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Tobijaszewska M, Martus G, Sunnerhagen T, Segelmark M, Ljungquist O. A population-based study on the incidence and aetiology of infectious complications in peritoneal dialysis in South Sweden. Infect Dis (Lond) 2024; 56:230-243. [PMID: 38100541 DOI: 10.1080/23744235.2023.2292133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/03/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Peritonitis is a major cause of morbidity in peritoneal dialysis (PD) and an independent risk factor for elevated all-cause mortality. The aims of this study were to report the incidence, trend, aetiology, and antimicrobial susceptibility of PD-associated peritonitis and catheter-related infections in South Sweden between 2011-2020. METHODS This population-based observational cohort study included all patients with PD between the years 2011-2020 in the county of Skåne. Data was accessed through the Swedish Renal Registry and the Department of Clinical Microbiology in Lund. Definitions issued by the International Society for Peritoneal Dialysis were implemented to assess PD-associated infections. RESULTS Medical records of 675 paediatric and adult PD patients were eligible for inclusion. Of those, 208 (31%) were female and the median age was 67 years (range 0-91). The overall rate of PD-peritonitis was 0.38 episodes per year at risk. Out of 484 episodes of peritonitis, 61% (n = 295) were caused by Gram-positive bacteria. There were 289 occurrences of exit site infections, of which most (n = 152, 53%) were Gram-positive. Tunnel infections occurred in 16 episodes and were caused by S. aureus or P. aeruginosa. Among all isolates, 37 were of MRSE, four of ESBL-producing E. coli, and one of MRSA. CONCLUSION The crude rate of PD-peritonitis was stable during the study period. Gram-positive bacteria dominated the microbial aetiology, and antibiotic resistance was limited. It is important to monitor the aetiology, incidence, and resistance rates in PD-associated infections, to base empirical antibiotic regimens and facilitate prevention.
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Affiliation(s)
- Marta Tobijaszewska
- Department of Infectious Diseases, Helsingborg hospital, Helsingborg, Sweden
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Giedre Martus
- Department of Endocrinology, Nephrology and Rheumatology, Skåne University Hospital, Lund, Sweden
- Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Torgny Sunnerhagen
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
- Clinical Microbiology, Infection Prevention and Control, Office for Medical Services, Region Skåne, Lund, Sweden
| | - Mårten Segelmark
- Department of Endocrinology, Nephrology and Rheumatology, Skåne University Hospital, Lund, Sweden
- Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Oskar Ljungquist
- Department of Infectious Diseases, Helsingborg hospital, Helsingborg, Sweden
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
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Gao L, Chen X, Feng S, Lu Y, Song K, Shen H, Wang Y, Jiang L, Wang Z. Outcomes of elderly peritoneal dialysis patients: 65-74 years old versus ≥ 75 years old. Ren Fail 2023; 45:2264977. [PMID: 37795800 PMCID: PMC10557534 DOI: 10.1080/0886022x.2023.2264977] [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: 04/14/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE To analyze the clinical data of elderly patients with peritoneal dialysis (PD) and compare patient and technique survival rates between Group 1 (65-74 years old) and Group 2 (≥75 years old). METHODS This retrospective study enrolled 296 elderly patients (≥65 years old) on maintenance PD who were admitted to the Peritoneal Dialysis Center of the Second Hospital of Soochow University. The patients were categorized by outcome into ongoing PD, changed to hemodialysis, renal recovery dialysis stopped, or death groups. The patients were divided into Group 1 (65-74 years old) and Group 2 (≥75 years old). Patient survival and technique survival rates were calculated by the Kaplan-Meier method. Factors associated with patient survival were analyzed using the Cox regression model. RESULTS There were 176 (59.5%) subjects in Group 1 and 120 (40.5%) subjects in Group 2. The primary causes of death were cardiovascular events, peritonitis, and other infections. The patient survival rates at 1, 3, and 5 years were 91.2%, 68.0%, and 51.3% in Group 1 and 76.8%, 37.5%, and 17.6% in Group 2 (p < 0.001, HR 0.387, 95% CI 0.282-0.530). There was no statistically significant difference in the technique survival rate between the two groups (p = 0.54). CONCLUSION The elderly PD patients in this cohort mostly died from cardiovascular events, with a higher patient survival rate in Group 1 and similar technique survival in both groups. Older age, lower prealbumin, higher creatinine, not being on activated vitamin D, and high Charlson's comorbidity index (CCI) score were independent risk factors for death.
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Affiliation(s)
- Luyan Gao
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuefeng Chen
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Sheng Feng
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ying Lu
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Kai Song
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Huaying Shen
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yun Wang
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Linsen Jiang
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhi Wang
- The Second Affiliated Hospital of Soochow University, Suzhou, China
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Ponce D, Nitsch D, Ikizler TA. Strategies to Prevent Infections in Dialysis Patients. Semin Nephrol 2023; 43:151467. [PMID: 38199826 DOI: 10.1016/j.semnephrol.2023.151467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Infections are the second leading cause of death among patients with end-stage kidney disease, behind only cardiovascular disease. In addition, patients on chronic dialysis are at a higher risk for acquiring infection caused by multidrug-resistant organisms and for death resulting from infection owing to their likelihood of requiring treatment that involves invasive devices, their frequent exposure to antibiotics, and their impaired immunity. Vascular access is a major risk factor for bacteremia, hospitalization, and mortality among hemodialysis (HD) patients. Catheter-related bacteremia is the most severe central venous catheter (CVC)-related infection and increases linearly with the duration of catheter use. Given the high prevalence of CVC use and its direct association with catheter-related bacteremia, which adversely impacts morbidity and mortality rates among HD patients, several prevention measures aimed at reducing the rates of CVC-related infection have been proposed and implemented. As a result, a large number of clinical trials, systematic reviews, and meta-analyses have been conducted to assess the effectiveness, clinical applicability, and long-term adverse effects of such measures. Peritoneal dialysis chronic treatment without the occurence of peritonitis is rare. Although most cases of peritonitis can be treated adequately with antibiotics, some cases are complicated by hospitalization or a temporary or permanent need to abstain from using the peritoneal dialysis catheter. Severe and long-lasting peritonitis can lead to peritoneal membrane failure, requiring the treatment method to be switched to HD. Some measures as patients training, early diagnosis, and choice of antibiotics can contribute to the successful treatment of peritonitis. Finally, medical directors are key leaders in infection prevention and are an important resource to implement programs to monitor and improve infection prevention practices at all levels within the dialysis clinic.
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Affiliation(s)
- Daniela Ponce
- Division of Internal Medicine, Botucatu School of Medicine, University of São Paulo State (UNESP). Botucatu, Sao paulo, Brazil.
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Department of Nephrology, Royal Free London NHS Foundation Trust, London, UK
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Gursu M, Shehaj L, Elcioglu OC, Kazancioglu R. The optimization of peritoneal dialysis training in long-term. FRONTIERS IN NEPHROLOGY 2023; 3:1108030. [PMID: 37675347 PMCID: PMC10479566 DOI: 10.3389/fneph.2023.1108030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/20/2023] [Indexed: 09/08/2023]
Abstract
Peritoneal dialysis is a home based therapy for patients with advanced chronic kidney disease. This method provides adequate clearance of uremic toxins and removal of excess fluid when a proper dialysis prescription is combined with patient adherence. Peritonitis is the most frequent infectious complication among these patients and may render the continuity of the treatment. Training patients and their caregivers have prime importance to provide proper treatment and prevent complications including infectious ones. The training methods before the onset of treatment are relatively well established. However, patients may break the rules in the long term and tend to take shortcuts. So, retraining may be necessary during follow-up. There are no established guidelines to guide the retraining of PD patients yet. This review tends to summarize data in the literature about retraining programs and also proposes a structured program for this purpose.
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Affiliation(s)
- Meltem Gursu
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
| | - Larisa Shehaj
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
- Department of Internal Medicine, Salus Hospital, Tirana, Albania
- ISN fellow in Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
| | - Omer Celal Elcioglu
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
| | - Rumeyza Kazancioglu
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
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Balkoca M, Turkmen E, Dilek M, Arik N, Sayarlioglu H. Evaluation of complications in urgent start peritoneal dialysis: Single-center experience. Ther Apher Dial 2023; 27:314-319. [PMID: 36127867 DOI: 10.1111/1744-9987.13916] [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: 07/20/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients who were urgent start peritoneal dialysis (USPD) were evaluated in terms of complications. METHODS The data from 102 patients (43 males and 59 females, mean age 58.18 ± 15.3 years) who were on peritoneal dialysis with a placed catheter between January 2014 and June 2019 in our Nephrology clinic was evaluated. The patients were divided into three groups according to the starting time of peritoneal dialysis. The development of complications between the groups (peritonitis, leakage, hernia), hemodialysis return time and overall survival times were compared. RESULTS There was no difference between the groups in terms of survival and complications. Diabetes, advanced age, albumin values were found to be risk factors for mortality, while no differences were found between the groups in terms of complications and mortality. CONCLUSION USPD can be recommended for both because it provides a permanent dialysis option and because it leads to fewer complications than urgent start HD.
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Affiliation(s)
- Murat Balkoca
- Department of Internal Medicine, Ondokuz Mayıs Üniversitesi, Samsun, Turkey
| | - Ercan Turkmen
- Department of Nephrology, Ondokuz Mayıs Üniversitesi, Samsun, Turkey
| | - Melda Dilek
- Department of Nephrology, Ondokuz Mayıs Üniversitesi, Samsun, Turkey
| | - Nurol Arik
- Department of Nephrology, Ondokuz Mayıs Üniversitesi, Samsun, Turkey
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KÖSE Ş, GÜMÜŞER F, SARI ND. Periton Diyalizi İle ilişkili Peritonitlerin İrdelenmesi. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1137818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Objective: In this study, it was aimed to determine the causative microorganisms isolated in peritonitis attacks in peritoneal dialysis (PD) patients in our hospital and methicilline resistance rate in Staphlococci.
Material and methods: 194 patients in the peritoneal dialysis unit of XXXXl Training and Research Hospital, Nephrology Clinic, between January 2009 and 2020, were evaluated retrospectively in terms of peritonitis development, causative microorganisms and methicillin resistance in Stapylococci, which is the most common causative agent.
Results: Peritonitis attack developed in 149 out of a total of 194 patients. The causative agent has been isolated in 91 (61%) of the patients who developed peritonitis. When we look at the order of frequency among all microorganisms isolated, methicillin-susceptible Staphylococci (MHS) 59 (44.02%), methicillin-resistant Staphylococci (MRS) 28 (20.89%), Escherichia coli 12 (8.95%), Streptococcus spp 12 (8.95%), Enterobacter spp 7 (5.22%), Pseudomonas spp 4 (2.98%), diphtheroid bacilli 4 (2.98%), Klebsiella spp 2 (1.49%), Acinetobacter spp 1 (0.07%), a total of 129 bacteria, including five fungi were detected. Methicillin resistance rate was 32.18% among Staphylococci, which was found to be the most common causative agent.
Conclusion: There is a need for studies with large patient groups to show the agents of peritonitis and the change in the resistance profile these microorganisms.
