Is the Distribution of Microorganisms and Peritonitis Affected by Seasonality in Peritoneal Dialysis? (original) (raw)
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Seasonal variation in peritoneal dialysis-associated peritonitis: a multi-centre registry study
Nephrology Dialysis Transplantation, 2012
Background. The role of seasonal variation in peritoneal dialysis (PD)-related peritonitis has been limited to a few small single-centre studies. Methods. Using all 6610 Australian patients receiving PD between 1 October 2003 and 31 December 2008, we evaluated the influence of seasons on peritonitis rates (Poisson regression) and outcomes (multivariable logistic regression). Results. The overall rate of peritonitis was 0.59 episodes per patient-year of treatment. Using winter as the reference season, the peritonitis incidence rate ratios (95% confidence interval) for summer, autumn and spring were 1.02 http://ndt.oxfordjournals.org/ Downloaded from (0.95-1.09), 1.01 (0.94-1.08) and 0.99 (0.92-1.06), respectively. Significant seasonal variations were observed in the rates of peritonitis caused by coagulase-negative Staphylococci (spring and summer peaks), corynebacteria (winter peak) and Gram-negative organisms (summer and autumn peaks). There were trends to seasonal variations in fungal peritonitis (summer and autumn peaks) and pseudomonas peritonitis (summer peak). No significant seasonal variations were observed for other organisms. Peritonitis outcomes did not significantly vary according to season. Conclusions. Seasonal variation has no appreciable influence on overall PD peritonitis rates or clinical outcomes. Nevertheless, significant seasonal variations were observed in the rates of peritonitis due to specific microorganisms, which may allow institutions to more precisely target infection control strategies prior to higher risk seasons.
Pediatrics International, 2009
Background : The aim of the present study was to perform a multicenter investigation in Turkish children on chronic peritoneal dialysis by examining the rates of peritonitis as well as causative organisms according to year . Methods : Twelve pediatric renal units participated in this study and data were obtained by review of the medical records. Results : One hundred and thirty-two patients were on continuous ambulatory peritoneal dialysis (CAPD), 21 were on automated peritoneal dialysis (APD) and 59 were on CAPD and APD at different times. Mean durations of CAPD and APD were 24.2 ± 21.1 months and 22.9 ± 12.8 months, respectively. Seventy-one (33%) out of 212 patients had no peritonitis episode. Overall peritonitis rate was one episode per 15.5 patient-months. The peritonitis rate was one episode per 15.4 patient-months for APD and one episode per 15.6 patient-months for CAPD. Coagulase-negative staphylococcus was the most common cause of peritonitis among patients with positive culture (20.6%). While the incidence of Gram-negative infection remained unchanged according to year in patients on CAPD ( P ϭ 0.68), the rate of Gram-negative peritonitis in children on APD was signifi cantly higher ( P ϭ 0.03). Conclusions : Peritonitis rate was similar in CAPD and APD, but the risk of Gram-negative peritonitis in APD was higher than that of CAPD.
Peritonitis in an urban peritoneal dialysis program: An analysis of infecting pathogens
American Journal of Kidney Diseases, 1995
0 We have previously found that race, level of education, and peritoneal dialysis system are factors that significantly and independently influence peritonitis rates in our patient population. We now extend these observations by assessing the pathogens responsible for peritonitis in these subgroups. Between January l,lQ81, and May 15,lQQ3,248 peritoneal dialysis patients underwent dialysis at our facilii. The rate of peritonitis by pathogen was determined in these patients using the fixed effects Poisson model. Total peritonitis rates in black patients (1.89 episodes/patient-year) were significantly greater compared with white patiints (1.11 episodes/patient-yeac P < 0.0001). Increased infection rates in black patients were significant for Sfaphy/ococcus epidennidis, Staphylococcus aufeus, and gram-negative pathogens. The level of education had a negative correlation with peritonitis rates (58 years, 2.00 episodes/patient-year; 9 to 12 years, 1.84 episodes/patient-year, and 213 years, 1.24 episodes/patient-year) with patients having 213 years of education at the start of dialysis demonstrating a significantly lower total peritonitis rate compared with patients with 9 to 12 years (P = 0.001) or 58 years (P < 0.001) of education. This was accounted for by a significant decrease in infection rates for S epidemidis, polymicrobial, and gram-negative organisms. Finally, patients on automated peritoneal dialysis had significantly lower total peritonitis rates (0.59 episodes/patient-year) compared with patients on either a connect (2.11 episodes/patientyear) or disconnect (1.48 episodes/patient-year) system. A significant decrease in infection rates for evety category of pathogen except fungal infections was found in patients on automated peritoneal dialysis in comparison to the other two systems. Overall, significant differences in S epidemidis infection rates was the single most important factor accounting for the differences in peritonitis rates observed between the various subgroups of patients evalwted. This is best demonstrated in the evaluation of the peritoneal dialysis systems in which S epidemidis infection rates were only 0.20 episodes/patient-year for automated peritoneal dialysis and 0.88 episodes/patientyear for the disconnect system compared with 0.88 episodes/patient-year for the connect system. Since S epidermidis infections generally are atbibuted to touch contamination, identifying patients at greatest risk allows the potential for intervention with closer supervision, adjustments in the peritoneal dialysis training/education approach, or a change in the peritoneal dialysis system. 0 1995 by the National
Southern African Journal of Infectious Diseases
Results: One hundred and twenty-eight patients underwent CAPD. The peritonitis rate was 1.45 episodes per year at risk. The prevalence of CAPD patients affected by at least one episode of CAPD-associated peritonitis during 2016 was 56.3%. The majority of episodes (76.7%) (n = 122) were mono-microbial. Gram-positive organisms accounted for 73.0% (n = 116) of the peritonitis episodes, coagulase-negative Staphylococcus being the most common. Gram-negative organisms accounted for 15.7% (n = 25) of the peritonitis episodes, and the common pathogens was Enterobacteriaceae. Conclusion: The peritonitis rate was alarmingly high, with 1.45 episodes per year at risk; this is three times more than the recommended 0.5 episodes per year according to the ISPD guidelines. The culture-negative rate of 8.8% is within ISPD-acceptable limits. There is a need to strengthen preventive measures with regard to peritonitis.
