the use of the best connection technology and screening and treating nasal carriage. To date, treatment is less than optimal and therefore, the primary goal should be prevention of catheter-related infections. Prevention is based on improving catheter design and implantation technique, while providing careful exit-site care. Regardless of how it is implemented, we must aggressively pursue the prevention of catheter-related infections by eradicating S.aureus exit-site carriage in PD patients. Based on its effectiveness in adult PD patients, its low rate of adverse effects, and its reasonable cost-effectiveness, application of mupirocin ointment at the exit-site is the current method of choice for preventing PD catheter infections caused byS. aureus. In addition to reducing S. aureus exit-site infections, mupirocin seems to reduce the rates of staphylococcal peritonitis and PD catheter loss. Whether the ointment should be applied in the nares, to the exit-site or both, and whether it should be used only in staphylococcal nasal carriers or all PD patients requires further study.
Collapse
Affiliation(s)
- E. Thodis
- The Division of Nephrology, Medical School, Democritus University, Alexandroupolis - Greece
| | - P. Passadakis
- The Division of Nephrology, Medical School, Democritus University, Alexandroupolis - Greece
| | - V. Vargemezis
- The Division of Nephrology, Medical School, Democritus University, Alexandroupolis - Greece
| | - D.G. Oreopoulos
- Division of Nephrology, University Health Network and University of Toronto, Toronto, Ontario - Canada
| |
Collapse
|
36
|
Oreopoulos DG, Lobbedez T, Gupta S. Peritoneal Dialysis: Where is it Now and Where is it Going? Int J Artif Organs 2018; 27:88-94. [PMID: 15061471 DOI: 10.1177/039139880402700203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
37
|
El-Reshaid W, Al-Disawy H, Nassef H, Alhelaly U. Comparison of peritonitis rates and patient survival in automated and continuous ambulatory peritoneal dialysis: a 10-year single center experience. Ren Fail 2016; 38:1187-92. [PMID: 27435043 DOI: 10.1080/0886022x.2016.1209025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Peritonitis is a common complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). In this retrospective study, peritonitis rates and patient survival of 180 patients on CAPD and 128 patients on APD were compared in the period from January 2005 to December 2014 at Al-Nafisi Center in Kuwait. All patients had prophylactic topical mupirocin at catheter exit site. Patients on CAPD had twin bag system with Y transfer set. The peritonitis rates were 1 in 29 months in CAPD and 1 in 38 months in APD (p < 0.05). Percentage of peritonitis free patients over 10-year period in CAPD and APD were 49 and 60%, respectively (p < 0.05). Time to develop peritonitis was 10.25 ± 3.1 months in CAPD compared to 16.1 ± 4 months in APD (p < 0.001). Relapse and recurrence rates were similar in both groups. Median patient survival in CAPD and APD groups with peritonitis was 13.1 ± 1 and 14 ± 1.4 months respectively (p = 0.3) whereas in peritonitis free patients it was 15 ± 1.4 months in CAPD and 23 ± 3.1 months in APD (p = 0.025). APD had lower incidence rate of peritonitis than CAPD. Patient survival was better in APD than CAPD in peritonitis free patients but was similar in patients who had peritonitis.
Collapse
Affiliation(s)
- Wael El-Reshaid
- a Department of Medicine, Faculty of Medicine , Kuwait University , Kuwait , Kuwait
| | - Hanan Al-Disawy
- b Division of Nephrology , Al-Nafisi Renal Centre , Kuwait, Kuwait
| | | | - Usama Alhelaly
- b Division of Nephrology , Al-Nafisi Renal Centre , Kuwait, Kuwait
| |
Collapse
|
38
|
Li PKT, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE, Fish DN, Goffin E, Kim YL, Salzer W, Struijk DG, Teitelbaum I, Johnson DW. ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment. Perit Dial Int 2016; 36:481-508. [PMID: 27282851 PMCID: PMC5033625 DOI: 10.3747/pdi.2016.00078] [Citation(s) in RCA: 610] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/04/2016] [Indexed: 12/19/2022] Open
Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Cheuk Chun Szeto
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Beth Piraino
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Javier de Arteaga
- Department of Nephrology, Hospital Privado and Catholic University, Cordoba, Argentina
| | - Stanley Fan
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
| | - Ana E Figueiredo
- Nursing School-FAENFI, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Douglas N Fish
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Eric Goffin
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Belgium
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - William Salzer
- University of Missouri-Columbia School of Medicine, Department of Internal Medicine, Section of Infectious Disease, MI, USA
| | - Dirk G Struijk
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| |
Collapse
|
39
|
