Peritoneal Dial Ysis-Rela Ted Peritonitis Treatment Recommendations: 1996 Update (original) (raw)
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Adult Peritoneal Dialysis-Related Peritonitis Treatment Recommendations: 2000 Update
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, 2000
Peritonitis is a common clinical problem that occurs in patients with end-stage renal disease treated by peritoneal dialysis (PD). Although the incidence of peritonitis varies from center to center, since the 1980s it has progressively declined, and during the past decade approximately 1 episode every 24 patient-treatment-months was routinely observed. In some centers, 1 episode every 60 patient-treatment-months has been achieved, in large part because of exceptional patient education, as well as new connector and catheter technologies. The more recent introduction of automated peritoneal dialysis (APD) has also contributed to the growth of PD, but this technique is also complicated by episodes of peritonitis. The development of disconnect systems has had an important effect on overall reduction of the incidence of peritonitis episodes, particularly those due to skin organisms. A variety of microorganisms may cause PD peritonitis. Gram-positive organisms, particularly Staphylococcus aureus and S. epidermidis, have been the most frequent pathogens. However, in patients utilizing the disconnect systems, with the reduction in the incidence of gram-positive staphylo coccus peritonitis, the relative incidence of gram-negative infection has increased. Many different antimicrobial agents have been used to treat PD peritonitis. As in the past, the current Committee reviewed experiences reported in the literature and formulated recommendations based upon these assessments. Over the years, a variety of different regimens have been proposed based upon these experiences. Antibiotics have been administered intraperitoneally (IP), or intravenously (IV), or orally, and a number of different dosing regimens have been utilized. Unfortunately, no single regimen has been shown in appropriate clinical trials to be most efficacious.
ISPD POSITION STATEMENT ON REDUCING THE RISKS OF PERITONEAL DIALYSIS–RELATED INFECTIONS
F or a peritoneal dialysis (PD) program to be successful, close attention must be paid to preventing PD-related infections (defined as exit-site infections, tunnel infections, and peritonitis). The variation in peritonitis rates in recently published studies (1-20) is astonishing: from a low of 0.06 episodes per year in a Taiwanese program to a high of 1.66 episodes per year at risk in an Israeli pediatric program ). Those rates mean that an individual patient, on average, may expect to have peritonitis as rarely as once every 17 years in one center, or as frequently as once every 7 months in another. Even at centers within a single country, there is often a marked variation in the peritonitis rate. For example, the Scottish registry has centers with rates that range from 0.43 episodes to 0.89 episodes per year (1), the London Thames centers vary from 0.14 episodes to 1.0 episodes per year (9), and the Austrian Study Group centers range from 0.07 episodes to 0.60 episodes per year (10). Explanations for such marked variations are lacking, but are likely related at least in part to differences in patient training and in infection-prevention protocols. Variations in the accuracy with which peritonitis episodes are recorded may also contribute in part to the differences in reported rates.
Single UK centre experience on the treatment of PD peritonitis--antibiotic levels and outcomes
Nephrology Dialysis Transplantation, 2007
Background. There are few studies of the pharmacokinetics of vancomycin and gentamicin in peritoneal dialysis (PD) patients and the influence of antibiotic concentrations on treatment outcome. Concerns about resistance to ceftazidime and potential of aminoglycoside toxicity make the choice of empiric antibiotic difficult. Methods. We retrospectively collected data from 613 patients on PD between 1 June 2002 and 31 December 2005. During this time, we adopted a protocol that minimized aminoglycoside exposure to patients with residual renal function and carefully monitored serum antibiotic concentrations.
Advances in peritoneal dialysis. Conference on Peritoneal Dialysis, 2004
The antibiotic treatment currently recommended by the International Society for Peritoneal Dialysis (ISPD) for peritonitis consists of a combination of a first- and a third-generation cephalosporin. The schedule formerly recommended combined a first-generation cephalosporin and an aminoglycoside. No comparison between the treatment schedules has been performed until now. We compared the effectiveness of these two regimens in peritoneal dialysis-related peritonitis at our center. From January 1999 to April 2000, we followed 107 patients in our PD clinic (period 1: 47% men; 32% with diabetes; mean age: 52 +/- 13 years). We followed a similar number of patients from January 2002 to July 2003 (period 2: 109 patients; 54% men; 51% with diabetes; mean age: 56 +/- 18 years). In each period, diagnosis and treatment of peritonitis were based on the recommendations of the ISPD as earlier described. Negative culture rates were similar in period 1 and period 2 (32% vs. 30%). In both study group...
Peritoneal dialysis-related infections recommendations: 2010 update. What is new?
