Incidence Of Peritonitis Research Articles

First Report of Tsukamurella conjunctivitidis CAPD-related Peritonitis

First Report of Tsukamurella conjunctivitidis CAPD-related Peritonitis

Seasonality of peritoneal dialysis-related peritonitis in Japan: a single-center, 10-year study.

Peritonitis is one of the major complications of peritoneal dialysis (PD). Although several reports have indicated seasonality of peritonitis, the observation periods were short, and there were no reports from Japan. Therefore, the purpose of this study was to investigate the long-term seasonality of peritonitis in a single institution in Japan. Of 126 patients who started PD in our hospital between January 1, 2009, and December 31, 2018, 25 patients (15 men, 10 patients with diabetes) developed peritonitis with a total of 42 episodes. The median age at onset was 63years, and the median duration from the start of PD to the onset of peritonitis was 22months. The 10-year incidence of peritonitis was 0.12 episodes per patient-year. Compared with the reference season of winter (December-February), the incidence rate ratios (95% confidence interval) for spring (March-May), summer (June-August), and autumn (September-November) were 1.75 (0.65-4.75), 1.56 (0.57-4.31), and 2.42 (0.94-6.23), respectively. In addition, no seasonality of Gram-positive and Gram-negative organisms was observed. No seasonality was evident in the incidence of PD-related peritonitis in our hospital over a 10-year period. These findings suggest that the development of peritonitis in Japanese PD patients is not affected by seasonality.

Optimizing Peritoneal Dialysis-Associated Peritonitis Prevention in the United States: From Standardized Peritoneal Dialysis-Associated Peritonitis Reporting and Beyond.

Peritoneal dialysis (PD)-associated peritonitis is the leading cause of permanent transition to hemodialysis among patients receiving PD. Peritonitis is associated with higher mortality risk and added treatment costs and limits more widespread PD utilization. Optimizing the prevention of peritonitis in the United States will first require standardization of peritonitis definitions, key data elements, and outcomes in an effort to facilitate nationwide reporting. Standardized reporting can also help describe the variability in peritonitis rates and outcomes across facilities in the United States in an effort to identify potential peritonitis prevention strategies and engage with stakeholders to develop strategies for their implementation. Here, we will highlight considerations and challenges in developing standardized definitions and implementation of national reporting of peritonitis rates by PD facilities. We will describe existing peritonitis prevention evidence gaps, highlight successful infection-reporting initiatives among patients receiving in-center hemodialysis or PD, and provide an overview of nationwide quality improvement initiatives, both in the United States and elsewhere, that have translated into a reduction in peritonitis incidence. We will discuss opportunities for collaboration and expansion of the Nephrologists Transforming Dialysis Safety (NTDS) initiative to develop knowledge translation pathways that will lead to dissemination of best practices in an effort to reduce peritonitis incidence.

The impact of the superficial cuff position on the exit site and tunnel infections in CAPD patients.

Peritoneal dialysis (PD) related infections continue to be a major cause of morbidity and mortality in patients on PD. In the last ten years, in order to reduce cuff and exit-site infections, in continuous ambulatory peritoneal dialysis (CAPD) patients, we have positioned the superficial cuff subcutaneously 4cm instead of 2cm internal to the exit-site. We analysed the infective episodes occurred in 123 CAPD patients (88 men and 35 women, mean age 62.4 ± 16.8) treated for 3337months between 1st January 2011 and 31th December 2018 at Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico. 31 of the 123 patients (25.2%) developed 52 episodes of exit site infection, with an incidence of 1 episode every 64.1 patient-months. The cumulative probability of remaining infection free was 80.7% at 12months and 61.8% at 36months. Gram-positive organism accounted for 78.7% of exit site infections. Forty-one episodes (87%) were successfully treated with medical therapy. Peritonitis incidence was 1 episode every 51.7 and 1 episode every 49.2 patient-months, in patients with or without a history of exit site infection respectively. The overall incidence of tunnel infection was 1 episode every 278.1 patient-months. Positioning the superficial cuff subcutaneously at least 4cm internal to the exit-site might prevent the bacterial cuff colonization and reduce ESIs, tunnel infections and peritonitis.