Mushahar L, Mei LW, Yusuf WS, Sivathasan S, Kamaruddin N, Idzham NJM. Exit-Site Dressing and Infection in Peritoneal Dialysis: A Randomized Controlled Pilot Trial. Perit Dial Int 2015; 36:135-9. [PMID: 26374836 DOI: 10.3747/pdi.2014.00195] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 12/08/2014] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ OBJECTIVE Peritoneal dialysis (PD)-related infection is a common cause of catheter loss and the main reason for PD drop-out. Exit-site infection (ESI) is a pathway to developing tunnel infection and peritonitis, hence rigorous exit-site care has always been emphasized in PD therapy. The aim of this study was to evaluate the effect of exit-site dressing vs non-dressing on the rate of PD-related infection. ♦ METHODS A prospective randomized controlled study was conducted in prevalent PD patients at the Hospital Tuanku Jaafar Seremban, Negeri Sembilan, Malaysia, from April 2011 until April 2013. All patients were required to perform daily washing of the exit site with antibacterial soap during a shower. In the dressing group (n = 54), patients were required to clean their exit site using povidone-iodine after drying, followed by topical mupirocin antibiotic application to the exit site. The exit site was then covered with a sterile gauze dressing and the catheter immobilized with tape. In the non-dressing group (n = 54), patients were not required to do any further dressing after drying. They were only required to apply mupirocin cream to the exit site and then left the exit site uncovered. The catheter was immobilized with tape. The primary outcome was ESI. The secondary outcomes were evidence of tunnel infection or peritonitis. ♦ RESULTS A total of 97 patients completed the study. There were a total of 12 ESI episodes: 4 episodes in 4 patients in the dressing group vs 8 episodes in 4 patients in the non-dressing group. This corresponds to 1 episode per 241.3 patient-months vs 1 episode per 111.1 patient-months in the dressing and non-dressing groups respectively. Median time to first ESI episode was shorter in the non-dressing than in the dressing group, but not significant (p = 0.25). The incidence of gram-positive ESI in both groups was similar. There were no gram-negative ESI in the non-dressing group compared with 2 in the dressing group. The peritonitis rate was 1 per 37.1 patient-month in the dressing group and 1 per 44.4 patient-months in the non-dressing group. Median time to first peritonitis episode was significantly shorter in the dressing group compared to non-dressing (p = 0.03). There was no impact of dressing disruptions in the occurrence of major PD catheter-related infection. ♦ CONCLUSION Use of a non-dressing technique with only prophylactic topical mupirocin cream application is effective in preventing PD-related infection. The non-dressing technique is more cost-effective and convenient for PD patients, with fewer disposables.
Collapse
Affiliation(s)
- Lily Mushahar
- Department of Nephrology, Hospital Tuanku Ja'afar, Seremban, Negeri Sembilan, Malaysia
| | - Lim Wei Mei
- Department of Nephrology, Hospital Tuanku Ja'afar, Seremban, Negeri Sembilan, Malaysia
| | - Wan Shaariah Yusuf
- Department of Nephrology, Hospital Tuanku Ja'afar, Seremban, Negeri Sembilan, Malaysia
| | - Sudhaharan Sivathasan
- Department of Nephrology, Hospital Tuanku Ja'afar, Seremban, Negeri Sembilan, Malaysia
| | - Norilah Kamaruddin
- Department of Nephrology, Hospital Tuanku Ja'afar, Seremban, Negeri Sembilan, Malaysia
| | | |
Collapse
|
40
|
Abstract
Reducing the frequency of peritonitis for patients undergoing peritoneal dialysis (PD) continues to be a challenge. This review focuses on recent updates in catheter care and other patient factors that influence infection rates. An experienced nursing staff plays an important role in teaching proper PD technique to new patients, but nursing staff must be cognizant of each patient's unique educational needs. Over time, many patients become less adherent to proper dialysis technique, such as washing hands or wearing a mask. This behavior is associated with higher risk of peritonitis and is modifiable with re-training. Prophylactic antibiotics before PD catheter placement can decrease the infection risk immediately after catheter placement. In addition, some studies suggest that prophylaxis against fungal superinfection after antibiotic exposure is effective in reducing fungal peritonitis, although larger randomized studies are needed before this practice can be recommended for all patients. Over time, exit site and nasal colonization with pathogenic organisms can lead to exit-site infections and peritonitis. For patients with Staphylococcus aureus colonization, exit-site prophylaxis with either mupirocin or gentamicin cream reduces clinical infection with this organism. Although there are limited data for support, antibiotic prophylaxis before gastrointestinal, gynecologic, or dental procedures may also help reduce the risk of peritonitis.