Key words: Peritoneal Dialysis, Peritonitis, Methicillin Resistance
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Forté V, Novelli S, Zaidan M, Snanoudj R, Verger C, Beaudreuil S. Microbiology and outcomes of polymicrobial peritonitis associated with peritoneal dialysis: a register-based cohort study from the French Language Peritoneal Dialysis Registry (RDPLF). Nephrol Dial Transplant 2022; 38:1271-1281. [PMID: 36130870 DOI: 10.1093/ndt/gfac267] [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: 12/23/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Previous studies have reported that polymicrobial peritonitis in peritoneal dialysis (PD) is associated with poor outcomes, but recent data from European cohorts are scarce. METHODS We included from the French Language Peritoneal Dialysis Registryall patients ≥ 18 years who started PD between January 2014 and November 2020. We compared microbiology and patient characteristics associated with mono- and polymicrobial peritonitis. We assessed patient outcomes after a first polymicrobial peritonitis using survival analysis with competing events. We differentiated microorganisms isolated from dialysis effluent as enteric or non-enteric pathogens. RESULTS 8848 patients contributed 13 023 patient-years of follow-up and 3348 culture-positive peritonitis, including 251 polymicrobial ones. This corresponded to rates of 0.32 and 0.02 episodes/patient-year, respectively. For most patients (72%) who experienced polymicrobial peritonitis, this was their first peritonitis episode. Enteric pathogens were more frequently isolated in poly- than in monomicrobial peritonitis (57 vs 44%, P < 0.001). In both cases of peritonitis with or without enteric pathogens, the poly- versus monomicrobial character of the peritonitis was not associated with mortality in patients who did not switch to hemodialysis (adjusted cause-specific hazard ratio, a.cs-HR, 1.2 [95% CI, 0.3-5.0], P = 0.78 and 1.1 [0.7-1.8], P = 0.73, respectively). However, the risks of death and switch to hemodialysis were higher for monomicrobial peritonitis with enteric pathogens, compared to those without (a.cs-HR, 1.3 [1.1-1.7], P = 0.02 and 1.9 [1.5-2.4], P < 0.0001, respectively). CONCLUSION Isolation of enteric pathogens, rather than the polymicrobial character of the peritonitis, is associated with poorer outcomes.
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Affiliation(s)
- Valentine Forté
- Sorbonne Université, Faculty of Medicine, APHP, Paris, France
| | - Sophie Novelli
- Université Paris-Saclay, UVSQ, Inserm, CESP, Villejuif, France
| | - Mohamad Zaidan
- Nephrology Dialysis Transplantation department, University Hospital Paris Saclay, APHP, Le Kremlin Bicêtre, France
| | - Renaud Snanoudj
- Nephrology Dialysis Transplantation department, University Hospital Paris Saclay, APHP, Le Kremlin Bicêtre, France
| | | | - Séverine Beaudreuil
- Nephrology Dialysis Transplantation department, University Hospital Paris Saclay, APHP, Le Kremlin Bicêtre, France
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Wang Y, Hu X, Yang L, Chen C, Cheng H, Hu H, Liang W, Tong Y, Wang M, Wang H. Application of High-Throughput Sequencing Technology in the Pathogen Identification of Diverse Infectious Diseases in Nephrology Departments. Diagnostics (Basel) 2022; 12:diagnostics12092128. [PMID: 36140529 PMCID: PMC9497786 DOI: 10.3390/diagnostics12092128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: The purpose of this study was to explore the clinical applications of high-throughput sequencing (HTS) in the identification of pathogens in patients with urinary tract infection (UTI), peritoneal dialysis-associated peritonitis (PDAP), central venous catheter related blood infections (CRBIs), and lung infections in the nephrology department. Methods: Midstream urine samples from 112 patients with UTI, peritoneal fluid samples from 67 patients with PDAP, blood samples from 15 patients with CRBI, and sputum specimens from 53 patients with lung infection were collected. The HTS and ordinary culture methods were carried out in parallel to identify the pathogens in each sample. Pathogen detection positive rate and efficacy were compared between the two methods. Results: The pathogen positive detection rates of HTS in UTI, PDAP, CRBI, and lung infection were strikingly higher than those of the culture method (84.8% vs. 35.7, 71.6% vs. 23.9%, 75% vs. 46.7%, 84.9% vs. 5.7%, p < 0.05, respectively). HTS was superior to the culture method in the sensitivity of detecting bacteria, fungi, atypical pathogens, and mixed microorganisms in those infections. In patients who had empirically used antibiotics before the test being conducted, HTS still exhibited a considerably higher positive rate than the culture method (81.6% vs. 39.0%, 68.1% vs. 14.9%, 72.7% vs. 36.4%, 83.3% vs. 4.2%, p < 0.05, respectively). Conclusions: HTS is remarkably more efficient than the culture method in detecting pathogens in diverse infectious diseases in nephrology, and is particularly potential in identifying the pathogens that are unable to be identified by the common culture method, such as in cases of complex infection with specific pathogens or subclinical infection due to preemptive use of antibiotics.
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Affiliation(s)
- Yujuan Wang
- Department of Nephrology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang District, Wuhan 430060, China
| | - Xiaoyi Hu
- Department of Nephrology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang District, Wuhan 430060, China
| | - Lianhua Yang
- Department of Nephrology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang District, Wuhan 430060, China
| | - Cheng Chen
- Department of Nephrology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang District, Wuhan 430060, China
| | - Hui Cheng
- Department of Nephrology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang District, Wuhan 430060, China
| | - Haiyun Hu
- Department of Nephrology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang District, Wuhan 430060, China
| | - Wei Liang
- Department of Nephrology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang District, Wuhan 430060, China
| | - Yongqing Tong
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang District, Wuhan 430060, China
| | - Ming Wang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang District, Wuhan 430060, China
- Correspondence: (M.W.); (H.W.)
| | - Huiming Wang
- Department of Nephrology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang District, Wuhan 430060, China
- Correspondence: (M.W.); (H.W.)
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Guía clínica de la Sociedad Española de Nefrología para la prevención y tratamiento de la infección peritoneal en diálisis peritoneal. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Peritoneal Dialysis-Related Peritonitis: Rate, Clinical Outcomes and Patient Survival. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2021; 42:47-55. [PMID: 35032377 DOI: 10.2478/prilozi-2021-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Peritoneal dialysis-related peritonitis remains the major complication and primary challenge to the long-term success of peritoneal dialysis (PD). The study aimed to analyze the peritonitis rate, the cause, the outcomes, and the association of peritonitis with the survival of patients on peritoneal dialysis. Patient data were collected retrospectively from medical charts. A total of 96 patients received peritoneal dialysis in the PD center from 1 January 1999 to 31 December 2018. Episodes of peritonitis (n=159) were registered in 54 (56.3%) patients. The study population was divided into two groups, a group of patients (n=54) who experienced peritonitis and a group of patients free of peritonitis (n=42). The peritonitis rate was 0.47 episodes per patient year. The majority of causative microorganisms were gram-positive bacteria (53.5%). Outcomes of the episodes of peritonitis were resolved infection in 84.9% of episodes, catheter removal in 11.3% of episodes, and death in 3.8% of the episodes of peritonitis. A Kaplan-Meier analysis and log-rank test revealed that the group with peritonitis tended to survive significantly longer than the peritonitis-free group. A 67% reduction rate in the risk of patient mortality was observed for the peritonitis group compared with the peritonitis-free group (hazard ratio: 0.33, 95% CI 0.19-0.57, P=0.000). The prevention and management of PD-related infections, resulted in their worldwide reduction, supporting the use of PD as a first-line dialysis modality.
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de la Espada Piña V, Ganga PLQ, Junquero JMG, Fosalba NA, Girón FF, Huete MJE, Ortega MP, Barrero GV, Salazar AM, Martínez FM, Guerrero MJM, de Mota EE, Cabrero SS, Rodríguez CR. Two decades of analysis of peritonitis in peritoneal dialysis in Andalusia: Epidemiological, clinical, microbiological and progression aspects. Nefrologia 2021; 41:417-425. [PMID: 36165110 DOI: 10.1016/j.nefroe.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 10/02/2020] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND This study focuses on the main complication associated with peritoneal dialysis, peritonitis. Its relevance derives from its high morbidity, the negative effect it has on the peritoneum as a dialysis membrane and its financial cost. METHODS Analytical, non-interventional, observational cohort study, whose main objective is the analysis of peritonitis in patients on peritoneal dialysis in Andalusia from 1 January 1999 to 31 December 2017, with a total of 2904 peritonitis cases. The database used is the Andalusian Autonomous Transplant Coordination Information System (SICATA). OBJECTIVES To ascertain how the rate of peritonitis is evolving in our community, analyse descriptive data pertaining to patients and peritonitis, ascertain the course of these infectious complications and analyse the factors that influence these cases of peritonitis and their outcomes: germ, hospitalisation and date. RESULTS The rate of peritonitis decreased progressively during the study period, from 0.7 peritonitis per patient in 1999 to 0.33 at the end of the period. Most infections were treated on an outpatient basis (72.5%). The most common germs were Gram-positive (55.9%), including coagulase-negative staphylococci (28.1%). Most cases of peritonitis progressed to healing (77.8%). The factors that significantly influence the need for hospitalisation and peritonitis progression were the causative germ and associated exit site infection. CONCLUSIONS In our population, the rate of peritonitis decreased progressively during the study period, meeting guideline recommendations.
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de la Espada Piña V, Quirós Ganga PL, Gil Junquero JM, Aresté Fosalba N, Fernández Girón F, Espigares Huete MJ, Peña Ortega M, Velasco Barrero G, Moreno Salazar A, Morales Martínez F, Marco Guerrero MJ, Esquivias de Mota E, Soriano Cabrero S, Remón Rodríguez C. Two decades of analysis of peritonitis in peritoneal dialysis in Andalusia: Epidemiological, clinical, microbiological and progression aspects. Nefrologia 2021. [PMID: 33422301 DOI: 10.1016/j.nefro.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND This study focuses on the main complication associated with peritoneal dialysis, peritonitis. Its relevance derives from its high morbidity, the negative effect it has on the peritoneum as a dialysis membrane and its financial cost. METHODS Analytical, non-interventional, observational cohort study, whose main objective is the analysis of peritonitis in patients on peritoneal dialysis in Andalusia from 1 January 1999 to 31 December 2017, with a total of 2,904 peritonitis cases. The database used is the Andalusian Autonomous Transplant Coordination Information System (SICATA). OBJECTIVES To ascertain how the rate of peritonitis is evolving in our community, analyse descriptive data pertaining to patients and peritonitis, ascertain the course of these infectious complications and analyse the factors that influence these cases of peritonitis and their outcomes: germ, hospitalisation and date. RESULTS The rate of peritonitis decreased progressively during the study period, from 0.7 peritonitis per patient in 1999 to 0.33 at the end of the period. Most infections were treated on an outpatient basis (72.5%). The most common germs were Gram-positive (55.9%), including coagulase-negative staphylococci (28.1%). Most cases of peritonitis progressed to healing (77.8%). The factors that significantly influence the need for hospitalisation and peritonitis progression were the causative germ and associated exit site infection. CONCLUSIONS In our population, the rate of peritonitis decreased progressively during the study period, meeting guideline recommendations.
