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Lumlertgul D, Tinroongroj N, Lumlertgul S, Siwapitak P, Tungkanakorn R, Kaewpanya S. Rescue plan for CAPD peritonitis: Using ultrasonography as a guide on when to remove the catheter. Ther Apher Dial 2023; 27:1113-1124. [PMID: 37632328 DOI: 10.1111/1744-9987.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 07/05/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023]
Abstract
INTRODUCTION Ultrasound has been found to facilitate early identification of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). METHODS A retrospective analysis was carried out to evaluate the effectiveness of ultrasonography-guided removal of the Tenckhoff catheter in reducing complications like a shift to hemodialysis or death in CAPD patients. RESULTS The "peritonitis rescue plan" supported timely decision-making for the removal of the infected catheter and resulted in a lower peritonitis episode per patient per month ratio (from 1:36 to 1:122) in 2021, a lower death rate (from 19% to 6.6%) and lower incidences of shifts to hemodialysis (from 2%-9% to 0%) as compared to that before the implementation of the plan in 2019. CONCLUSION The implementation of the "peritonitis rescue plan" and the removal of the infected catheter within 3 days of peritonitis being detected was successful in improving the standard of care for patients undergoing CAPD.
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Affiliation(s)
- Dusit Lumlertgul
- CAPD Institute, Chiangmai Kidney Clinic, Chiangmai, Thailand
- Faculty of Medicine, Chiangmai University, Chiangmai, Thailand
- Renal Disease Unit, Pan Hospital, Chiang Rai, Thailand
- Renal Disease Unit, Fang Hospital, Chiangmai, Thailand
| | - Nantawan Tinroongroj
- CAPD Institute, Chiangmai Kidney Clinic, Chiangmai, Thailand
- Bangkok Hospital, Chiangmai, Thailand
| | - Suthaporn Lumlertgul
- CAPD Institute, Chiangmai Kidney Clinic, Chiangmai, Thailand
- Department of Emergency Medicine, Chulalongkorn Hospital, Bangkok, Thailand
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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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3
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Li PKT, Chow KM, Cho Y, Fan S, Figueiredo AE, Harris T, Kanjanabuch T, Kim YL, Madero M, Malyszko J, Mehrotra R, Okpechi IG, Perl J, Piraino B, Runnegar N, Teitelbaum I, Wong JKW, Yu X, Johnson DW. ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Perit Dial Int 2022; 42:110-153. [PMID: 35264029 DOI: 10.1177/08968608221080586] [Citation(s) in RCA: 184] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Peritoneal dialysis (PD)-associated peritonitis is a serious complication of PD and prevention and treatment of such is important in reducing patient morbidity and mortality. The ISPD 2022 updated recommendations have revised and clarified definitions for refractory peritonitis, relapsing peritonitis, peritonitis-associated catheter removal, PD-associated haemodialysis transfer, peritonitis-associated death and peritonitis-associated hospitalisation. New peritonitis categories and outcomes including pre-PD peritonitis, enteric peritonitis, catheter-related peritonitis and medical cure are defined. The new targets recommended for overall peritonitis rate should be no more than 0.40 episodes per year at risk and the percentage of patients free of peritonitis per unit time should be targeted at >80% per year. Revised recommendations regarding management of contamination of PD systems, antibiotic prophylaxis for invasive procedures and PD training and reassessment are included. New recommendations regarding management of modifiable peritonitis risk factors like domestic pets, hypokalaemia and histamine-2 receptor antagonists are highlighted. Updated recommendations regarding empirical antibiotic selection and dosage of antibiotics and also treatment of peritonitis due to specific microorganisms are made with new recommendation regarding adjunctive oral N-acetylcysteine therapy for mitigating aminoglycoside ototoxicity. Areas for future research in prevention and treatment of PD-related peritonitis are suggested.