P1179PREDICTIVE FACTORS OF PERITONITIS IN PERITONEAL DIALYSIS PATIENTS AFTER TENCKHOFF CATHETER IMPLANTATION : A META-ANALYSIS

Abstract Background and Aims Chronic kidney disease is one of the leading cause of years living with disability. Peritoneal dialysis has been an effective treatment for end-stage renal disease (ESRD). Unfortunately, there are infectious and non-infectious complication after tenckhoff catheter implantation in patients. Peritonitis has been the most common major clinical problem and is often the cause for failure of peritoneal dialysis. Many researchers have studied the predictive factors of peritonitis in peritoneal dialysis patients after tenckhoff catheter implantation, but their conclusion were not always consistent. Therefore we performed a meta-analysis to make a more integrated and precise estimation. Method Multiple databases were searched for comparative studies without language or date restrictions. Gray literature was sought. The meta-analysis study was conducted using Revman 5.3, with p <0.05 considered significant. Aspects investigated included age at implantation, diabetes mellitus, and gender. Two reviewers independently assessed study eligibility and the quality of included studies. Results A total of 7 studies were identified and analyzed, and 3 were multi-institutional. Reporting standards were highly variable. Overall, 7730 patients with ESRD were incorporated in this study. Meta-analysis demonstrated there was significant difference in the incidence of peritonitis with age at implantation, (OR= 1.98 [1.81, 2.17], p=0.00001). Significant difference was not seen in the incidence of peritonitis with diabetes mellitus, (OR= 1.03 [0.23, 4.55], p=0.97). Meta-analysis showed that there was no association between gender with incidence of peritonitis (OR= 1.57 [0.62, 3.97], p=0.35), while male had a higher peritonitis incidence (See figure). No publication bias was noted in this study Conclusion Peritonitis is still a major problem in patients with peritoneal dialysis. Age at implantation is the predictive factors that affect peritonitis incidence in peritoneal dialysis patients after tenckhoff catheter implantation, while gender and diabetes mellitus do not appear to be correlated with peritonitis incidence.

SO008STREPTOCOCCI NOW DOMINATE THE CLINICAL SPECTRUM OF PERITONEAL DIALYSIS (PD)-RELATED PERITONEAL INFECTIONS. AN ANALYSIS OF TRENDS DURING 30 YEARS