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Zhao J, Yang L, Zhu X, Zhang X, Li X, Liu S, Zhuang X, Zhou W, Luo P, Cui W. [Clinical characteristics and treatment outcomes of first peritonitis in patients receiving long-term peritoneal dialysis: a multicenter study]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1740-1746. [PMID: 33380390 DOI: 10.12122/j.issn.1673-4254.2020.12.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyze the clinical characteristics and treatment outcomes of the first episode of peritoneal dialysis-associated peritonitis (PDAP) in patients receiving long-term peritoneal dialysis. METHODS The clinical data of patients with the first episode of PDAP in 4 general hospitals in Jilin Province from 2013 to 2019 were collected retrospectively. According to the duration of dialysis, the patients were divided into long-term (≥36 months) and short-term (< 36 months) dialysis groups for comparison of the clinical data, treatment outcomes and long-term prognostic events. RESULTS A total of 625 patients with PDAP were enrolled, including 93 on long-term and 532 on short-term dialysis. Compared with those on short-term dialysis, the patients on long-term dialysis had significantly higher hemoglobin levels and lower glomerular filtration rates when the first episode of PDAP occurred (P < 0.05), were more susceptible to gram-negative bacterial infections (P < 0.05), and had significantly lower initial treatment response rate (P=0.009) and complete cure rate (P=0.018) and higher extubation rate (P=0.017). Multivariate logistic regression analysis showed that in patients on long-term dialysis, the risks of extubation and treatment failure for the first episode of PDAP were 3.05 times (OR: 3.05, 95%CI: 1.35-6.91, P=0.008) and 2.81 times (OR: 2.81, 95%CI: 1.45-5.44, P=0.002) those in patients with short-term dialysis, respectively. Fungal infection (OR: 45.40, 95%CI: 1.488-1385.5, P=0.029) and mixed bacterial infection (OR: 16.50, 95%CI: 1.106-246.123, P=0.042) were independent risk factors for treatment failure of the first episode of PDAP in patients on long-term dialysis. Maintenance peritoneal dialysis, technical failure, or all-cause mortality did not differ significantly between the two groups. Multivariate Cox regression analysis suggested that long-term dialysis was not an independent risk factor for technical failure (OR: 1.36, 95%CI: 0.84-2.19, P=0.206) or all-cause mortality (OR: 1.51, 95%CI: 0.97-2.35, P=0.068) in patients with PDAP. CONCLUSIONS Compared with those on short-term dialysis, patients on long-term dialysis are prone to gram-negative bacterial infection when the first episode of PDAP occurs with worse treatment outcomes but similar long-term outcomes. Long-term dialysis is an independent risk factor of extubation and treatment failure for the first episode of PDAP, and fungal and mixed bacterial infections are independent risk factors for treatment failure of the first PDAP in patients with long-term dialysis.
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Affiliation(s)
- Jing Zhao
- Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
| | - Liming Yang
- Department of Nephrology, Second Division of First Hospital of Jilin University, Changchun 130031, China
| | - Xueyan Zhu
- Department of Nephrology, Jilin Central Hospital, Jilin 132011, China
| | - Xiaoxuan Zhang
- Department of Nephrology, Jilin FAW General Hospital, Changchun 130011, China
| | - Xinyang Li
- Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
| | - Shichen Liu
- Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
| | - Xiaohua Zhuang
- Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
| | - Wenhua Zhou
- Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
| | - Ping Luo
- Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
| | - Wenpeng Cui
- Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
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Santos JE, Rodríguez Magariños C, García Gago L, Astudillo Jarrín D, Pértega S, Rodríguez-Carmona A, García Falcón T, Pérez Fontán M. Long-term trends in the incidence of peritoneal dialysis-related peritonitis disclose an increasing relevance of streptococcal infections: A longitudinal study. PLoS One 2020; 15:e0244283. [PMID: 33347487 PMCID: PMC7751873 DOI: 10.1371/journal.pone.0244283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/08/2020] [Indexed: 11/18/2022] Open
Abstract
Background The selective impact of strategies for prevention of PD-related peritonitis (PDrP) may have modified, in the long term, the causal spectrum, clinical presentation and outcomes of these infections. Objectives To compare trends in the incidence of PDrP by different microorganisms during a 30-year period, with a particular focus on streptococcal infections. To analyze the clinical presentation and outcomes of these infections. Secondarily, to investigate how the isolation of different species of streptococci can influence the clinical course of PDrP by this genus of bacteria. Method Following a retrospective, observational design we investigated 1061 PDrP (1990–2019). We used joinpoint regression analysis to explore trends in the incidence of PDrP by different microorganisms, and compared the risk profile (Cox), clinical presentation and outcomes (logistic regression) of these infections. Main results Our data showed a progressive decline in the incidence of PDrP by staphylococci and Gram negative bacteria, while the absolute rates of streptococcal (average annual percent change +1.6%, 95% CI -0.1/+3.2) and polymicrobial (+1.8%, +0.1/+3.5) infections tended to increase, during the same period. Remarkably, streptococci were isolated in 58.6% of polymicrobial infections, and patients who suffered a streptococcal PDrP had a 35.8% chance of presenting at least one other infection by the same genus. The risk profile for streptococcal infections was comparable to that observed for PDrP overall. Streptococcal PDrP were associated with a severe initial inflammatory response, but their clinical course was generally nonaggressive thereafter. We did not observe a differential effect of different groups of streptococci on the clinical presentation or outcome of PDrP. Conclusions Time trends in the incidence of PDrP by different microorganisms have granted streptococci an increasing relevance as causative agents of these infections, during the last three decades. This behaviour suggests that current measures of prevention of PDrP may not be sufficiently effective, in the case of this genus of microorganisms.
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Affiliation(s)
| | | | | | | | - Sonia Pértega
- Division of Epidemiology, University Hospital A Coruña, A Coruña, Spain
| | | | | | - Miguel Pérez Fontán
- Division of Nephrology, University Hospital A Coruña, A Coruña, Spain
- Health Sciences Faculty, University of A Coruña, A Coruña, Spain
- * E-mail:
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Incidence and characteristics of methicillin-resistant coagulase-negative Staphylococcus aureus in peritoneal dialysis-associated peritonitis in a single center using molecular methods. Int Urol Nephrol 2020; 53:373-380. [PMID: 32804344 DOI: 10.1007/s11255-020-02605-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Peritonitis is a serious complication of peritoneal dialysis and coagulase-negative Staphylococcus (CNS) is the most frequent cause of peritoneal dialysis (PD)-infections in many centers. This study aimed to investigate the molecular epidemiology of CNS isolated from PD-peritonitis in a Brazilian single center, focusing on the genetic determinants conferring methicillin resistance. METHODS Bacterial strains were isolated from peritoneal fluid of patients presenting PD-peritonitis, identified by phenotypic and molecular methods, and those identified as CNS were submitted to mecA detection, SCCmec, pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). RESULTS Over the 18-year period of this study (1995-2011), a total of 878 peritonitis episodes were diagnosed in this unit, 115 were caused by coagulase-negative staphylococci of which 72 by Staphylococcus epidermidis. mecA gene was detected in 55 CNS (47.8%), more frequently on the more recent years. SCCmec type III was the most frequent cassette, followed by SCCmec type IV and SCCmec type II. A diverstity of pulsotypes was observed among the S. epidermidis isolates, but five clusters (based on the 80% cutoff) were identified. Diversified sequence types (ST02, ST05, ST06, ST09, ST23, ST59 and ST371) were detected. CONCLUSIONS Detection of SCCmec type III among coagulase-negative Staphylococcus underscores the role of hospital environments as potential source of methicillin-resistant Staphylococcus causing peritonitis in PD patients.
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Zeng Y, Jiang X, Feng S, Jiang L, Wang Z, Shen H, Jiang S. The influence of seasonal factors on the incidence of peritoneal dialysis-associated peritonitis. Ren Fail 2020; 42:807-817. [PMID: 32781861 PMCID: PMC7472476 DOI: 10.1080/0886022x.2020.1804401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate the effects of climatic variables on peritoneal dialysis-associated peritonitis (PDAP) among patients receiving PD, such as seasonal variations in temperature and humidity. METHODS A retrospective analysis was performed on PD patients, from 1 January 2011, to 31 December 2019. We evaluated the influence of seasonal factors on peritonitis rates and outcomes. RESULTS Over the 9-year study period, 667 peritonitis episodes occurred, in 401 PD patients. Diarrhea-associated peritonitis occurred more frequently in summer compared with other seasons. Eating raw and cold food was identified as the primary cause of peritonitis in the summer. More peritonitis episodes occurred during summer. The peritonitis rate associated with gram-negative bacteria (p = 0.050) during summer was higher than those in all other seasons. The gram-negative bacterial peritonitis rate was positively correlated with monthly mean temperature (r = 0.504, p < 0.01) and humidity (r = 0.561, p < 0.01). A similar trend was observed for Enterobacterial peritonitis (temperature: r = 0.518, p < 0.01; humidity: r = 0.456, p = 0.001). Logistic regression analysis showed that summer was a risk factor for peritonitis (p = 0.041). Peritonitis prognosis during summer was significantly worse than those for all other seasons (p = 0.037). CONCLUSIONS Seasonal variations exist in the incidence of dialysis-associated peritonitis, with peak incidents caused by gram-negative bacteria in the summer. High average temperature and humidity are associated with significant increases in the gram-negative bacteria and Enterobacterial peritonitis rates. Peritonitis prognosis during summer is worse.
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Affiliation(s)
- Ying Zeng
- Department of Nephrology, the Second Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Xiaomei Jiang
- Department of Nephrology, the Second Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Sheng Feng
- Department of Nephrology, the Second Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Linsen Jiang
- Department of Nephrology, the Second Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Zhi Wang
- Department of Nephrology, the Second Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Huaying Shen
- Department of Nephrology, the Second Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Shan Jiang
- Department of Nephrology, the Second Affiliated Hospital of Soochow University, Suzhou, P.R. China
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Hepburn KS, Lambert K, Mullan J, McAlister B, Lonergan M, Cheikh Hassan HI. Peritoneal dialysis-related peritonitis as a risk factor for cardiovascular events. Intern Med J 2020; 51:404-410. [PMID: 32034855 DOI: 10.1111/imj.14769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/11/2020] [Accepted: 02/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of mortality in peritoneal dialysis (PD) patients. Infection is known to increase the risk of cardiovascular events (CVE); however, no studies have examined the association between PD peritonitis and CVE. AIM To examine peritonitis as a risk factor for CVE in PD patients. METHODS This retrospective cohort study included all adults undertaking PD for ≥3 months in one Australian health district from 2001 to 2015. Baseline characteristics and peritonitis event information was obtained from the Australian and New Zealand Dialysis and Transplant registry. The Centre for Health Research Illawarra Shoalhaven Population facilitated data linkage using ICD10 coding to capture CVE information. RESULTS A total of 211 patients was included, with median age of 66 years (interquartile range 54.49-74.45); 64% were male. Peritonitis occurred in 114 (54%) patients and 65 (30.8%) patients experienced a CVE. Identified risk factors for CVE included: cerebrovascular disease (hazard ratio (HR) 2.72, 95% confidence interval (CI) 1.36-5.47), diabetes (HR 2.41, 95% CI 1.47-3.96), coronary artery disease (HR 1.67, 95% CI 1.01-2.77) and age (HR 1.03, 95% CI 1.01-1.06). There was no significant increase in risk of CVE following peritonitis (HR 1.37, 95% CI 0.81-2.32, P = 0.24), even when accounting for age, cerebrovascular disease, diabetes and existing coronary artery disease (HR 1.32, 95% CI 0.78-2.23, P = 0.30). CONCLUSIONS We did not find an increase in the risk of CVE following a peritonitis episode in PD patients. This result may be due to small sample size or rapid peritonitis treatment mitigating cardiovascular risk.