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Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Kai Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yeoungjee Cho
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Stanley Fan
- Translational Medicine and Therapeutic, William Harvey Research Institute, Queen Mary University, London, UK
| | - Ana E Figueiredo
- Nursing School Escola de Ciências da Saúde e da Vida Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tess Harris
- Polycystic Kidney Disease Charity, London, UK
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Magdalena Madero
- Division of Nephrology, Department of Medicine, National Heart Institute, Mexico City, Mexico
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Diseases, The Medical University of Warsaw, Poland
| | - Rajnish Mehrotra
- Division of Nephrology, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, DC, USA
| | - Ikechi G Okpechi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, South Africa
| | - Jeff Perl
- St Michael's Hospital, University of Toronto, ON, Canada
| | - Beth Piraino
- Department of Medicine, Renal Electrolyte Division, University of Pittsburgh, PA, USA
| | - Naomi Runnegar
- Infectious Management Services, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Isaac Teitelbaum
- Division of Nephrology, Department of Medicine, University of Colorado, Aurora, CO, USA
| | | | - Xueqing Yu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangzhou, China
- Guangdong Academy of Medical Sciences, Guangzhou, China
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
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4
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Wang R, Bai Y, Yang Y, Wu X, Li R. A Comparison of Production Performance, Egg Quality, and Cecal Microbiota in Laying Hens Receiving Graded Levels of Vitamin B 12. Front Vet Sci 2021; 8:712183. [PMID: 34746275 PMCID: PMC8566728 DOI: 10.3389/fvets.2021.712183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/16/2021] [Indexed: 02/01/2023] Open
Abstract
The objective of the study was to investigate the effect of fortified diets with standard vs. high levels of vitamin B12 on cecal microbiota composition, production performance, and eggshell quality of laying hens. Dietary treatments consisted of a basal diet with no supplementation of vitamin B12 or supplemented with 25, 100, and 400 μg/kg vitamin B12, respectively. A total of 432 laying hens were randomly assigned to four treatments with six replicates per treatment. No significant effect of dietary treatments on the production performance of hens was detected. The shell thickness of eggs from hens fed diet supplemented with 100 μg/kg of vitamin B12 was higher (P < 0.01) than that of eggs from hens fed control diet or supplemented with 25 μg/kg vitamin B12. The shell percentage of eggs from hens fed diet supplemented with 400 μg/kg of vitamin B12 was higher (P < 0.01) than that of eggs from hens fed other treatment diets. Dietary vitamin B12 did not modulate diversity of the cecal microbiota of the layers. At genus level, the cecal content from layers fed diet with supplemental level of 100 or 400 μg/kg of vitamin B12 had higher (P < 0.01) abundance of Faecalibacterium and lower (P < 0.05) abundance of Acinetobacter compared with the cecal content from layers fed other two diets. The abundance of Lactobacillus in the cecal samples from layers fed 100 μg/kg of supplemental level of vitamin B12 was higher (P < 0.05) than that from layers fed other three diets. The abundance of Butyricicoccus was higher (P < 0.05), while Bilophila was lower (P < 0.05) in the cecal content of layers fed 400 μg/kg of vitamin B12 diet compared with those from layers fed other three diets. The results of PICRUSt analysis indicated that 10 predicted metabolic functions of the cecal microbial communities were positively correlated to dietary vitamin B12 level. Overall, dietary supplementation of 100 or 400 μg/kg of vitamin B12 had equivalent effects and caused the significant change in composition and metabolic functions of cecal microorganisms, which could positively impact eggshell quality, metabolism, and gut health of laying hens.
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Affiliation(s)
- Rui Wang
- Laboratory of Poultry Production, College of Animal Science, Shanxi Agricultural University, Taigu, China.,Department of Life Sciences, Luliang University, Luliang, China
| | - Yan Bai
- Laboratory of Poultry Production, College of Animal Science, Shanxi Agricultural University, Taigu, China
| | - Yu Yang
- Laboratory of Poultry Production, College of Animal Science, Shanxi Agricultural University, Taigu, China
| | - Xiaotian Wu
- Laboratory of Poultry Production, College of Animal Science, Shanxi Agricultural University, Taigu, China
| | - Ruirui Li
- Laboratory of Poultry Production, College of Animal Science, Shanxi Agricultural University, Taigu, China
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Interaction of Staphylococcus aureus and Acinetobacter baumannii during In Vitro β-Lactam Exposure. Antimicrob Agents Chemother 2021; 65:AAC.02414-20. [PMID: 33495215 DOI: 10.1128/aac.02414-20] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 01/08/2021] [Indexed: 12/31/2022] Open
Abstract
We sought to determine if Acinetobacter baumannii is capable of altering the pharmacodynamics of an antistaphylococcal β-lactam. Two strains of methicillin-susceptible Staphylococcus aureus (MSSA) and two A. baumannii isolates were studied in 24-h static time-killing experiments under monoculture or coculture conditions. Bacterial killing of meropenem was described using an empirical pharmacokinetics/pharmacodynamics model that was developed using Hill functions. A mechanism-based pharmacodynamic model was also used to describe the effect of meropenem on each species of bacterium, interspecies interactions, and strain-based covariate effects. Monte Carlo simulations of bacterial killing effects were generated based on the population pharmacokinetics of meropenem in 2,500 simulated critically ill subjects over 48 h. Against one of the two MSSA isolates, the magnitude of bacterial killing (E Δ) decreased from -4.61 (95% confidence interval [CI], -5.85 to -3.38) to -2.23 (95% CI, -2.85 to -1.61) when cultured in the presence of carbapenem-resistant A. baumannii (CRAB). Similarly, the data were best described by a mechanism-based model where the number of A. baumannii cells produced a systematic increase in the S. aureus concentration for a 50% maximum killing effect (KC50) of 3.53-fold, thereby decreasing MSSA sensitivity to meropenem. A covariate effect by the CRAB isolate resulted in a more pronounced increase in the MSSA KC50 for meropenem (31.8-fold increase). However, Monte Carlo simulations demonstrated that a high-intensity meropenem regimen is capable of sustained killing against both MSSA isolates despite protection from A. baumannii Thus, A. baumannii and MSSA engage in complex interactions during β-lactam exposure, but optimal antimicrobial dosing is likely capable of killing MSSA despite the potentially beneficial interplay with A. baumannii.