Abstract Background and Aims Peritoneal infections remain as a significant source of morbidity and mortality in PD patients. A steady decline of their incidence has been accompanied by changes in the etiologic spectrum of these infections, during the last decades. We have undertaken a review of trends in the compared incidence of PD-related peritonitis in our centre during a 30-year period, with a particular interest in streptococcal infections. Method Following an observational, retrospective design, we analyzed trends in the incidence and outcomes of peritoneal infections diagnosed in our centre between January 1990 and October 2019. We mainly focused on the incidence, risk factors and outcomes of streptococcal peritonitis. We excluded fungal peritonitis (very low incidence), surgical enteric infections and non-infectious peritonitis. Treatment failure was defined by transfer to hemodialysis for at least 3 months after the infection or death related to peritonitis. We applied Cox’s model to define clinical predictors of streptococcal infection, and stepwise logistic regression to investigate predictors of treatment failure. Results We recorded 1026 episodes of peritoneal infection in 878 patients, including 234 (22.8%) streptococcal infections, 57 (5.6%) infections by Staphylococcus aureus (SAu), 285 (27.8%) infections by coagulase-negative staphylococci (CNSt), 182 (17.7%) infections by gram-negative bacteria, 135 (13.2%) infections with 2 or more microorganisms and 133 (13.0%) culture-negative cases. Remarkably, streptococci were also main components in polimicrobial infections (present in 58.2% of cases). The incidence of peritonitis decreased during the observation period, from 0.91 (1990-94) to 0.47 episodes (2015-19) per patient and year This decline affected preferentially infections by SAu (0.068 to 0.006) and CNSt (0.361 to 0.067), while the incidence of infections by other etiologic agents remained essentially stable. As a consequence, the relative clinical spectrum moved to a predominance of streptococcal (10.7 to 23.3%), polimicrobial (8.0 to 15.7%) and culture-negative infections (4.7 to 16.2%). On multivariate analysis, patients suffering streptococcal infections were older (p=0.019), and presented lower albumin levels (p=0.004), than either patients suffering infections of other etiologies or presenting a peritonitis-free clinical course. After logistic regression analysis, older age, longer time on dialysis at the time of the infection, comorbidity, previous immunosuppression and plasma albumin were most consistent predictors of peritonitis-related mortality and treatment failure. Streptococcal peritonitis showed more benign outcomes than SAu (p<0,001) or gramnegative infections (p=0.032), with rates of treatment failure comparable to those observed for CNSt, non-enteric polimicrobial or culture-negative infections. Conclusion Streptococcal and polimicrobial (often including streptococci) infections have become dominant in the clinical spectrum of PD-related peritonitis, after the decline in the incidence of staphylococcal infections. The clinical aggressiveness of these infections appears intermediate between that observed in Staphylococcus aureus and CNSt infections.

P1141CT IMAGING FEATURES AND INFLUENCE FACTORS IN PEROTONEAL DIALYSIS RELATED PERITONEAL INJURY

Abstract Background and Aims Peritoneal dialysis (PD) is one of the most important renal replacement methods for end-stage renal disease. CT scan found some patients have peritoneal thickening, omental structure change. However, the underlying regularity of change still unknown. This study aim to investigate the regularity of change and influencing factors of CT peritoneal imaging features in PD patients. Method A 173 total routinely follow-up patients on CAPD are evaluated by the abdominal CT scans. A total of 109 patients were enrolled for analysis according to the inclusion criteria. The 109 patients who meet the criteria were evaluated by the semi-quantitative scoring system, including the thickness of the parietal peritoneum, the calcification of parietal peritoneum and omentum, abdominal compartment and encapsulated effusion, bowel dilatation and intestinal obstruction, and the correlation between CT imaging evaluation index and age, dialysis age, primary disease, type of peritoneal transport, glucose exposure, and the incidence of peritonitis were analyzed. Logistic regress was used to analyze the influence factors of peritoneal thickening and abnormal omental structure and the risk incidence of peritoneal thickening and abnormal omental structure. Results 70 patients with parietal peritoneum thickness, 63 patients with abnormal omental structure, 4 patients with the calcification of parietal peritoneum and omentum, 11 patients with abdominal compartment and encapsulated effusion, 24 patients with bowel dilatation and intestinal obstruction. The peritoneal thickening and abnormal omental structure in patients with dialysis age > 5 years was significantly higher than that of age < 1 year. The peritoneal thickening and abnormal omental structure in patients with peritonitis more than once was significantly higher than that in patients without peritonitis. The abnormal omental structure in patients with total glucose exposure > 165kg was significantly higher than that with total glucose exposure <60 kg. The abnormal omental structure in patients with high-average peritoneal transport was significantly higher than that with low-average peritoneal transport. The risk factors of abnormal omental structure including dialysis age, the peritonitis occurrences, the cumulative score of peritonitis, the total glucose exposure, and the high-average peritoneal transport. The independent risk factors are the occurrence and the cumulative score of peritonitis. The incidence risk of peritoneal thickening and abnormal omental structure will increase 4.364 and 5.393 times separately with the occurrence of peritonitis, and increase 2.191 and 2.072 times separately with the cumulative score of peritonitis increased by 1 point. Conclusion The main imaging features of peritoneal dialysis patients with progressive peritoneal injury are thickness of the parietal peritoneum and the structure change of omentum. The major risk factor of progressive peritoneal injury is peritonitis. The abdominal CT scan can comprehensively investigate the characteristics and extent of peritoneal dialysis and injury, which is benefit for the early diagnosis of peritoneal injury.