Collapse
Affiliation(s)
- Jonathan H Segal
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | |
Collapse
|
41
|
Barraclough KA, Hawley CM, Playford EG, Johnson DW. Prevention of access-related infection in dialysis. Expert Rev Anti Infect Ther 2014; 7:1185-200. [DOI: 10.1586/eri.09.100] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
42
|
Vychytil A. [Peritoneal dialysis from the beginnings up to today: which developments of the last decades were important?]. Wien Med Wochenschr 2013; 163:255-65. [PMID: 23591854 DOI: 10.1007/s10354-013-0191-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 03/13/2013] [Indexed: 11/25/2022]
Abstract
During the past years new developments in peritoneal dialysis (PD) technique have resulted in continuous improvement of patient outcome. The importance of salt and fluid balance, residual renal function and peritoneal glucose load are of increasing interest, whereas small solute clearances have lost importance. In patients with high peritoneal transport rates automated PD (APD) is indicated. However, APD can also be chosen as initial PD treatment since recent studies show comparable or even better survival as compared to continuous ambulatory PD patients. Alternative PD solutions improve peritoneal ultrafiltration (icodextrin), reduce peritoneal glucose load (amino acid solution, icodextrin) and protect the peritoneal membrane (solutions with low concentration of glucose degradation products). Infection risk can be reduced when using antibiotic creams, but resistances should be considered. Ongoing studies will clarify if non-antibiotic agents, e.g. medihoney, are effective in preventing PD-associated infections. Due to these improvements PD and hemodialysis have become equivalent treatments.
Collapse
Affiliation(s)
- Andreas Vychytil
- Abteilung für Nephrologie und Dialyse, Klinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.
| |
Collapse
|
43
|
Warady BA, Bakkaloglu S, Newland J, Cantwell M, Verrina E, Neu A, Chadha V, Yap HK, Schaefer F. Consensus guidelines for the prevention and treatment of catheter-related infections and peritonitis in pediatric patients receiving peritoneal dialysis: 2012 update. Perit Dial Int 2013; 32 Suppl 2:S32-86. [PMID: 22851742 DOI: 10.3747/pdi.2011.00091] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri 64108, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Nessim SJ, Jassal SV. Gentamicin-resistant infections in peritoneal dialysis patients using topical gentamicin exit-site prophylaxis: a report of two cases. Perit Dial Int 2012; 32:339-41. [PMID: 22641737 DOI: 10.3747/pdi.2011.00224] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sharon J Nessim
- Division of Nephrology, Jewish General Hospital, McGill University, Toronto, Ontario, Canada.
| | | |
Collapse
|
45
|
Li PKT, Szeto CC, Piraino B, Bernardini J, Figueiredo AE, Gupta A, Johnson DW, Kuijper EJ, Lye WC, Salzer W, Schaefer F, Struijk DG. Peritoneal dialysis-related infections recommendations: 2010 update. Perit Dial Int 2012; 30:393-423. [PMID: 20628102 DOI: 10.3747/pdi.2010.00049] [Citation(s) in RCA: 585] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Pierce DA, Williamson JC, Mauck VS, Russell GB, Palavecino E, Burkart JM. The effect on peritoneal dialysis pathogens of changing topical antibiotic prophylaxis. Perit Dial Int 2012; 32:525-30. [PMID: 22302770 DOI: 10.3747/pdi.2011.00183] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Prophylactic gentamicin 0.1% cream has demonstrated efficacy in preventing both exit-site infection (ESI) and peritonitis attributable to gram-positive and gram-negative organisms; however, the effect of this practice on the gentamicin susceptibility patterns of bacterial pathogens isolated from such infections is unknown. We therefore examined the effect of a change in our prophylactic topical antibiotic exit-site protocol (from mupirocin 2% cream to gentamicin 0.1% cream) on infection rates and susceptibility patterns. METHODS This retrospective observational cohort study examined two periods of time: before and after the change in exit-site protocol. Each period was 30 months in duration, with a 2-month implementation period between, during which patient data were excluded. Demographic, clinical, and microbiology data were collected for each patient and episode of infection. RESULTS Overall, 377 patients were evaluated. In the mupirocin period (MUP), 145 infections occurred in 79 patients, and in the gentamicin period, 145 infections occurred in 93 patients. No significant effect was found either in overall episodes of infection (0.53 per year) or in episodes of peritonitis (0.429 vs 0.375 per year), but episodes of ESI increased significantly (0.098 vs 0.153 per year; p = 0.024; odds ratio: 1.55; 95% confidence interval: 1.05 to 2.28). Episodes of Staphylococcus aureus peritonitis increased by 38% (0.018 vs 0.025 per year), and episodes of S. aureus ESI increased significantly by 150% (0.022 vs 0.055 per year; p = 0.03; hazard ratio: 3.00; 95% confidence interval: 1.09 to 8.26). Episodes of pseudomonal peritonitis declined by 68% (0.022 vs 0.007 per year), and episodes of pseudomonal ESI increased by 150% (0.007 vs 0.018 per year). The gentamicin susceptibility for gram-positive isolates demonstrated no significant change; however, the gentamicin susceptibility for Enterobacteriaceae decreased by 12% and for Pseudomonas, by 14%. CONCLUSIONS The significant increase in episodes of ESI and the decrease in susceptibility for both Enterobacteriaceae and Pseudomonas isolates represent a concerning trend. Centers should examine trends in infection rates and in bacterial susceptibilities to determine the most appropriate agent for ESI prophylaxis.