Microbiology of Peritonitis in Peritoneal Dialysis Patients with Multiple Episodes
Peritoneal Dialysis International, 2012
Background Peritoneal dialysis (PD)–associated peritonitis clusters within patients. Patient factors contribute to peritonitis risk, but there is also entrapment of organisms within the biofilm that forms on PD catheters. It is hypothesized that this biofilm may prevent complete eradication of organisms, predisposing to multiple infections with the same organism. Methods Using data collected in the Canadian multi-center Baxter POET (Peritonitis, Organism, Exit sites, Tunnel infections) database from 1996 to 2005, we studied incident PD patients with 2 or more peritonitis episodes. We determined the proportion of patients with 2 or more episodes caused by the same organism. In addition, using a multivariate logistic regression model, we tested whether prior peritonitis with a given organism predicted the occurrence of a subsequent episode with the same organism. Results During their time on PD, 558 patients experienced 2 or more peritonitis episodes. Of those 558 patients, 181 (32%) ...
Microbiological profile of peritoneal dialysis peritonitis and predictors of hospitalization
Advances in peritoneal dialysis. Conference on Peritoneal Dialysis, 2011
Peritonitis, the major complication of peritoneal dialysis (PD), is associated with high morbidity and mortality. It is a major cause of hospitalization and transfer to hemodialysis. In the present study, we aimed to identify predictors of hospitalization in PD-related peritonitis and to examine its microbiology profile over time in our unit to determine the best therapeutic approach. We studied all peritonitis episodes that occurred in a 6-year period (January 1, 2004, to December 31, 2009), evaluating whether adequate treatment could be delivered on an outpatient basis. During the study period, 411 patients were on PD, and 229 peritonitis episodes were recorded in 91 patients. Peritonitis were treated according to unit protocol. The average hospital stay was 11.6 +/- 6.6 days. We observed an increase of Streptococcus (to 19.4% from 7.7%) and a stabilization of coagulase-negative Staphylococcus, S. epidermidis, and S. aureus (from 9.5%, 22.6%, and 3.2% to 7.7%, 30.8%, and 3.8% resp...
Journal of clinical nephrology and renal care, 2020
Peritoneal dialysis related peritonitis is a major risk factor for drop-out of patients on continuous ambulatory peritoneal dialysis. Data on factors affecting outcome of chronic peritoneal dialysis related peritonitis and microbiology is limited. In this regard, a retrospective, observational study was conducted at Post Graduate Institute of Medical Education and Research, Chandigarh, India, wherein we reviewed medical records of chronic peritoneal dialysis patients for 3 years between 01 July 2015 and 30 June 2018. We abstracted data pertaining to social, demographic and clinical characteristics of patients, occurrence of peritonitis including microbiological spectrum and outcomes. Conventional culture method involving manual inoculation was used in initial 1½ years, after which automated culture (BACTEC) was used. A total of 334 chronic peritoneal dialysis patients were screened retrospectively for infective peritonitis. Out of these, 74 patients had 97 episodes of peritonitis; 54 patients had single episode and 19 had two episodes (repeat-16 and relapsing-3) and none had preceding or ongoing exit site or tunnel infection. Occurrence of peritonitis was highest during monsoon (36%) and least during autumn (12%). Cumulative culture positivity was 39.2% with gram-positivity in 60.5% patients. Predominant microorganism was Staphylococcus epidermidis (23.7%) followed by Escherichia coli (13.2%). 51 patients (74 episodes) recovered with antibiotic therapy alone, while 23 patients required peritoneal catheter removal in view of refractory (n-20)/ fungal (n-3) peritonitis. 6.8% patients had peritonitis related mortality. Outcome with respect to recovery was comparable (76.3%) in culture positive and culture negative episodes.