Randomised clinical trial: palliative long-term abdominal drains vs large-volume paracentesis in refractory ascites due to cirrhosis.

Palliative care remains suboptimal in end-stage liver disease. To inform a definitive study, we assessed palliative long-term abdominal drains in end-stage liver disease to determine recruitment, attrition, safety/potential effectiveness, questionnaires/interview uptake/completion and make a preliminary cost comparison. A 12-week feasibility nonblinded randomised controlled trial comparing large-volume paracentesis vs long-term abdominal drains in refractory ascites due to end-stage liver disease with fortnightly home visits for clinical/questionnaire-based assessments. Study success criteria were attrition not >50%, <10% long-term abdominal drain removal due to complications, the long-term abdominal drain group to spend <50% ascites-related study time in hospital vs large-volume paracentesis group and 80% questionnaire/interview uptake/completion. Of 59 eligible patients, 36 (61%) were randomised, 17 to long-term abdominal drain and 19 to large-volume paracentesis. Following randomisation, median number (IQR) of hospital ascitic drains (long-term abdominal drain group vs large-volume paracentesis group) were 0 (0-1) vs 4 (3-7); week 12 serum albumin (g/L) and serum creatinine (μmol/L) were 29 (26.5-32.5) vs 30 (25-35) and 104.5 (81-115.5) vs 127 (63-158) respectively. Total attrition was 42% (long-term abdominal drain group 47%, large-volume paracentesis group 37%). Median (IQR) fortnightly community/hospital/social care ascites-related costs and percentage study time in hospital were lower in the long-term abdominal drain group, £329 (253-580) vs £843 (603-1060) and 0% (0-0.74) vs 2.75% (2.35-3.84) respectively. Self-limiting cellulitis/leakage occurred in 41% (7/17) in the long-term abdominal drain group vs 11% (2/19) in the large-volume paracentesis group; peritonitis incidence was 6% (1/17) vs 11% (2/19) respectively. Questionnaires/interview uptake/completion were ≥80%; interviews indicated that long-term abdominal drains could transform the care pathway. The REDUCe study demonstrates feasibility with preliminary evidence of long-term abdominal drain acceptability/effectiveness/safety and reduction in health resource utilisation. ISRCTN30697116, date assigned: 07/10/2015.