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Affiliation(s)
- Kirsten S Hepburn
- Department or Renal Medicine, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Kelly Lambert
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), University of Wollongong, Wollongong, New South Wales, Australia
| | - Judy Mullan
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), University of Wollongong, Wollongong, New South Wales, Australia
| | - Brendan McAlister
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra and Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Maureen Lonergan
- Department or Renal Medicine, Wollongong Hospital, Wollongong, New South Wales, Australia.,Graduate School of Medicine University of Wollongong, University of Wollongong, Wollongong, New South Wales, Australia
| | - Hicham I Cheikh Hassan
- Department or Renal Medicine, Wollongong Hospital, Wollongong, New South Wales, Australia.,Graduate School of Medicine University of Wollongong, University of Wollongong, Wollongong, New South Wales, Australia
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Toleman MA. The Future of Peritoneal Dialysis in a Moving Landscape of Bacterial Resistance. Perit Dial Int 2020; 37:134-140. [DOI: 10.3747/pdi.2016.00038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Mark A. Toleman
- Department of Infection and Immunity School of Medicine, Cardiff University The Heath hospital, Heath Park Cardiff, UK
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Zelenitsky SA, Howarth J, Lagacé-Wiens P, Sathianathan C, Ariano R, Davis C, Verrelli M. Microbiological Trends and Antimicrobial Resistance in Peritoneal Dialysis-Related Peritonitis, 2005 to 2014. Perit Dial Int 2020; 37:170-176. [DOI: 10.3747/pdi.2016.00136] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/26/2016] [Indexed: 12/27/2022] Open
Abstract
BackgroundInformation related to the microbiology of peritonitis is critical to the optimal management of patients receiving peritoneal dialysis (PD). The goal was to characterize the microbiological etiology and antimicrobial susceptibilities of PD-related peritonitis (PDRP) from 2005 to 2014, inclusive.MethodsThe distribution of organisms in culture-positive PDRP was described for new episodes and relapse infections, and further detailed for monomicrobial and polymicrobial peritonitis. Annual and overall rates of PDRP were also characterized. Antimicrobial susceptibility rates were calculated for the most common and significant organisms.ResultsWe identified 539 episodes of PDRP including 501 new and 38 relapse infections. New episodes of peritonitis were associated with a single organism in 85% of cases, and 44% of those involved staphylococci. Polymicrobial PDRP was more likely to involve gram-negative organisms, observed in 58% versus 24% of monomicrobial infections. Antimicrobial resistance was relatively stable from 2005 to 2014. Methicillin resistance was present in 57% of Staphylococcus epidermidis and 20% of other coagulase-negative staphylococci. Methicillin-resistant Staphylococcus aureus (MRSA) accounted for only 11% of S. aureus peritonitis compared with 2% in our previous study of PDRP from 1991 to 1998. Ciprofloxacin resistance in Escherichia coli increased from 3% in our previous study to 24% in 2005 – 2014.ConclusionsThis study characterizes important differences in the distribution of organisms in new episodes of PDRP and relapse infections, as well as monomicrobial versus polymicrobial peritonitis. It also shows relatively stable rates of antimicrobial resistance from 2005 to 2014, but some increases compared with our previous study.
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Affiliation(s)
- Sheryl A. Zelenitsky
- College of Pharmacy, Manitoba, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; St. Boniface Hospital, Manitoba, Canada
| | | | - Philippe Lagacé-Wiens
- Max Rady College of Medicine, Manitoba, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; St. Boniface Hospital, Manitoba, Canada
| | - Christie Sathianathan
- Max Rady College of Medicine, Manitoba, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; St. Boniface Hospital, Manitoba, Canada
- Winnipeg, Manitoba, Canada; and Manitoba Renal Program, Manitoba, Canada
| | - Robert Ariano
- College of Pharmacy, Manitoba, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; St. Boniface Hospital, Manitoba, Canada
| | - Christine Davis
- College of Pharmacy, Manitoba, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; St. Boniface Hospital, Manitoba, Canada
- Winnipeg, Manitoba, Canada; and Manitoba Renal Program, Manitoba, Canada
| | - Mauro Verrelli
- Max Rady College of Medicine, Manitoba, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; St. Boniface Hospital, Manitoba, Canada
- Winnipeg, Manitoba, Canada; and Manitoba Renal Program, Manitoba, Canada
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Chen HC, Shieh CC, Sung JM. IncreasingStaphylococcusSpecies Resistance in Peritoneal Dialysis-Related Peritonitis Over a 10-Year Period in a Single Taiwanese Center. Perit Dial Int 2020; 38:266-270. [DOI: 10.3747/pdi.2017.00226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/01/2018] [Indexed: 01/31/2023] Open
Abstract
BackgroundPeritonitis is a major complication of peritoneal dialysis (PD). Staphylococcus species are gram-positive bacteria that are most commonly associated with peritoneal peritonitis. The increasing antimicrobial resistance rate is a severe burden when considering the initial choice of antibiotics. This investigation examined the trends of staphylococcal infection as well as the resistance rate and clinical outcomes from 2006 to 2015 in southern Taiwan.MethodsWe retrospectively investigated all PD-related peritonitis episodes in southern Taiwan between January 2006 and December 2015 and evaluated the clinical characteristics of peritonitis, microbiological prevalence and resistance of Staphylococcus species, and outcomes in patients.ResultsAmong 244 episodes of peritonitis, Staphylococcus species accounted for approximately 65% of the gram-positive bacteria that caused the infection. The methicillin resistance rate among Staphylococcus species substantially increased to 64% by 2015 in both Staphylococcus aureus and coagulase-negative staphylococci in southern Taiwan. Notably, patients with methicillin-resistant staphylococcal infection exhibited a significantly higher hospitalization rate than those with methicillin-sensitive staphylococcal infection. However, the catheter removal rate and transfer to hemodialysis exhibited no differences between the 2 groups.ConclusionPeritonitis is the most serious complication in patients on PD, and microbiological trends have changed over the past 10 years at a single center in southern Taiwan. The number of methicillin-resistant Staphylococcus species has substantially increased. Empirical initial antibiotic therapy should be adapted on the basis of the growing microbiological resistance.
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Affiliation(s)
- Ho-Ching Chen
- Renal Division, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Chang Shieh
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Junne-Ming Sung
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Renal Division, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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Ljungman S, Jensen JE, Paulsen D, Petersons A, Ots-Rosenberg M, Saha H, Struijk DG, Wilkie M, Heimbürger O, Stegmayr B, Elung-Jensen T, Johansson AC, Rydström M, Gudmundsdottir H, Petzold M. Retraining for prevention of peritonitis in peritoneal dialysis patients: A randomized controlled trial. Perit Dial Int 2020; 40:141-152. [PMID: 32063220 DOI: 10.1177/0896860819887626] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Peritonitis is more common in peritoneal dialysis (PD) patients nonadherent to the PD exchange protocol procedures than in compliant patients. We therefore investigated whether regular testing of PD knowledge with focus on infection prophylaxis could increase the time to first peritonitis (primary outcome) and reduce the peritonitis rate in new PD patients. METHODS This physician-initiated, open-label, parallel group trial took place at 57 centers in Sweden, Denmark, Norway, Finland, Estonia, Latvia, the Netherlands, and the United Kingdom from 2010 to 2015. New peritonitis-free PD patients were randomized using computer-generated numbers 1 month after the start of PD either to a control group (n = 331) treated according to center routines or to a retraining group (n = 340), which underwent testing of PD knowledge and skills at 1, 3, 6, 12, 18, 24, 30, and 36 months after PD start, followed by retraining if the goals were not achieved. RESULTS In all, 74% of the controls and 80% of the retraining patients discontinued the study. The groups did not differ significantly regarding cumulative incidence of first peritonitis adjusted for competing risks (kidney transplantation, transfer to hemodialysis and death; hazard ratio 0.84; 95% confidence interval (CI) 0.65-1.09) nor regarding peritonitis rate per patient year (relative risk 0.93; 95% CI 0.75-1.16). CONCLUSIONS In this randomized controlled trial, we were unable to demonstrate that regular, targeted testing and retraining of new PD patients increased the time to first peritonitis or reduced the rate of peritonitis, as the study comprised patients with a low risk of peritonitis, was underpowered, open to type 1 statistical error, and contamination between groups.
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Affiliation(s)
- Susanne Ljungman
- Department of Nephrology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jørgen E Jensen
- Department of Nephrology, Odense University Hospital, Denmark
| | - Dag Paulsen
- Department of Medicine, Innlandet Hospital HF, Lillehammer, Norway
| | - Aivars Petersons
- Nephrology Center, Department of Medicine, P. Stradins Clinical University Hospital, Riga, Latvia
| | - Mai Ots-Rosenberg
- Department of Internal Medicine, University Hospital of Tartu, Estonia
| | - Heikki Saha
- Department of Internal Medicine, Tampere University Hospital, Finland
| | - Dirk G Struijk
- Medisch Centrum, University of Amsterdam, the Netherlands
| | - Martin Wilkie
- Renal Unit, Department of Nephrology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Olof Heimbürger
- Patient Area Endocrinology and Nephrology, Karolinska University Hospital and Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
| | - Bernd Stegmayr
- Department of Nephrology, Public Health, and Clinical Medicine, Umeå University, Sweden
| | - Thomas Elung-Jensen
- Department of Nephrology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | | | | | | | - Max Petzold
- Health Metrics Unit, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
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Alkan Çeviker S, Günal Ö, Kılıç SS, Demirağ MD. Sürekli Ayaktan Periton Diyalizi Hastalarında Gelişen Peritonitlerin Epidemiyolojik ve Mikrobiyolojik Özelliklerinin Analizi. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2019. [DOI: 10.17944/mkutfd.541192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Poeppl W, Rainer-Harbach E, Kussmann M, Pichler P, Zeitlinger M, Wiesholzer M, Burgmann H, Reznicek G. Compatibility of linezolid with commercial peritoneal dialysis solutions. Am J Health Syst Pharm 2019; 75:1467-1477. [PMID: 30257843 DOI: 10.2146/ajhp170318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Results of a compatibility and stability study of linezolid admixed in commercial peritoneal dialysis (PD) solutions stored at various temperatures are reported. METHODS Test samples were prepared by adding linezolid i.v. injection (2 mg/mL) to infusion bags of 4 PD solutions (Extraneal, Nutrineal, Physioneal 40 Glucose 1.36%, and Physioneal 40 Glucose 2.27%, all from Baxter Healthcare Corporation). Assessments were conducted at various time points during storage of test samples at refrigeration temperature (6 °C) or room temperature (25 °C) for 14 days and at body temperature (37 °C) for 24 hours. Linezolid concentrations over time were determined by high-performance liquid chromatography, physical compatibility was determined by pH measurement and visual inspection, and antimicrobial activity was monitored by a disk diffusion method. The influence of solution warming by heating plate on drug stability was investigated. RESULTS Linezolid was stable in all tested solutions for 14 days at refrigeration and room temperatures and for 24 hours at body temperature. No linezolid adsorption to container material was detected. There were only minor variations in pH values, and visual inspection revealed no diluent abnormalities. With 1 exception, antimicrobial activity of >90% was retained in all PD solution samples for the duration of the study under all temperature conditions. CONCLUSION Linezolid injection 2 mg/mL remained stable and was compatible with the PD solutions studied for up to 2 weeks at refrigeration or room temperature and up to 24 hours at body temperature.