Revista Argentina de microbiología
This study reports the infectious peritonitis rates in 44 patients on peritoneal dialysis in three different systems over the last 15 years, covering clinical outcomes, exit-site infections, tunnel infections, causative microorganisms, and the history of susceptibility of organisms causing peritonitis, in order to establish our center-specific selection of empiric therapy. Two microbiological procedures were herein used: method A, where 100 ml of dialysate were centrifuged and cultured in standard media and into blood-culture bottles; and method B, where 10 ml were directly injected into blood-culture bottles. Swabs from the exit-site or tunnel were taken when purulent drainage was observed. There were 96 episodes of peritonitis during 110.43 patient-years (0.87 episodes/patient-year). Sensitivity of method A was 96.88% (93/96 episodes) versus 81.25% (78/96) of method B (p=0.001). Gram stain sensitivity was 36.46%. The etiologic agents were 64 (56.64%) gram-positive cocci, 22 (19.47...
International Journal of Nephrology and Renovascular Disease, 2014
Background: Infectious peritonitis (IP) is the most common complication in peritoneal dialysis (PD). The purpose of this study is to assess the prevalence of IP and to determine its clinical, biological, and evolutive characteristics. Patients and methods: We conducted a five year, five months retrospective study from July 2006 to December 2011. All patients on peritoneal dialysis that have been followed on PD for a minimum of 3 months and who presented IP during follow-up were included. Data were analyzed using SPSS 17.0. Results: The 76 episodes of IP were identified in 36 patients. The peritonitis rate (months × patients/peritonitis), as calculated by the Registre de Dialyse Péritonéale de Langue Française (RDPLF Registry) [French peritoneal dialysis registry] in December 2011, was 18.59. Time to occurrence of peritonitis from the start of peritoneal exchange was 15.44±10 months. The mean age of our patients was 49.1±16.8 years [10-80]: the youngest patient's age was 10, while the oldest was 80 years old (male to female: sex ratio M/F=1,66). Also, 22% of our patients were diabetic. The mean follow-up in PD was 22.6±14 months. Abdominal pain was present in 79% of the cases. Fever and vomiting were noted in 42% and 38% of cases, respectively. The C-reactive protein rate was elevated in 77% of cases, and leukocytosis was found in 27% of cases. Bacteriological proof was present in 73.68% of cases. Gram-positive cocci were involved in 56.6% of microbiologically proven IP cases. Gram-negative bacilli were represented in 37.7%. The outcome was favorable in 89.4%. The PD catheter was removed in 2.63% of the cases. In addition, 7.89% of our patients were transferred to hemodialysis. Discussion: The rate of IP remains high in our series. More than one-half of the peritonitis cases with positive cultures (56.6%) were caused by Gram-positive cocci. Gram-negative bacilli ranked second (27.7%). These results agree with data in the literature. Moreover, the rate of culture-negative IP in our series is high (26%). Evolution is good in most cases (89%). Conclusion: Despite the gradual decrease of its rate, peritonitis remains frequent in our center and calls for optimization of means of prevention. The high frequency of negative culture IP in our study urges us toward better collaboration with biologists to target antibiotic therapy and improve IP management.
Microbiology and Outcomes of Peritonitis in Australian Peritoneal Dialysis Patients
Peritoneal Dialysis International, 2011
with the aim of describing the nature of peritonitis, therapies, and outcomes in patients on peritoneal dialysis (PD) in Australia. At least 1 episode of PD was observed in 6639 patients. The overall peritonitis rate was 0.60 episodes per patient-year (95% confidence interval: 0.59 to 0.62 episodes), with 6229 peritonitis episodes occurring in 3136 patients. Of those episodes, 13% were culture-negative, and 11% were polymicrobial. Gram-positive organisms were isolated in 53.4% of single-organism peritonitis episodes, and gramnegative organisms, in 23.6%. Mycobacterial and fungal peritonitis episodes were rare. Initial antibiotic therapy for most peritonitis episodes used 2 agents (most commonly vancomycin and an aminoglycoside); in 77.2% of episodes, therapy was subsequently changed to a single agent. Tenckhoff catheter removal was required in 20.4% of cases at a median of 6 days, and catheter removal was more common in fungal, mycobacterial, and anaerobic infections, with a median time to removal of 4 -5 days. Peritonitis was the cause of death in 2.6% of patients. Transfer to hemodialysis and hospitalization were frequent outcomes of peritonitis. There was no relationship between center size and peritonitis rate. The peritonitis rate in Australia between 2003 and 2008 was higher than that reported in many other countries, with a particularly higher rate of gram-negative peritonitis.