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Htay H, Cho Y, Pascoe EM, Hawley C, Clayton PA, Borlace M, Badve SV, Sud K, Boudville N, Chen JH, Sypek M, Johnson DW. Multicentre registry data analysis comparing outcomes of culture-negative peritonitis and different subtypes of culture-positive peritonitis in peritoneal dialysis patients. Perit Dial Int 2021; 40:47-56. [PMID: 32063153 DOI: 10.1177/0896860819879891] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The outcomes of culture-negative peritonitis in peritoneal dialysis (PD) patients have been reported to be superior to those of culture-positive peritonitis. The current study aimed to examine whether this observation also applied to different subtypes of culture-positive peritonitis. METHODS This multicentre registry study included all episodes of peritonitis in adult PD patients in Australia between 2004 and 2014. The primary outcome was medical cure. Secondary outcomes were catheter removal, hemodialysis transfer, relapsing/recurrent peritonitis and peritonitis-related death. These outcomes were analyzed using mixed effects logistic regression. RESULTS Overall, 11,122 episodes of peritonitis occurring in 5367 patients were included. A total of 1760 (16%) episodes were culture-negative, of which 77% were medically cured. Compared with culture-negative peritonitis, the odds of medical cure were lower in peritonitis caused by Staphylococcus aureus (adjusted odds ratio (OR) 0.62, 95% confidence interval (CI) 0.52-0.73), Pseudomonas species (OR 0.20, 95% CI 0.16-0.26), other gram-negative organisms (OR 0.48, 95% CI 0.41-0.56), polymicrobial organisms (OR 0.30, 95% CI 0.25-0.35), fungi (OR 0.02, 95% CI 0.01-0.03), and other organisms (OR 0.61, 95% CI 0.49-0.76), while the odds were similar in other (non-staphylococcal) gram-positive organisms (OR 1.11, 95% CI 0.97-1.28). Similar results were observed for catheter removal and hemodialysis transfer. Compared with culture-negative peritonitis, peritonitis-related mortality was significantly higher in culture-positive peritonitis except that due to other gram-positive organisms. There was no difference in the odds of relapsing/recurrent peritonitis between culture-negative and culture-positive peritonitis. CONCLUSION Culture-negative peritonitis had superior outcomes compared to culture-positive peritonitis except for non-staphylococcal gram-positive peritonitis.