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Affiliation(s)
- Wolfgang Poeppl
- Military Medical Cluster East, Austrian Armed Forces, Vienna, Austria, and Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | | | - Manuel Kussmann
- Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Petra Pichler
- Department of Internal Medicine I, Division of Nephrology and Hematology, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Martin Wiesholzer
- Department of Internal Medicine I, Division of Nephrology and Hematology, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Heinz Burgmann
- Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
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Balzer MS, Claus R, Haller H, Hiss M. Are ISPD Guidelines on Peritonitis Diagnosis Too Narrow? A 15-Year Retrospective Single-Center Cohort Study on PD-Associated Peritonitis Accounting for Untrained Patients. Perit Dial Int 2019; 39:220-228. [DOI: 10.3747/pdi.2018.00179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/10/2018] [Indexed: 12/23/2022] Open
Abstract
Background Peritoneal dialysis (PD)-associated peritonitis remains by far the most important complication requiring patients to transfer to hemodialysis and has a major impact on patient morbidity and mortality. Current International Society for Peritoneal Dialysis (ISPD) guidelines on peritonitis recommend analysis of peritonitis episodes only in trained patients. In a large tertiary care center, we analyzed peritonitis episodes accounting for different groups of untrained patients and compared these with episodes in the trained patient population. Methods We analyzed data collected prospectively over a 15-year time span regarding differences between peritonitis episodes in trained patients and episodes in untrained patients post-catheter insertion but prior to training completion as well as on in-center intermittent PD with respect to incidence rates, pathogenic organisms, outcome, and peritonitis predictors. Results In 275 patients, a total of 160 peritonitis episodes in trained patients were counted. A total of 27 additional episodes in untrained patients were recorded. When accounting for these episodes, the peritonitis incidence significantly increased and the percentage of peritonitis-free patients decreased. Peritonitis episodes in untrained patients were most often culture-negative and the pathogen spectrum differed significantly compared with episodes counted as per ISPD recommendations, while outcome of peritonitis episodes did not differ. Predictors of peritonitis after multivariate logistic regression analysis included glomerulonephritis as primary kidney disease, being on home PD rather than being on in-center intermittent PD, and higher dialysis vintage. Conclusions Depending on local practice patterns, we argue that centers should additionally monitor peritonitis episodes in untrained patients because computation of statistics as per ISPD recommendations could underestimate peritonitis incidence and may depict a distorted pathogen spectrum.
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Affiliation(s)
- Michael S. Balzer
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Robert Claus
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Hermann Haller
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Marcus Hiss
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
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Compatibility of ciprofloxacin with commercial peritoneal dialysis solutions. Sci Rep 2019; 9:6512. [PMID: 31019280 PMCID: PMC6482149 DOI: 10.1038/s41598-019-42854-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 04/05/2019] [Indexed: 11/13/2022] Open
Abstract
Intraperitoneal administration of antibiotics together with peritoneal dialysis fluids (PDFs) remains the preferable route for treatment of peritoneal dialysis-related peritonitis. For home based therapy, antibiotic-containing PDFs are stored for up to two weeks and warmed up to body-temperature before administration. The present study investigated the compatibility of ciprofloxacin with five commercial PDFs at refrigeration-temperature, room-temperature and body-temperature. Ciprofloxacin concentrations were determined using high-performance liquid chromatography. Drug-diluent stability was evaluated by measurement of pH-values and visual inspection at each sampling point. The antimicrobial activity of ciprofloxacin was assessed by an E. coli disk diffusion method. Ciprofloxacin was stable at refrigeration-temperature and body-temperature in all PDFs evaluated over the whole study period of 14 days and 24 hours, respectively. At room-temperature, in contrast, ciprofloxacin demonstrated only limited stability in particular when tested in mixed Physioneal. Except for Physioneal 1.36%, no relevant drug adsorption was observed and the antimicrobial activity of ciprofloxacin was found to be preserved in each PDF at each storage condition investigated. Intraperitoneal ciprofloxacin might be used for inpatient and home based therapy of peritoneal dialysis-related peritonitis and no compensatory dose adjustment is needed when stored for up to two weeks at refrigeration-temperature before use.
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Yang J, Qi XM, Wu YG. The Application Analysis of Multiplex Real-Time Polymerase Chain Reaction Assays for Detection of Pathogenic Bacterium in Peritoneal Dialysis-Associated Peritonitis. Blood Purif 2019; 47:337-345. [PMID: 30602148 DOI: 10.1159/000495780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/26/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS To estimate the clinical value of bacterial detection in peritoneal dialysis-associated peritonitis (PDAP) by multiplex real-time polymerase chain reaction (RT-PCR). This study was undertaken to evaluate multiplex RT-PCR for identifying clinically significant bacteria in PDAP. METHODS Seventy peritoneal dialysate specimens were collected and traditional bacterial culture and universal primer RT-PCR detection of the bacterial were used. RESULTS The positive rate of traditional culture method was 65.71% (46/70) and that of universal primer RT-PCR was 81.42% (57/70). For 6 clinical commonly pathogenic bacteria, multiplex, and monoplex RT-PCR all detected 38 positive ones within the 57 specimens that were detected positive by universal primer RT-PCR. The results of the 2 methods were completely identical. Detecting bacteria by universal primer PCR and Monoplex RT-PCR needs 4-5 and 6-9 h, respectively, while multiplex RT-PCR needs less than 3 h. CONCLUSION Our results demonstrated that the multiplex RT-PCR can detect several kinds of bacteria simultaneously and it is also more practical and convenient than monoplex RT-PCR.
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Affiliation(s)
- Jing Yang
- Department of Nephropathy, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiang-Ming Qi
- Department of Nephropathy, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yong-Gui Wu
- Department of Nephropathy, The First Affiliated Hospital of Anhui Medical University, Hefei, China,
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Rottembourg J, Rostoker G. La réalité de la dialyse péritonéale en France : 40 ans après. Nephrol Ther 2018; 14:507-517. [DOI: 10.1016/j.nephro.2018.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/03/2018] [Accepted: 02/18/2018] [Indexed: 02/06/2023]
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Moloi MW, Kajawo S, Noubiap JJ, Mbah IO, Ekrikpo U, Kengne AP, Bello AK, Okpechi IG. Prevalence of peritonitis and mortality in patients treated with continuous ambulatory peritoneal dialysis (CAPD) in Africa: a protocol for a systematic review and meta-analysis. BMJ Open 2018; 8:e020464. [PMID: 29794094 PMCID: PMC5988068 DOI: 10.1136/bmjopen-2017-020464] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 04/06/2018] [Accepted: 04/18/2018] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Continuous ambulatory peritoneal dialysis (CAPD) is the ideal modality for renal replacement therapy in most African settings given that it is relatively cheaper than haemodialysis (HD) and does not require in-centre care. CAPD is, however, not readily utilised as it is often complicated by peritonitis leading to high rates of technique failure. The objective of this study is to assess the prevalence of CAPD-related peritonitis and all-cause mortality in patients treated with CAPD in Africa. METHODS AND ANALYSIS We will search PubMed, EMBASE, SCOPUS, Africa Journal Online and Google Scholar for studies conducted in Africa from 1 January 1980 to 30 June 2017 with no language restrictions. Eligible studies will include cross-sectional, prospective observational and cohort studies of patients treated with CAPD. Two authors will independently screen, select studies, extract data and conduct risk of bias assessment. Data consistently reported across studies will be pooled using random-effects meta-analysis. Heterogeneity will be evaluated using Cochrane's Q statistic and quantified using I2 statistics. Graphical and formal statistical tests will be used to assess for publication bias. ETHICS AND DISSEMINATION Ethical approval will not be needed for this study as data used will be extracted from already published studies. Results of this review will be published in a peer-reviewed journal and presented at conferences. The Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015) framework guided the development of this protocol. PROSPERO REGISTRATION NUMBER CRD42017072966.
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Affiliation(s)
- Mothusi Walter Moloi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Shepherd Kajawo
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
- Division of Clinical Practice and Patient Care, National University of Science and Technology, Bulawayo, Zimbabwe
| | - Jean Jacques Noubiap
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | | | - Udeme Ekrikpo
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Uyo, Uyo, Nigeria
| | - Andre Pascal Kengne
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Aminu K Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ikechi G Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
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The microbiome in chronic kidney disease patients undergoing hemodialysis and peritoneal dialysis. Pharmacol Res 2018; 130:143-151. [DOI: 10.1016/j.phrs.2018.02.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 12/19/2022]
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Kussmann M, Hauer S, Pichler P, Reznicek G, Burgmann H, Poeppl W, Zeitlinger M, Wiesholzer M. Influence of different peritoneal dialysis fluids on the in vitro activity of fosfomycin against Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa. Eur J Clin Microbiol Infect Dis 2018; 37:1091-1098. [PMID: 29546637 PMCID: PMC5948293 DOI: 10.1007/s10096-018-3221-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 02/25/2018] [Indexed: 11/29/2022]
Abstract
Peritonitis is still the main infectious complication among patients on peritoneal dialysis. For treatment of peritoneal dialysis-related peritonitis, the intraperitoneal administration of antibiotics admixed to peritoneal dialysis fluids (PDFs) should be preferred. However, the influence of diverse PDFs on the activity of frequently used antibiotics has been investigated insufficiently. Thus, the present study set out to investigate the in vitro activity of fosfomycin against Escherichia coli, Pseudomonas aeruginosa, Staphylococcus epidermidis, and Staphylococcus aureus in commercially available PDFs. Time-kill curves in four different PDFs (Dianeal®, Extraneal®, Nutrineal®, and Physioneal®) were performed over 24 h with two different concentrations of fosfomycin (150 and 400 mg/L) and without antibiotics as control. Cation-adjusted Mueller Hinton broth (CA-MHB) was used as a comparator solution. In blank PDFs, bacterial growth of each organism evaluated was reduced when compared to CA-MHB. For S. aureus in blank Physioneal®, a reduction under the limit of detection was observed within 24 h. The activity of fosfomycin was reduced in all PDFs when compared to CA-MHB except for P. aeruginosa in Nutrineal® where the activity of fosfomycin was increased when investigated at 400 mg/L. Against E.coli, bactericidal activity was demonstrated in Extraneal®, Nutrineal®, and Physioneal®. Fosfomycin resistance (MIC > 1024 mg/L) was observed for P. aeruginosa in CA-MHB at both concentrations and in Nutrineal® at 150 mg/L. Fosfomycin is active in PDFs particularly against the frequently isolated enterobacterium E. coli. The choice of the respective PDF considerably influences the microbiological outcome in vitro. Further studies are warranted to investigate the clinical relevance of these findings.
