1
|
Sakurada T, Miyazaki M, Nakayama M, Ito Y. Peritoneal dialysis-related infections in elderly patients. Clin Exp Nephrol 2024:10.1007/s10157-024-02531-5. [PMID: 38914913 DOI: 10.1007/s10157-024-02531-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 06/16/2024] [Indexed: 06/26/2024]
Abstract
This review outlines the epidemiology, characteristics, risk factors, and prognosis of peritoneal dialysis (PD)-related peritonitis, PD catheter-related infections, and the effects of assisted PD in elderly patients from the Japanese perspective. Based on the literature, the incidence of peritonitis is likely to be higher in elderly patients than in younger patients. The most frequent causative bacteria in elderly patients are Gram-positive bacteria, as in adult PD patients, most commonly due to transcatheter infection. However, elderly patients may have difficulty recognizing cloudy drainage fluid due to decreased visual acuity. Hypokalemia, the use of gastric acid suppressants, prophylactic antibiotic use before endoscopy, biocompatible fluids and hypoalbuminemia considered modifiable risk factors for peritonitis. However, the mechanism by which treatment of hypokalemia prevents peritonitis is unknown. Currently, the relationship between gastric acid suppression therapy and peritonitis in elderly patients is debatable, with no evidence to strongly recommend uniform discontinuation of gastric acid suppression therapy. Exit-site infection (ESI) is a major risk factor for the development of peritonitis, and appropriate prevention and management of ESI may reduce infection-related hospitalizations in PD patients. Currently, no randomized, controlled trials have verified the effectiveness of antibiotic application for ESI in Japan, but results from other countries are awaited. In assisted PD, it is extremely important that family members, caregivers, and nurses who support the procedure receive sufficient education and training from medical professionals familiar with PD. Early detection and treatment of PD-related infections are required because the risk of death increases in elderly patients.
Collapse
Affiliation(s)
- Tsutomu Sakurada
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, 216-8511, Japan.
| | | | - Masaaki Nakayama
- St Luke's International University, Visiting Researcher, Tokyo, Japan
| | | |
Collapse
|
2
|
Johnson DW, Chow KM, Li PKT. Reply to: Opinion on exit-site care recommendations. Perit Dial Int 2024; 44:82-83. [PMID: 38031424 DOI: 10.1177/08968608231213576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Affiliation(s)
- David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Kai Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
3
|
Moghiseh L, Nobahar M, Ghorbani R, Sirafian S. The impact of Propolis on catheter exit site infection and peritonitis in peritoneal Dialysis patients: a clinical trial. BMC Nephrol 2022; 23:408. [PMID: 36564743 PMCID: PMC9789634 DOI: 10.1186/s12882-022-03036-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Peritonitis is one of the major complications of peritoneal dialysis. The most common cause of peritonitis is infection at the catheter exit site. This study aimed to determine the effect of propolis on the incidence of catheter exit site infection and peritonitis in peritoneal dialysis patients. METHOD This study was a double-blind clinical trial (2019-2020) with peritoneal dialysis patients. Ninety peritoneal dialysis patients were allocated to three groups (placebo, control, intervention) using block randomization method. Catheter exit site was washed with 0.9% normal saline and dressing was done every other day after the morning peritoneal dialysis exchange by use of normal saline in placebo, mupirocin in control, and propolis in intervention group, for 6 months. DISCUSSION 10% of the patients in the placebo and 6.7% in the control group developed catheter Exit Site Infection, but none patient in the intervention group developed this infection (P = 0.469). Whereas 6.7% in both the placebo and control groups developed peritonitis, but none patient in the intervention group contracted peritonitis (P = 0.997). No significant differences in the incidence of catheter exit site infection and peritonitis among the three groups were observed. Considering that mupirocin is of chemical origin and may lead to drug resistance whereas propolis is of plant origin and does not produce drug resistance, the use of propolis is recommended. TRIAL REGISTRATION Iranian Registry of Clinical Trials [ IRCT20110427006318N10 ] (17/01/2019).
Collapse
Affiliation(s)
- Lila Moghiseh
- grid.486769.20000 0004 0384 8779Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Monir Nobahar
- grid.486769.20000 0004 0384 8779Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran ,grid.486769.20000 0004 0384 8779Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran ,grid.486769.20000 0004 0384 8779Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran ,grid.486769.20000 0004 0384 8779Nursing Care Research Center and Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, 3513138111 Iran
| | - Raheb Ghorbani
- grid.486769.20000 0004 0384 8779Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran ,grid.486769.20000 0004 0384 8779Department of Epidemiology and Biostatistics, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Shiva Sirafian
- grid.411036.10000 0001 1498 685XIsfahan Kidney Diseases Research Center, Internal Medicine Department, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
4
|
González-Sanchidrián S, Nacarino-Muriel MDC, García-Girón AM, Fernández-Vivas F, Pazos-Pacheco MDC, Gallego-Domínguez S. Análisis de las infecciones del orificio de salida del catéter peritoneal. Efectividad de un protocolo basado en la aplicación de mupirocina tópica diaria. ENFERMERÍA NEFROLÓGICA 2021. [DOI: 10.37551/s2254-28842021010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivos: Analizar las infecciones del orificio de salida del catéter peritoneal, identificando los principales factores relacionados con las mismas; asimismo se ha comparado la efectividad de un protocolo basado en la utilización diaria de mupirocina tópica en la cura del orificio de salida frente a la utilización suero salino. Material y Método: Estudio observacional, retrospectivo. Recogimos variables demográficas, clínicas, la etiología y evolución de los episodios de infección del orificio en un periodo de 2 años. Utilizamos un protocolo de profilaxis con suero fisiológico y con mupirocina crema al 2%. Resultados: Estudiamos 75 pacientes, edad media 60,3±13,9 años, 66,7% varones, mediana de tiempo en diálisis peritoneal 24,3 meses (rango intercuartílico 11-48,7). La incidencia de infección del orificio de salida fue del 26,7%, el 77% fueron originadas por microorganismos de piel y mucosas. La infección del orificio de salida se relacionó con el estado portador nasal de Staphylococcus aureus (p=0,048) y la extrusión del dacron externo (p=0,004). De los 4 pacientes que presentaron una peritonitis secundaria a la infección del orificio de salida, 3 fueron trasferidos a hemodiálisis (p=0,025). Con el protocolo de antibioterapia tópica diaria se redujo un 68% la tasa de infecciones. Conclusiones: La exteriorización del anillo externo del catéter peritoneal es un factor predisponente de infecciones. La aplicación diaria de mupirocina es una estrategia efectiva para reducir la incidencia de infección del orificio y peritonitis. La erradicación de portadores nasales de Staphylococcus aureus puede contribuir a reducir la pérdida del catéter y la transferencia a hemodiálisis.