International Urology and Nephrology, 2011
The International Society of Peritoneal Dialysis (ISPD) 2010 guidelines on PD-related infections reflect the bulk of knowledge acquired over the last 5 years. It includes new information about causative agents of peritonitis, isolation techniques, or therapeutic regimens. Monitoring of infection rates by reporting of peritonitis and exit site infections, isolated microorganism, and presumed etiology is recommended. Furthermore, special focus is given on careful evaluation of each episode of peritonitis in order to determine the route of infection and to reassess patient's training. In this article, we record the changes in the last ISPD (2010) guidelines compared to the previous ones published in March 2005.
American Journal of Kidney Diseases, 2004
Background: A large proportion (15% to 50%) of the end-stage renal disease population are on peritoneal dialysis (PD). The major limitation is peritonitis, which leads to technique failure, hospitalization, and increased mortality. Oral, nasal, and topical antibiotic prophylaxis; exit-site disinfectants; and other antimicrobial interventions are used to prevent it. This study was conducted to assess what evidence supports these approaches. Methods: The Cochrane CENTRAL Registry, MEDLINE, EMBASE, and reference lists were searched for randomized trials of antimicrobial agents in patients on PD. Two reviewers extracted data on the number of patients with 1 or more episodes and rates of peritonitis and exit-site and tunnel infection, catheter removal and/or replacement, technique failure, antibiotic toxicity, and all-cause mortality. Analysis was by means of a random-effects model, and results are expressed as relative risk (RR) and 95% confidence intervals (CI). Results: Nineteen eligible trials (1,949 patients) were identified. Nasal mupirocin compared with placebo significantly reduced the exit-site and tunnel infection rate (1 trial; 2,716 patient-months; RR, 0.58; 95% CI, 0.40 to 0.85), but not peritonitis rate (1 trial; 2,716 patient-months; RR, 0.84; 95% CI, 0.44 to 1.60). Perioperative intravenous antibiotic therapy compared with no treatment significantly reduced the risk for early peritonitis (4 trials; 335 patients; RR, 0.35; 95% CI, 0.15 to 0.80), but not exit-site and tunnel infection (3 trials; 114 patients; RR, 0.32; 95% CI, 0.02 to 4.81). Conclusion: Based on 1 study, nasal mupirocin reduces exit-site and tunnel infection, but not peritonitis. Based on 4 studies, preoperative intravenous prophylaxis reduces early peritonitis, but not exit-site and tunnel infection. No other antimicrobial intervention has proven efficacy. Given the large number of patients on PD therapy and the importance of peritonitis, the lack of adequately powered randomized trials to inform decision making about strategies to prevent peritonitis is striking. Am J Kidney Dis 44:591-603.
BMC Infectious Diseases, 2014
Background: The choice of antimicrobials for initial treatment of peritoneal dialysis (PD)-related peritonitis is crucial for a favorable outcome. There is no consensus about the best therapy; few prospective controlled studies have been published, and the only published systematic reviews did not report superiority of any class of antimicrobials. The objective of this review was to analyze the results of PD peritonitis treatment in adult patients by employing a new methodology, the proportional meta-analysis. Methods: A review of the literature was conducted. There was no language restriction. Studies were obtained from MEDLINE, EMBASE, and LILACS. The inclusion criteria were: (a) case series and RCTs with the number of reported patients in each study greater than five, (b) use of any antibiotic therapy for initial treatment (e.g., cefazolin plus gentamicin or vancomycin plus gentamicin), for Gram-positive (e.g., vancomycin or a first generation cephalosporin), or for Gram-negative rods (e.g., gentamicin, ceftazidime, and fluoroquinolone), (c) patients with PD-related peritonitis, and (d) studies specifying the rates of resolution. A proportional meta-analysis was performed on outcomes using a random-effects model, and the pooled resolution rates were calculated. Results: A total of 64 studies (32 for initial treatment and negative culture, 28 reporting treatment for Gram-positive rods and 24 reporting treatment for Gram-negative rods) and 21 RCTs met all inclusion criteria (14 for initial treatment and negative culture, 8 reporting treatment for Gram-positive rods and 8 reporting treatment for Gram-negative rods). The pooled resolution rate of ceftazidime plus glycopeptide as initial treatment (pooled proportion = 86% [95% CI 0.82-0.89]) was significantly higher than first generation cephalosporin plus aminoglycosides (pooled proportion = 66% [95% CI 0.57-0.75]) and significantly higher than glycopeptides plus aminoglycosides (pooled proportion = 75% [95% CI 0.69-0.80]. Other comparisons of regimens used for either initial treatment, treatment for Gram-positive rods or Gram-negative rods did not show statistically significant differences. Conclusion: We showed that the association of a glycopeptide plus ceftazidime is superior to other regimens for initial treatment of PD peritonitis. This result should be carefully analyzed and does not exclude the necessity of monitoring the local microbiologic profile in each dialysis center to choice the initial therapeutic protocol.