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Affiliation(s)
- Manuel Kussmann
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Stefan Hauer
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Petra Pichler
- Department of Internal Medicine I, University hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | | | - Heinz Burgmann
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Wolfgang Poeppl
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
- Military Medical Cluster East, Austrian Armed Forces, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University Vienna, Waehringerguertel 18-20, A-1090, Vienna, Austria.
| | - Martin Wiesholzer
- Department of Internal Medicine I, University hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
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Phui VE, Tan CHH, Chen CK, Lai KH, Chew KF, Chua HH, Ngu LLS, Hii LWS. Causative organisms and outcomes of peritoneal dialysis-related peritonitis in Sarawak General Hospital, Kuching, Malaysia: a 3-year analysis. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-017-0117-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Redpath Mahon A, Neu AM. A contemporary approach to the prevention of peritoneal dialysis-related peritonitis in children: the role of improvement science. Pediatr Nephrol 2017; 32:1331-1341. [PMID: 27757588 DOI: 10.1007/s00467-016-3531-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/24/2016] [Accepted: 09/27/2016] [Indexed: 01/22/2023]
Abstract
Peritonitis is a leading cause of hospitalizations, morbidity, and modality change in pediatric chronic peritoneal dialysis (CPD) patients. Despite guidelines published by the International Society for Peritoneal Dialysis aimed at reducing the risk of peritonitis, registry data have revealed significant variability in peritonitis rates among centers caring for children on CPD, which suggests variability in practice. Improvement science methods have been used to reduce a variety of healthcare-associated infections and are also being applied successfully to decrease rates of peritonitis in children. A successful quality improvement program with the goal of decreasing peritonitis will not only include primary drivers directly linked to the outcome of peritonitis, but will also direct attention to secondary drivers that are important for the achievement of primary drivers, such as health literacy and patient and family engagement strategies. In this review, we describe a comprehensive improvement science model for the reduction of peritonitis in pediatric patients on CPD.
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Affiliation(s)
- Allison Redpath Mahon
- Pediatric Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Alicia M Neu
- Pediatric Nephrology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Compatibility of fosfomycin with different commercial peritoneal dialysis solutions. Eur J Clin Microbiol Infect Dis 2017; 36:2237-2242. [PMID: 28685187 PMCID: PMC5653715 DOI: 10.1007/s10096-017-3051-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 06/19/2017] [Indexed: 10/24/2022]
Abstract
For treatment of peritoneal dialysis-related peritonitis, intraperitoneal administration of antibiotics remains the preferable route. For home-based therapy, patients are commonly supplied with peritoneal dialysis fluids already containing antimicrobial agents. The present study set out to investigate the compatibility of fosfomycin with different peritoneal dialysis fluids, namely, Extraneal®, Nutrineal®, Physioneal® 1.36% and Physioneal® 2.27%, under varying storage conditions. The peritoneal dialysis fluid bags including 4 g fosfomycin were stored over 14 days at refrigeration temperature (6°C) and room temperature (25°C) and over 24 h at body temperature (37°C). Drug concentrations over time were determined by using high-performance liquid chromatography coupled to a mass spectrometer. In addition, drug activity was assessed by a disk diffusion method, diluent stability by visual inspection and drug adsorption by comparison of the measured and calculated concentrations. Blank peritoneal dialysis fluids and deionized water were used as comparator solutions. Fosfomycin was stable in all peritoneal dialysis fluids and at each storage condition investigated over the whole study period. The remaining drug concentrations ranged between 94% and 104% of the respective initial concentrations. No significant drug adsorption was observed for any peritoneal dialysis fluid at any storage condition. No relevant reduction of antimicrobial activity was observed. Fosfomycin is compatible with Extraneal®, Nutrineal® and Physioneal® for up to two weeks at refrigeration or room temperature and may be used for home-based therapy. No dose adjustment is needed due to adsorption or degradation.
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Lu YA, Tu KH, Lee CC, Wu PW, Chang CJ, Tian YC, Yang CW, Chu PH. Prognostic impact of peritonitis in hemodialysis patients: A national-wide longitudinal study in Taiwan. PLoS One 2017; 12:e0173710. [PMID: 28301536 PMCID: PMC5354379 DOI: 10.1371/journal.pone.0173710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 02/24/2017] [Indexed: 12/04/2022] Open
Abstract
Background Peritonitis has been independently associated with increased morbidity and mortality in peritoneal dialysis patients. However, there are few reports on peritonitis in hemodialysis patients. We aim at investigating both the risk profiles and prognostic impact of peritonitis in hemodialysis patients. Methods This nation-wide longitudinal study uses claims data obtained from the Taiwan National Health Insurance Research Database. A total of 80,733 incident hemodialysis patients of age ≥ 20 years without a history of peritonitis were identified between January 1, 1998 and December 31, 2009. Predictors of peritonitis events were estimated using Cox proportional hazard models. Time-dependent Cox proportional hazard models were used to estimate hazard ratio for mortality attributed to peritonitis exposure. Results Of 80,733 incident hemodialysis patients over a 13-year study period, peritonitis was diagnosed in 935 (1.16%), yielding an incidence rate of 2.91 per 1000 person-years. Female gender, liver cirrhosis and polycystic kidney disease were three of the most significant factors for peritonitis in both non-diabetic and diabetic hemodialysis patients. The cumulative survival rate of patients with peritonitis was 38.8% at 1 year and 10.1% at 5 years. A time-dependent Cox multivariate analysis showed that peritonitis had significantly increased hazard ratio for all cause mortality. Additionally, the risk of mortality remained significantly higher for non-diabetic hemodialysis patients that experienced peritonitis. Conclusions The risk of peritonitis in hemodialysis patients is higher in female gender, liver cirrhosis and polycystic kidney disease. Although peritonitis is a rare condition, it is associated with significantly poorer outcome in hemodialysis patients.
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Affiliation(s)
- Yueh-An Lu
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kun-Hua Tu
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Chia Lee
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Patricia W. Wu
- Department of Radiology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chee-Jen Chang
- Graduate Institute of Clinical Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Tao-Yuan, Taiwan
- Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Ya-Chung Tian
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
- Healthcare Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
- Heart Failure Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
- * E-mail:
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Montelli AC, Sadatsune T, Mondelli AL, Cunha ML, Caramori JC, Barretti P, Camargo CH. Frequency and antimicrobial susceptibility of bacterial agents causing peritoneal dialysis-peritonitis in a Brazilian single center over 20 years. COGENT MEDICINE 2016. [DOI: 10.1080/2331205x.2016.1242246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Augusto C. Montelli
- Department of Internal Medicine, Botucatu Medical School, UNESP—Universidade Estadual Paulista, Botucatu Campus, Brazil
- Department of Microbiology and Immunology, Biosciences Institute of Botucatu, UNESP—Universidade Estadual Paulista, Distrito de Rubião Jr, s/n, CEP 18618-970, Botucatu Campus, Sao Paulo, Brazil
| | - Terue Sadatsune
- Department of Microbiology and Immunology, Biosciences Institute of Botucatu, UNESP—Universidade Estadual Paulista, Distrito de Rubião Jr, s/n, CEP 18618-970, Botucatu Campus, Sao Paulo, Brazil
| | - Alessandro L. Mondelli
- Department of Internal Medicine, Botucatu Medical School, UNESP—Universidade Estadual Paulista, Botucatu Campus, Brazil
| | - Maria L.R.S. Cunha
- Department of Microbiology and Immunology, Biosciences Institute of Botucatu, UNESP—Universidade Estadual Paulista, Distrito de Rubião Jr, s/n, CEP 18618-970, Botucatu Campus, Sao Paulo, Brazil
| | - Jacqueline C.T. Caramori
- Department of Internal Medicine, Botucatu Medical School, UNESP—Universidade Estadual Paulista, Botucatu Campus, Brazil
| | - Pasqual Barretti
- Department of Internal Medicine, Botucatu Medical School, UNESP—Universidade Estadual Paulista, Botucatu Campus, Brazil
| | - Carlos H. Camargo
- Department of Internal Medicine, Botucatu Medical School, UNESP—Universidade Estadual Paulista, Botucatu Campus, Brazil
- Department of Microbiology and Immunology, Biosciences Institute of Botucatu, UNESP—Universidade Estadual Paulista, Distrito de Rubião Jr, s/n, CEP 18618-970, Botucatu Campus, Sao Paulo, Brazil
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Kussmann M, Schuster L, Wrenger S, Pichler P, Reznicek G, Burgmann H, Poeppl W, Zeitlinger M, Wiesholzer M. Influence of Different Peritoneal Dialysis Fluids on the In Vitro Activity of Cefepime, Ciprofloxacin, Ertapenem, Meropenem and Tobramycin Against Escherichia Coli. Perit Dial Int 2016; 36:662-668. [PMID: 27680756 DOI: 10.3747/pdi.2015.00161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 02/22/2016] [Indexed: 11/15/2022] Open
Abstract
♦ BACKGROUND: Peritonitis is a major problem among patients on peritoneal dialysis (PD). The influence of diverse PD fluids on the activity of frequently used antibiotics has been insufficiently investigated. Thus, the present study set out to investigate the impact of different PD fluids on the activity of cefepime, ciprofloxacin, ertapenem, meropenem, and tobramycin against Escherichia coli. ♦ METHODS: Time-kill curves in 4 different PD fluids (Dianeal PDG4, Extraneal, Nutrineal PD4 and Physioneal 40, all Baxter Healthcare Corp., Deerfield, IL, USA) were performed over 24 hours with 4 different concentrations (1 × minimum inhibitory concentration [MIC], 4 × MIC, 8 × MIC, 30 × MIC) of each antibiotic evaluated and without antibiotics as control. Cation-adjusted Mueller Hinton broth (CA-MHB) was used as comparator solution. ♦ RESULTS: In all PD fluids investigated, bacterial growth and antimicrobial activity of all antibiotics tested was significantly reduced compared with the CA-MHB comparator solution. Except at high concentrations of 30 × MIC, cefepime, ertapenem and meropenem demonstrated a strongly reduced activity in all PD fluids investigated. Ciprofloxacin and tobramycin were highly active and bactericidal in all PD fluids and demonstrated dose-dependent activity. ♦ CONCLUSION: The antimicrobial activity of cefepime, ertapenem and meropenem is limited or even nullified in certain PD fluids in vitro, whereas ciprofloxacin and tobramycin show excellent activity. The choice of PD fluids can impact the activity of antimicrobial agents and might influence microbiological outcome. Further studies are required to verify the clinical relevance of our findings.