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Affiliation(s)
- Htay Htay
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, Diamantina Institute, University of Queensland, Brisbane, Australia.,Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Yeoungjee Cho
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, Diamantina Institute, University of Queensland, Brisbane, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, Diamantina Institute, University of Queensland, Brisbane, Australia
| | - Carmel Hawley
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, Diamantina Institute, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Australia.,Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Australia.,School of Medicine, Faculty of Health Sciences, University of Adelaide, Australia
| | - Monique Borlace
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Australia
| | - Sunil V Badve
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Australia.,Department of Nephrology, St George Hospital, Sydney, Australia
| | - Kamal Sud
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Australia.,Department of Renal Medicine, Nepean and Westmead Hospitals, Sydney, Australia.,University of Sydney Medical School, Australia
| | - Neil Boudville
- Medical School, University of Western Australia, Australia
| | - Jenny Hc Chen
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Australia.,School of Medicine, University of New South Wales, Sydney, Australia.,Department of Nephrology, Wollongong Hospital, Australia
| | - Matthew Sypek
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Australia.,Department of Nephrology, Royal Melbourne Hospital, Victoria, Australia
| | - David W Johnson
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, Diamantina Institute, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
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Htay H, Cho Y, Johnson DW. Longer antibiotic durations for treating peritoneal dialysis-associated peritonitis: helpful or harmful? Clin Kidney J 2021; 14:735-738. [PMID: 33779659 PMCID: PMC7986446 DOI: 10.1093/ckj/sfaa277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Indexed: 11/21/2022] Open
Abstract
Relapsing, recurrent or repeat peritonitis is a devastating complication for peritoneal dialysis (PD) patients and is usually associated with poor outcomes including prolonged hospitalization, catheter removal, hemodialysis transfer and even death. Despite its critical importance and frequent occurrence, there is limited available evidence to facilitate evidence-informed treatment of PD peritonitis. This editorial comments on the findings and limitations of a randomized controlled study published in this journal, which reported that extending antibiotic treatment duration for an additional week beyond that recommended by the International Society for PD did not reduce the risk of relapsing, recurrent or repeat peritonitis, and may have increased the risk of repeat peritonitis. These results are explored in the context of the existing literature and recommendations for practice and research are provided.
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Affiliation(s)
- Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Yeoungjee Cho
- Centre for Kidney Disease Research, The University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
- Metro South and Integrated Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - David W Johnson
- Centre for Kidney Disease Research, The University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
- Metro South and Integrated Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, QLD, Australia
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Htay H, Choo JCJ, Johnson DW, Pascoe EM, Jayaballa M, Oei EL, Ng LC, Wu SY, Foo MWY. Chlorhexidine-impregnated sponge dressing for prevention of catheter exit-site infection in peritoneal dialysis patients: a pilot study. Int Urol Nephrol 2020; 53:803-812. [PMID: 33025409 DOI: 10.1007/s11255-020-02674-w] [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: 08/01/2020] [Accepted: 09/29/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The study aimed to examine effect of chlorhexidine dressing in the prevention of peritoneal dialysis (PD)-related infection in PD patients. METHODS This single-center pilot study recruited 50 incident PD patients to use weekly chlorhexidine dressing. The primary outcome was exit-site/tunnel infection rate. Secondary outcomes were peritonitis rate, time to first PD-related infection, infection-related hospitalization, technique and patient survival, adverse events, and chlorhexidine dressing acceptability. These clinical outcomes were compared with those of a historical cohort (2016-2017) using daily gentamicin cream. RESULTS A total of 50 patients were recruited to use chlorhexidine and followed up for one year. The exit-site/tunnel infection rate was 0.09 (95% confidence interval [CI] 0.02-0.22) and peritonitis rate was 0.07 (95% CI 0.01-0.19) episodes per patient-year with chlorhexidine dressing. The 1-year infection-free survival rates for exit-site/tunnel infection and peritonitis were 92% and 94%, respectively. The 1-year technique and patient survival rates were 86% and 96%, respectively. Overall, 12% of participants developed localized contact dermatitis with chlorhexidine. Most participants (73%) reported that chlorhexidine dressings were very acceptable. Compared to a historical cohort using gentamicin cream (n = 238), the chlorhexidine group had similar exit-site/tunnel infection rates (incidence rate ratio [IRR] 0.65, 95% CI 0.22-1.92) but had lower peritonitis rates (IRR 0.24, 95% CI 0.07-0.77), and lower PD infection-related hospitalization rates (IRR 0.21, 95% CI 0.06-0.69) after adjusting for age, sex, race, primary kidney disease, and diabetes mellitus. CONCLUSION Weekly chlorhexidine dressing was associated with acceptable PD-related infection outcomes and was well-accepted by patients, although had a 12% rate of delayed localized contact dermatitis. TRIAL REGISTRATION NUMBER AND DATE The study was registered under www.clinicaltrials.gov with the reference number of NCT03406520 on 23 January 2018.
