Outbreak of sterile peritonitis among continuous cycling peritoneal dialysis patients (original) (raw)
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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.
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.
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
Controversies in the Management of Infective Complications of Peritoneal Dialysis
Nephron Clinical Practice, 2011
associated peritonitis (PDP) is the key factor in successful management of PD. PDP is the most common reason for patients to transfer to haemodialysis and causes significant morbidity with mortality in the region of 3.5-10% [1]. Even in those who do not immediately suffer technique failure, it can cause loss of residual renal function and dialysis adequacy, peritoneal membrane failure, decreases ultrafiltration and increases the risk of encapsulating peritoneal sclerosis [2]. Which Is the Best Diagnostic Technique? PDP is defined by the International Society of Peritoneal Dialysis (ISPD) as 2 out of 3 of the following: (1) signs and symptoms; (2) white cell count (WCC) 1 100/ml of PD effluent (PDE) and 1 50% neutrophils after a dwell of at least 2 h, and (3) a positive culture of an organism from the PDE [3]. The correct culture of PDE is important to ensure appropriate antibiotics are used. ISPD guidelines recommend sampling 50 ml of PDE with aseptic technique. In automated PD (APD) the larger volumes and shorter dwell times mean the PDE may not appear cloudy and the WCC may be ! 100/ml. In this instance, a 1-to 2-hour or longer dwell is recommended before sampling. The PDE is centrifuged and the sediment resuspended in sterile Key Words Continuous ambulatory peritoneal dialysis ؒ Peritoneal dialysis ؒ Peritoneal effluent ؒ Peritonitis ؒ Exit-site infection ؒ Tunnel infection ؒ Antibiotic prophylaxis
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.
PERITONEAL DIALYSIS-RELATED INFECTIONS RECOMMENDATIONS: 2005 UPDATE
2005
Adequate performance measurement should be based on evidence-based guidelines. The recently published update of the International Society for Peritoneal Dialysis recommendations for peritoneal dialysisrelated infections provides an opportunity to define a limited set of quality indicators as suitable for performance measurement and useful as targets for the improvement of dialysis care. Suitable quality indicators seem the incidence of peritonitis (target less than one episode every 18 months) and the percentage of culture-negative episodes (<20%). The lack of uniformity in definitions and the lack of studies providing evidence for firm recommendations are major limitations for further improvements in prevention, diagnosis and outcome of peritoneal dialysisrelated infectious complications.
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.
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%) ...
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.
Peritoneal dialysis infections: An opportunity for improvement
2014
Peritoneal dialysis (PD) cathetereassociated infections remain a challenging cause of technique failure. Patient training and preventive measures are key elements in the management of infection rates. Twenty-seven of the 167 PD catheter transfer sets analyzed (19%) yielded a positive microbial culture (58% gram-negative bacteria). These results show that subclinical contamination, particularly from environmental gram-negative bacteria, is a potential hazard, indicating the need for a protocol for regular transfer set changes.