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Affiliation(s)
- Manuel Kussmann
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Linda Schuster
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Sarah Wrenger
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Petra Pichler
- Department of Internal Medicine I, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | | | - Heinz Burgmann
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Wolfgang Poeppl
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria.,Department of Dermatology, Medical University of Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Martin Wiesholzer
- Department of Internal Medicine I, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
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Kotera N, Tanaka M, Aoe M, Chikamori M, Honda T, Ikenouchi A, Miura R, Sugahara M, Furuse S, Saito K, Mise N. Age-Related Differences of Organism-Specific Peritonitis Rates: A Single-Center Experience. Ther Apher Dial 2016; 20:655-660. [PMID: 27500906 DOI: 10.1111/1744-9987.12449] [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: 11/14/2015] [Revised: 04/01/2016] [Accepted: 04/26/2016] [Indexed: 11/27/2022]
Abstract
Peritonitis remains an important cause of morbidity and mortality in peritoneal dialysis (PD) patients, but its incidence and the distribution of causative organisms vary widely between institutions and age groups. This study was performed to investigate the recent status and risk factors of PD-related peritonitis and to clarify differences between age groups. We retrospectively reviewed the medical records of 119 PD patients treated at our department between January 2002 and January 2013. We calculated both overall and organism-specific peritonitis rates and also analyzed risk factors. Sixty-three episodes of peritonitis occurred during 261.5 patient-years for an incident rate of 0.24 episodes/patient-year. Multivariate analysis showed that older age (≥65 years) and hypoalbuminemia (<3.0 g/dL) were associated with an increased risk of peritonitis (P = 0.035 and P = 0.029, respectively). In elderly patients (≥65 years old), the rate of peritonitis due to Gram-positive and Gram-negative bacteria was 0.17 and 0.08 episodes/patient-year, respectively, and Gram-positive peritonitis was markedly more frequent than in younger patients (<65 years old). In particular, there was a high frequency of Staphylococcus aureus peritonitis in elderly patients (0.09 episodes/patient-year) and it had a poor outcome. At our department, the risk of peritonitis was increased in older patients and patients with hypoalbuminemia. The distribution of causative organisms was markedly different between age groups and analysis of organism-specific peritonitis rates helped to identify current problems with our PD program.
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Affiliation(s)
- Nagaaki Kotera
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan.,Kugayama Kidney Clinic, Tokyo, Japan
| | - Mototsugu Tanaka
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan.,Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mari Aoe
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Masatomo Chikamori
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Tomoko Honda
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Ayako Ikenouchi
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Rika Miura
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Mai Sugahara
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Satoshi Furuse
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Katsunori Saito
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Naobumi Mise
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
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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.
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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
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Deciphering the Contribution of Biofilm to the Pathogenesis of Peritoneal Dialysis Infections: Characterization and Microbial Behaviour on Dialysis Fluids. PLoS One 2016; 11:e0157870. [PMID: 27336367 PMCID: PMC4918928 DOI: 10.1371/journal.pone.0157870] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/06/2016] [Indexed: 12/20/2022] Open
Abstract
Infections are major complications in peritoneal dialysis (PD) with a multifactorial etiology that comprises patient, microbial and dialytic factors. This study aimed at investigating the contribution of microbial biofilms on PD catheters to recalcitrant infections and their interplay with PD related-factors. A prospective observational study was performed on 47 patients attending Centro Hospitalar of Porto and Vila Nova de Gaia/Espinho to whom the catheter was removed due to infectious (n = 16) and non-infectious causes (n = 31). Microbial density on the catheter was assessed by culture methods and the isolated microorganisms identified by matrix-assisted laser desorption/ionization time-of-flight intact cell mass spectrometry. The effect of conventional and three biocompatible PD solutions on 16 Coagulase Negative Staphylococci (CNS) and 10 Pseudomonas aeruginosa strains planktonic growth and biofilm formation was evaluated. Cultures were positive in 87.5% of the catheters removed due infectious and 90.3% removed due to non-infectious causes. However, microbial yields were higher on the cuffs of catheters removed due to infection vs. non-infection. Staphylococci (CNS and Staphylococcus aureus) and P. aeruginosa were the predominant species: 32% and 20% in the infection and 43.3% and 22.7% in the non-infection group, respectively. In general, PD solutions had a detrimental effect on planktonic CNS and P. aeruginosa strains growth. All strains formed biofilms in the presence of PD solutions. The solutions had a more detrimental effect on P. aeruginosa than CNS strains. No major differences were observed between conventional and biocompatible solutions, although in icodextrin solution biofilm biomass was lower than in bicarbonate/lactate solution. Overall, we show that microbial biofilm is universal in PD catheters with the subclinical menace of Staphylococci and P. aeruginosa. Cuffs colonization may significantly contribute to infection. PD solutions differentially impact microbial species. This knowledge is important for the development of infection diagnosis, treatment and preventive strategies.
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van Diepen ATN, van Esch S, Struijk DG, Krediet RT. The Association Between Glucose Exposure and the Risk of Peritonitis in Peritoneal Dialysis Patients. Perit Dial Int 2016; 36:533-9. [PMID: 27044793 DOI: 10.3747/pdi.2014.00318] [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] [Received: 12/10/2014] [Accepted: 10/10/2015] [Indexed: 12/20/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND AND OBJECTIVE Little or no clinical evidence is available on the association between glucose exposure and peritoneal host defense in peritoneal dialysis (PD) patients. The objective of the present study was to quantify the exposure to glucose during the first year on PD and investigate the association with subsequent peritonitis. ♦ METHODS We analyzed prospectively collected demographic and peritonitis data from incident adult PD patients between 1990 and 2010. For the present study, we conducted a review of both in- and outpatient medical records of all patients to obtain their day-to-day dialysis schemes during the first year on PD. From these data, the average exposure to glucose was quantified. The exposure was stratified into low- and high-glucose groups based on the median, analyzed per standard deviation and in quartiles. Cox proportional hazard models were used to calculate crude and adjusted hazard ratios (HRs) and 95% confidence intervals for the association between glucose exposure and peritonitis. Adjustments were made for age, sex, primary kidney disease, diabetes mellitus, Davies comorbidity score and the treatment period. ♦ RESULTS In total, 230 patients were included in the study of whom 151 (66%) experienced a first peritonitis episode. The median follow-up time was 2.6 years (interquartile range [IQR]: 1.9 - 3.8) in the low-glucose group and 3.1 (IQR: 2.1 - 4.2) in the high-glucose group. After adjustment for confounding factors, no association between high glucose exposure and the risk of peritonitis was found (HR: 0.81; 0.55 - 1.17). No association was present when glucose exposure was analyzed per standard deviation (SD) (HR: 0.98; 0.79 - 1.21) or patient quartiles were applied. No association was identified between glucose exposure and severe peritonitis, Staphylococcus aureus peritonitis, or a peritonitis episode that lasted more than 14 days. ♦ CONCLUSIONS Exposure to glucose is not associated with an increased risk of peritonitis. The equilibrium between glycemic harm to peritoneal host defense and detrimental effects of glucose on invading microorganisms may determine the susceptibility to peritoneal infection.
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Affiliation(s)
- Anouk T N van Diepen
- Division of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sadie van Esch
- St. Elisabeth Hospital, Department of Nephrology and Internal Medicine, Tilburg, The Netherlands
| | - Dirk G Struijk
- Division of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Dianet, Amsterdam-Utrecht, The Netherlands
| | - Raymond T Krediet
- Division of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Higuchi C, Ito M, Masakane I, Sakura H. Peritonitis in peritoneal dialysis patients in Japan: a 2013 retrospective questionnaire survey of Japanese Society for Peritoneal Dialysis member institutions. RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0014-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lofaro D, Vogelzang JL, van Stralen KJ, Jager KJ, Groothoff JW. Infection-related hospitalizations over 30 years of follow-up in patients starting renal replacement therapy at pediatric age. Pediatr Nephrol 2016; 31:315-23. [PMID: 26463555 PMCID: PMC4689769 DOI: 10.1007/s00467-015-3209-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 07/29/2015] [Accepted: 08/12/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Pediatric renal replacement therapy (RRT) patients surviving long-term are at a much higher risk of mortality compared with the age-matched general population. Recently, we demonstrated a transition from cardiovascular disease to infection as the main cause of death in a long-term follow-up study of pediatric RRT. Here, we explore the burden of infections requiring hospitalization over 30 years of follow-up on RRT. METHODS The cohort comprised all 234 Dutch patients on RRT under 15 years of age between 1972 and 1992. We analyzed infection-related hospitalizations during the period 1980–2010. We evaluated the Hospital Admission Rate (HAR) per patient-years (py) and infectious over noninfectious HAR ratio (HARR). RESULTS The HAR decreased significantly over time for all patients. The rate of hemodialysis-related infections decreased between 1980 and 1999, but stabilized during 2000–2010, whereas peritoneal dialysis-related infections decreased progressively. Transplantation-related infections did not change, except for urinary tract infections (UTIs), which increased significantly from 3.3/100 py [95%CI 3.2–3.4] in 1980–1989 to 4.4/100 py [4.2–4.5] in 2000–2010 (p <0.001). The contribution of infection to HAR increased significantly in transplanted patients (HARR: 1980–1989: 0.25 [0.2–0.3]; 2000–2010: 1.0 [0.79–1.27], p <0.001). CONCLUSIONS Our findings indicate a relative increase in infections requiring hospitalization over time in patients starting RRT during the pediatric age, especially severe UTIs in transplantation. More attention paid to urological abnormalities in cases of recurrent UTI and tailored adjustment of immunosuppression may reduce risk in these patients.