Collapse
Affiliation(s)
- Silvia González-Sanchidrián
- Servicio de Nefrología. Hospital San Pedro de Alcántara. Complejo Hospitalario Universitario de Cáceres. Cáceres. España
| | | | - Ana María García-Girón
- Servicio de Nefrología. Hospital San Pedro de Alcántara. Complejo Hospitalario Universitario de Cáceres. Cáceres. España
| | - Fidel Fernández-Vivas
- Servicio de Nefrología. Hospital San Pedro de Alcántara. Complejo Hospitalario Universitario de Cáceres. Cáceres. España
| | - María del Carmen Pazos-Pacheco
- Servicio de Nefrología. Hospital San Pedro de Alcántara. Complejo Hospitalario Universitario de Cáceres. Cáceres. España
| | - Sandra Gallego-Domínguez
- Servicio de Nefrología. Hospital San Pedro de Alcántara. Complejo Hospitalario Universitario de Cáceres. Cáceres. España
| |
Collapse
|
5
|
Oki R, Hamasaki Y, Komaru Y, Miyamoto Y, Matsuura R, Yamada D, Iwagami M, Doi K, Kume H, Nangaku M. Catheter Diversion Procedure With Exit-Site Renewal Promotes Peritoneal Dialysis Catheter Survival. Kidney Int Rep 2020; 6:325-332. [PMID: 33615057 PMCID: PMC7879110 DOI: 10.1016/j.ekir.2020.11.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/30/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Catheter-related infections such as exit site infection (ESI) and tunnel infection (TI) are major causes of peritoneal dialysis (PD) discontinuation. For ESI/TI treatment, catheter diversion procedure (CDP) with exit-site renewal for catheter salvage presents an alternative to catheter removal. Nevertheless, CDP capability of improving PD catheter survival remains unclear. Methods We retrospectively reviewed our hospital patients who started PD during 2001–2019 (n=148): 33 treated for ESI/TI by CDP (CDP group) and 115 treated for ESI/TI using conservative therapy or none (non-CDP group). A “virtual discontinuation group” was designated for patients in the CDP group who had received PD catheter removal instead of CDP and who had stopped PD. Kaplan-Meier analysis and log-rank test PD were used for intergroup catheter survival comparison. Associations between clinical factors and PD discontinuation or death were examined using Cox proportional hazards regression analyses. Results For patients (76% male, mean age of 61.7±13.0 years), 40 CDP were performed for 33 CDP group patients. Infection-free rates at 30 and 90 days after CDP were, respectively, 90% and 67%. The CDP group PD catheter survival rate was significantly higher than that of virtual discontinuation group (P < .01) and higher than that of the non-CDP group (P = .03). Multivariate analysis revealed independent association of serum albumin concentration (hazard ratio 0.33, 95% confidence interval 0.17–0.67), PD+HD combination therapy (hazard ratio 0.29, 95% confidence interval 0.17–0.49), and CDP (hazard ratio 0.44, 95% confidence interval 0.24–0.80) with PD discontinuation or death. Conclusion Results show that CDP may improve PD catheter survival as an effective and less-invasive surgical treatment for ESI/TI to avoid withdrawal of PD.
Collapse
Affiliation(s)
- Rikako Oki
- Department of Hemodialysis and Apheresis, University of Tokyo Hospital, Tokyo, Japan
| | - Yoshifumi Hamasaki
- Department of Hemodialysis and Apheresis, University of Tokyo Hospital, Tokyo, Japan
- Correspondence: Yoshifumi Hamasaki, Department of Hemodialysis and Apheresis, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Yohei Komaru
- Department of Hemodialysis and Apheresis, University of Tokyo Hospital, Tokyo, Japan
| | - Yoshihisa Miyamoto
- Department of Hemodialysis and Apheresis, University of Tokyo Hospital, Tokyo, Japan
| | - Ryo Matsuura
- Department of Hemodialysis and Apheresis, University of Tokyo Hospital, Tokyo, Japan
| | - Daisuke Yamada
- Department of Urology, University of Tokyo Hospital, Tokyo, Japan
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tokyo, Japan
| | - Kent Doi
- Department of Acute Medicine, University of Tokyo Hospital, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, University of Tokyo Hospital, Tokyo, Japan
| | - Masaomi Nangaku
- Department of Hemodialysis and Apheresis, University of Tokyo Hospital, Tokyo, Japan
| |
Collapse
|