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Affiliation(s)
- Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore.
| | - Jason Chon Jun Choo
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - David W Johnson
- Princess Alexandra Hospital, Brisbane, Australia.,Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Metro South and Ipswich Nephrology and Transplant Services (MINTS), Brisbane, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - Mathini Jayaballa
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Elizabeth Ley Oei
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Li Choo Ng
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Sin Yan Wu
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Marjorie Wai Yin Foo
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
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Htay H, Seng JJB, Yong MHA, Pang SC, Wu SY, Chan CM, Sim MH, Johnson DW, Foo MWY. Comparison of Clinical Presentation and Outcomes of Peritonitis in the Elderly and Younger Peritoneal Dialysis Patients. Perit Dial Int 2019; 39:163-168. [DOI: 10.3747/pdi.2018.00056] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 07/01/2018] [Indexed: 11/15/2022] Open
Abstract
Background The incidence of elderly patients receiving peritoneal dialysis (PD) has increased. This study aimed to examine the clinical presentation and outcomes of peritonitis in elderly PD patients compared with younger PD patients. Methods This single-center, retrospective, observational cohort study included all adult PD patients who developed peritonitis between January 2011 and December 2014. Elderly was defined as ≥ 65 years old at PD initiation. The primary outcome was medical cure, defined as a peritonitis episode cured by antibiotics without being complicated by catheter removal, transfer to hemodialysis (HD), relapsing peritonitis, or death. The secondary outcomes were clinical manifestations (fever, cloudy dialysate) and complications (catheter removal, transfer to HD, relapse, hospitalization, and mortality). Peritonitis outcomes were compared using multivariable logistic regression. Results Overall, 377 peritonitis episodes occurred in 247 patients. Of these, 126 episodes occurred in 79 elderly patients and 251 episodes occurred in 168 younger patients. Baseline demographic data were comparable between the 2 groups, except that elderly patients were significantly more likely to have diabetes mellitus (66% vs 46%), diabetic nephropathy (55% vs 39%), and a lower serum albumin than younger patients. Medical cure was comparable between the 2 groups (71% vs 72%, respectively, p = 0.67, adjusted odds ratio [AOR] 0.89, 95% confidence interval [CI]: 0.52 – 1.53). Compared with younger patients, elderly patients experiencing peritonitis had lower odds of fever (OR 0.53, 95% CI: 0.30 – 0.94), cloudy dialysate (OR 0.45, 95% CI: 0.23 – 0.88), and catheter removal (AOR 0.50, 95% CI: 0.26 – 0.98), but similar odds of transfer to HD (AOR 0.70, 95% CI: 0.32 – 1.51), relapse (AOR 1.57, 95% CI: 0.46 – 5.40), hospitalization (AOR 1.55, 95% CI: 0.52 – 4.56), and all-cause mortality (AOR 1.88, 95% CI: 0.83 – 4.26). Conclusions Compared with younger patients, elderly PD patients with peritonitis achieved similar medical cure rates, a lower catheter removal rate, and comparable rates of HD transfer, relapse, hospitalization, and death. Elderly PD patients experiencing peritonitis were less likely to present with fever or cloudy dialysate.
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Affiliation(s)
- Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | | | | | - Suh Chien Pang
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Sin Yan Wu
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Choong Meng Chan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Mui Hian Sim
- Department of Pharmacy, Singapore General Hospital, Singapore
| | - David W. Johnson
- Department of Nephrology, Princess Alexandra Hospital, Australia
- Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry
- Translational Research Institute, Brisbane, Australia
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A Case of Relapsing Peritoneal Dialysis-Associated Peritonitis by Dokdonella koreensis. Case Rep Infect Dis 2018; 2018:3820513. [PMID: 30073100 PMCID: PMC6057316 DOI: 10.1155/2018/3820513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/14/2018] [Indexed: 12/05/2022] Open
Abstract
Peritonitis is a common and serious complication of peritoneal dialysis (PD) with significant morbidity. We report the first case of relapsing Dokdonella koreensis peritonitis in a patient on peritoneal dialysis. A 63-year-old Chinese man, with history of renal failure on continuous ambulatory peritoneal dialysis, presented with cloudy peritoneal effluent and abdominal pain. There was no sign or symptom suggestive of exit-site/tunnel tract infection. Peritoneal effluent cultures yielded Dokdonella koreensis which was initially misidentified as Weeksella virosa and Brevundimonas species by the API® 20 NE and VITEK® 2 GN ID card, respectively. He was treated with intraperitoneal amikacin, but the infection relapsed within a few days upon completing each antibiotic course. He eventually required removal of catheter and was transferred to hemodialysis. Infections due to unusual organisms may pose a diagnostic issue as currently available commercial tests will not be able to identify them. There is a role for using 16S rRNA sequencing to help identify these organisms and guide patient management.
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