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Affiliation(s)
- Danilo Lofaro
- />Kidney and Transplantation Research Centre, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, Via F. Migliori, 87100 Cosenza, Italy
| | - Judith L. Vogelzang
- />Department of Pediatric Nephrology, Academic Medical Center, Emma Children’s Hospital, Amsterdam, The Netherlands
| | - Karlijn J van Stralen
- />ERA-EDTA Registry and ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kitty J. Jager
- />ERA-EDTA Registry and ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap W. Groothoff
- />Department of Pediatric Nephrology, Academic Medical Center, Emma Children’s Hospital, Amsterdam, The Netherlands
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Chen SS, Sheth H, Piraino B, Bender F. Long-Term Exit-Site Gentamicin Prophylaxis and Gentamicin Resistance in a Peritoneal Dialysis Program. Perit Dial Int 2015; 36:387-9. [PMID: 26634567 DOI: 10.3747/pdi.2015.00162] [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: 07/09/2015] [Accepted: 10/06/2015] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND Daily gentamicin cream exit-site prophylaxis reduces peritoneal dialysis (PD)-related gram-negative infections. However, there is a concern about the potential for increasing gentamicin resistance with the long-term use of prophylactic gentamicin. This study evaluated the incidence of gentamicin-resistant PD-related infections over more than 2 decades. ♦ METHODS Study data on prevalent PD patients were retrieved from a prospectively maintained institutional review board (IRB)-approved PD registry at a single center from January 1, 1991, to December 31, 2000, and January 1, 2004, to December 31, 2013. The rates of gram-negative infections, fungal infections and those infections with organisms resistant to gentamicin were examined for the 2 periods. Period 1 from 1991 to 2000 when S. aureus prophylaxis consisted initially of oral rifampin to treat nasal carriage with S. aureus, and was then daily exit-site mupirocin ointment for all PD patients, was compared to the period from 2004 to 2013 when daily exit-site gentamicin cream was prescribed as prophylaxis (Period 2). ♦ RESULTS The study included a total of 444 PD patients (265 and 179 in Period 1 and Period 2, respectively). No significant difference was noted in demographics between the 2 periods except race. The gram-negative exit-site infection rates for Period 1 and Period 2 were 0.109 versus 0.027 (p < 0.0001). Gram-negative peritonitis rates were similar. There were 3 episodes of gentamicin-resistant infections in each period. Fungal infections remained consistently low. ♦ CONCLUSION Despite a decade of exit-site gentamicin prophylaxis, gentamicin-resistant PD-related infections and fungal infections remained very low and similar to the prior period.
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Affiliation(s)
- Shan Shan Chen
- Nephrology Division, Department of Medicine at the University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Heena Sheth
- Renal-Electrolyte Division, Department of Medicine at the University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Beth Piraino
- Renal-Electrolyte Division, Department of Medicine at the University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Filitsa Bender
- Renal-Electrolyte Division, Department of Medicine at the University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Nakao M, Yamamoto I, Maruyama Y, Nakashima A, Matsuo N, Tanno Y, Ohkido I, Ikeda M, Yamamoto H, Yokoyama K, Yokoo T. 33 Years of Peritoneal Dialysis-Associated Peritonitis: A Single-Center Study in Japan. Ther Apher Dial 2015; 20:60-5. [PMID: 26577015 DOI: 10.1111/1744-9987.12372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 06/25/2015] [Accepted: 08/10/2015] [Indexed: 11/28/2022]
Abstract
Peritoneal dialysis-associated peritonitis (PD-associated peritonitis) could influence the outcome of PD patients, including technique survival. Although the use of the twin-bag system has decreased the incidence of peritonitis, the effects of biocompatible PD solutions are controversial. Additionally, since both infection-causing microorganisms and antimicrobial therapies have changed over time, the duration of treatment of peritonitis (the duration of peritonitis) seems to have changed. The study included 527 patients who received PD between January 1980 and December 2012 at a single center. We divided patients undergoing PD into three groups according to the type of PD system used, namely single-bag and conventional PD solutions (S+C group, N = 145), twin-bag and conventional PD solutions (T+C group, N = 171) and twin-bag and biocompatible PD solutions (T+B group, N = 211), and analyzed PD-associated peritonitis incidences. Incidences of PD-associated peritonitis (times per patient-months) and peritonitis-free time were 1/59.4, 1/70.6 and 1/103.1, and 52, 97, and 100 months for the S+C, T+C and T+B groups, respectively. The duration of peritonitis, has thus, become dramatically shorter in recent years. Streptococcus sp. were associated with shortest and fungi with longest durations of peritonitis. Staphylococcus sp. and Pseudomonas aeruginosa were predominant in the S+C group. The twin-bag system has made a greater contribution to reductions in PD-associated peritonitis than biocompatible PD solutions. Furthermore, changes in microorganisms, antimicrobial therapies, patient education and improved PD system devices have presumably affected the reduction in the duration of peritonitis.
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Affiliation(s)
- Masatsugu Nakao
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Izumi Yamamoto
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yukio Maruyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Akio Nakashima
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Nanae Matsuo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yudo Tanno
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Ichiro Ohkido
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masato Ikeda
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyasu Yamamoto
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Keitaro Yokoyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Kitterer D, Latus J, Pöhlmann C, Alscher MD, Kimmel M. Microbiological Surveillance of Peritoneal Dialysis Associated Peritonitis: Antimicrobial Susceptibility Profiles of a Referral Center in GERMANY over 32 Years. PLoS One 2015; 10:e0135969. [PMID: 26405797 PMCID: PMC4583423 DOI: 10.1371/journal.pone.0135969] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/28/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives Peritonitis is one of the most important causes of treatment failure in peritoneal dialysis (PD) patients. This study describes changes in characteristics of causative organisms in PD-related peritonitis and antimicrobial susceptibility. Methods In this single center study we analyzed retrospective 487 susceptibility profiles of the peritoneal fluid cultures of 351 adult patients with peritonitis from 1979 to 2014 (divided into three time periods, P1-P3). Results Staphylococcus aureus decreased from P1 compared to P2 and P3 (P<0.05 and P<0.01, respectively). Methicillin-resistant S. aureus (MRSA) occurred only in P3. Methicillin-resistant Staphylococcus epidermidis (MRSE) increased in P3 over P1 and P2 (P <0.0001, respectively). In P2 and P3, vancomycin resistant enterococci were detected. The percentage of gram-negative organisms remained unchanged. Third generation cephalosporin resistant gram-negative rods (3GCR-GN) were found exclusively in P3. Cefazolin-susceptible gram-positive organisms decreased over the three decades (93% in P1, 75% in P2 and 58% in P3, P<0.01, P<0.05 and P<0.0001, respectively). Vancomycin susceptibility decreased and gentamicin susceptibility in gram-negatives was 94% in P1, 82% in P2 and 90% in P3. Ceftazidim susceptibility was 84% in P2 and 93% in P3. Conclusions Peritonitis caused by MSSA decreased, but peritonitis caused by MRSE increased. MRSA peritonitis is still rare. Peritonitis caused by 3GCR-GN is increasing. An initial antibiotic treatment protocol should be adopted for PD patients to provide continuous surveillance.
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Affiliation(s)
- Daniel Kitterer
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Joerg Latus
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Christoph Pöhlmann
- Department of Diagnostic and Laboratory Medicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - M. Dominik Alscher
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Martin Kimmel
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
- * E-mail:
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Abstract
Due to ongoing limitations in the availability and timeliness of kidney transplantation, most patients with end-stage renal disease (ESRD) require some form of dialysis during their lifetime. Worldwide, ESRD patients most commonly receive hemodialysis (HD) or one of two forms of peritoneal dialysis (PD), continuous ambulatory PD (CAPD) or automated PD (APD). In this review, we analyze the data available from the last several decades on overall survival associated with HD as compared to PD as well as with CAPD compared to APD. Because of the inherent difficulty in randomly assigning patients to different dialysis modalities, the survival data available are virtually all observational and fraught with many confounding factors and limitations. However, over the last 10 – 15 years as overall survival of dialysis patients has steadily improved and statistical methods to analyze observational data have evolved, a pattern of virtual equivalence in survival among patients on HD vs. PD and on CAPD vs. APD has emerged. As such, impact upon lifestyle and upon quality of life likely should remain the predominant factors in guiding nephrologists and their patients in their choice of dialysis modality.
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Kussmann M, Schuster L, Zeitlinger M, Pichler P, Reznicek G, Wiesholzer M, Burgmann H, Poeppl W. The influence of different peritoneal dialysis fluids on the in vitro activity of ampicillin, daptomycin, and linezolid against Enterococcus faecalis. Eur J Clin Microbiol Infect Dis 2015; 34:2257-63. [PMID: 26337433 DOI: 10.1007/s10096-015-2477-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/20/2015] [Indexed: 11/28/2022]
Abstract
Intraperitoneal administration of antibiotics is recommended for the treatment of peritoneal dialysis-related peritonitis. However, little data are available on a possible interference between peritoneal dialysis fluids and the activity of antimicrobial agents. Thus, the present in vitro study set out to investigate the influence of different peritoneal dialysis fluids on the antimicrobial activity of ampicillin, linezolid, and daptomycin against Enterococcus faecalis. Time-kill curves in four different peritoneal dialysis fluids were performed over 24 h with four different concentrations (1 × MIC, 4 × MIC, 8 × MIC, 30 × MIC) of each antibiotic evaluated. Cation-adjusted Mueller-Hinton broth was used as the comparator solution. All four peritoneal dialysis fluids evaluated had a bacteriostatic effect on the growth of Enterococcus faecalis. Compared to the cation-adjusted Mueller-Hinton broth comparator solution, the antimicrobial activity of all antibiotics tested was reduced. For ampicillin and linezolid, no activity was found in any peritoneal dialysis fluid, regardless of the concentration. Daptomycin demonstrated dose-dependent activity in all peritoneal dialysis fluids. Bactericidal activity was observed at the highest concentrations evaluated in Dianeal® PDG4 and Extraneal®, but not in concentrations lower than 30 × MIC and not in Nutrineal® PD4 and Physioneal® 40. The antimicrobial activity of ampicillin and linezolid is limited in peritoneal dialysis fluids in vitro. Daptomycin is highly effective in peritoneal dialysis fluids and might, thus, serve as an important treatment option in peritoneal dialysis-related peritonitis. Further studies are needed to evaluate the clinical impact of the present findings.
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Affiliation(s)
- M Kussmann
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - L Schuster
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - M Zeitlinger
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - P Pichler
- Department of Internal Medicine I, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - G Reznicek
- Department of Pharmacognosy, University of Vienna, Vienna, Austria
| | - M Wiesholzer
- Department of Internal Medicine I, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - H Burgmann
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - W Poeppl
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Szeto CC. Peritonitis rates of the past thirty years: from improvement to stagnation. Perit Dial Int 2015; 34:151-3. [PMID: 24676740 DOI: 10.3747/pdi.2014.00007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Cheuk-Chun Szeto
- Department of Medicine and Therapeutics Prince of Wales Hospital The Chinese University of Hong Kong Shatin, Hong Kong SAR, PR China
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François K, Bargman JM. Evaluating the benefits of home-based peritoneal dialysis. Int J Nephrol Renovasc Dis 2014; 7:447-55. [PMID: 25506238 PMCID: PMC4260684 DOI: 10.2147/ijnrd.s50527] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Peritoneal dialysis (PD) is an effective renal replacement strategy for patients suffering from end-stage renal disease. PD offers patient survival comparable to or better than in-center hemodialysis while preserving residual kidney function, empowering patient autonomy, and reducing financial burden to payors. The majority of patients suffering from kidney failure are eligible for PD. In patients with cardiorenal syndrome and uncontrolled fluid status, PD is of particular benefit, decreasing hospitalization rates and duration. This review discusses the benefits of chronic PD, performed by the patient or a caregiver at home. Recognition of the benefits of PD is a cornerstone in stimulating the use of this treatment strategy.
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Affiliation(s)
- Karlien François
- Division of Nephrology, University Health Network Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Joanne M Bargman
- Division of Nephrology, University Health Network Toronto General Hospital, University of Toronto, Toronto, ON, Canada
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