Collapse
Affiliation(s)
- Dwayne A Pierce
- Department of Pharmacy, Wake Forest Baptist Health, Winston–Salem, North Carolina, USA.
| | | | | | | | | | | |
Collapse
|
47
|
Eriguchi M, Tsuruya K, Yoshida H, Yamada S, Tanaka S, Suehiro T, Nakano T, Taniguchi M. Validation of the Exit-Site Scoring System Recommended by the 2005 Guidelines of the International Society for Peritoneal Dialysis. Perit Dial Int 2011; 31:698-700. [DOI: 10.3747/pdi.2010.00287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - K. Tsuruya
- Department of Integrated Therapy for Chronic Kidney Disease Graduate School of Medical Sciences Kyushu University Fukuoka, Japan
| | - H. Yoshida
- Department of Integrated Therapy for Chronic Kidney Disease Graduate School of Medical Sciences Kyushu University Fukuoka, Japan
| | - S. Yamada
- Department of Medicine and Clinical Science
| | - S. Tanaka
- Department of Medicine and Clinical Science
| | - T. Suehiro
- Department of Medicine and Clinical Science
| | - T. Nakano
- Department of Medicine and Clinical Science
| | | |
Collapse
|
48
|
Piraino B, Bernardini J, Brown E, Figueiredo A, Johnson DW, Lye WC, Price V, Ramalakshmi S, Szeto CC. ISPD position statement on reducing the risks of peritoneal dialysis-related infections. Perit Dial Int 2011; 31:614-30. [PMID: 21880990 DOI: 10.3747/pdi.2011.00057] [Citation(s) in RCA: 209] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Beth Piraino
- University of Pittsburgh School of Medicine,1 Pittsburgh, Pennsylvania, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
Despite substantial advances in peritoneal dialysis (PD) as a renal replacement modality, PD-related infection remains an important cause of morbidity, technique failure, and mortality. This review describes the microbiology and outcomes of PD peritonitis and catheter infection, followed by a discussion of several strategies that may reduce the risk of PD-related infections. Strategies that are reviewed include use of antibiotics at the time of PD catheter insertion, selection of PD catheter design and insertion technique, patient training, PD connectology, exit site prophylaxis, periprocedural prophylaxis, fungal prophylaxis, and choice of PD solutions.
Collapse
|
50
|
Davenport A, Wellsted D. Does antifungal prophylaxis with daily oral fluconazole reduce the risk of fungal peritonitis in peritoneal dialysis patients? The Pan Thames Renal Audit. Blood Purif 2011; 32:181-5. [PMID: 21811065 DOI: 10.1159/000328735] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 04/20/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Fungal peritonitis increases the risk of transfer to haemodialysis and mortality. METHODS We audited the effect of co-prescription of daily oral fluconazole with antibiotics in the Pan Thames centres on fungal peritonitis. RESULTS We found 49 (1.5%) fungal peritonitis cases in 3,322 episodes of peritonitis. Two centres co-prescribed prophylactic fluconazole with antibiotics, with a fungal peritonitis rate of 0.0032/patient year, compared to 0.0099 from centres not using prophylaxis. However, centres using fungal prophylaxis had lower peritonitis rates of 0.036, compared to 0.05 for the other centres. Correcting for background peritonitis rates, there was no significant difference in the incidence of fungal peritonitis. CONCLUSIONS In centres with a low incidence of fungal peritonitis, additional co-prescription of fluconazole with antibiotics appeared to reduce the risk of fungal peritonitis. However, variation in practice between centres is the main determinant of the observed incidence of fungal peritonitis rather than the use of antifungal prophylaxis.
Collapse
Affiliation(s)
- Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, Royal Free Campus, London, UK.
| | | | | |
Collapse
|