P1224ROLE OF DIAGNOSTIC IMAGING DURING PERITONITIS IN PERITONEAL DIALYSIS PATIENTS

Abstract Background and Aims Peritonitis in peritoneal dialysis (PD) patients can be directly related to PD or secondary to intrabdominal infection (secondary peritonitis). The indication and role of imaging of abdomen during peritonitis in PD patients is unclear. Method This was a single center, retrospective study, including all the first episode of peritonitis in incident PD patients from the period of January 2013 to October 2017. Primary aim of the study was to identify the incidence of secondary peritonitis diagnosed by imaging of abdomen (defined as positive scan finding of intraabdominal lesions) in PD patients with peritonitis. Secondary outcomes were predictors for secondary peritonitis analyzed by multivariable logistic regression. Results There were total 527 incident PD patients during the study period. Of these, 153 patients (29%) developed at least one episode of peritonitis. The mean age of patients with peritonitis was 57.7 ± 3.4 years, 49 % were male, and 52% had diabetes mellitus. Out of 153, 78 patients (51%) underwent diagnostic imaging of abdomen to look for secondary peritonitis. Majority of them had contrast enhanced computed tomography (CT) scan (95%) and the remaining had non-contrast CT scan or ultrasound of abdomen. Of 78 patients who underwent scan, 12 patients (16%) were reported to have intra-abdominal lesions (secondary peritonitis) including colitis (n=2), pancreatitis (n=1), cholecystitis (n=4), appendicitis (n=1), intestinal obstruction (n=2), liver abscess (n=1), gastric cancer (n=1). According to the causative micro-organisms, the positive scan finding of intra-abdominal lesions was more commonly observed in Gram-negative peritonitis (n=7, 58%), followed by fungal/mycobacterial peritonitis (n=2, 17%), Gram-positive peritonitis (n=2, 17%), polymicrobial peritonitis (n=1, 8%), but none (0%) in culture negative peritonitis. Among patients with Gram-negative peritonitis who underwent the imaging of abdomen, only 12% (7/58) were reported to have intra-abdominal lesions. In multivariable logistic regression, the presenting symptoms including fever (odds ratio (OR) 1.51, 95% confidence interval (CI) 0.40 – 5.68), abdominal pain (OR 1.08, 95% CI 0.24 -1.78), presence of cloudy of effluent (OR 0.66, 95% CI 0.19 -2.29), hypotension on presentation (OR 3.61, 95% CI 0.75 -17.46) or effluent white cell counts on presentation (OR 0.99, 95% CI 0.93 -1.05) were not significantly associated with secondary peritonitis. Conclusion A considerable number of patients underwent imaging of abdomen during peritonitis regardless of causative organisms, only a few of them had intra-abdominal lesions. Future prospective study is needed to guide the role of imaging in PD patients during peritonitis.

P1444CHANGES IN TREATMENTS AND OUTCOMES OF PATIENTS INITIATING PERITONEAL DIALYSIS DURING THE LAST 10 YEARS: DATA FROM SWEDISH RENAL REGISTRY

Abstract Background and Aims The recent years have witnessed several therapeutic improvements regarding both peritoneal dialysis (PD) treatment itself and the prevention and management of complications. We evaluated trends in implementation of therapeutic improvements and their relationship with survival and other relevant clinical outcomes in PD patients from Sweden. Method Using the Swedish Renal Registry (SRR), clinical data from all patients initiating PD in Sweden between 2006 and 2015 were linked to other national healthcare registries to obtain information on vital status, hospitalization and diagnoses during in and out-patient care, along with information on all dispensed drugs, from inclusion to the end of 2017. We first evaluated trends in the use of PD-related treatments and of selected key medications within 2-year blocks. We then evaluated the incidence of death, major cardiovascular events (MACE), technique failure, transplantation and peritonitis episodes within one and two years from PD initiation using standardized incidence rates via logistic regression to account for differences in patient characteristics over time. In subsequent Cox regression models, we studied whether adjustment for implementation of these therapeutic changes modified observed trends in clinical outcomes. Finally, patient survival was compared against the age-sex matched general Swedish population using standardized incidence ratios (SIR). Results 3,312 patients (mean age 63±15 years; 34% women) initiated PD in Sweden during the study period. Across 2-year time blocks, there was no difference over time in the distribution of age, sex or comorbidities with the exception of an increased proportion of patients with chronic pulmonary disease. The proportion of patients undergoing automated peritoneal dialysis and using icodextrin increased over time, while mean standard Kt/V and weekly creatinine clearance did not change. The use of non-calcium phosphate binders, cinacalcet and calcium-channel blockers increased, and the use of angiotensin-converting enzyme inhibitors /angiotensin receptor blockers, erythropoietin, iron, and calcium supplements showed decreasing trends. After standardization for differences in demography and comorbidities, the one-year incidence of peritonitis decreased by 13% and the rate of kidney transplantation increased by 52% in 2014/15 compared to 2006/07. The rates of death, MACE or technique failure did not show differences over time. Similar results were observed with 2-years of follow up and when applying Cox models; Per 2-year period, the risk of peritonitis within one year decreased by 8% (HR 0.92, 95% CI 0.87-0.98) regardless of age, sex, comorbidity and the abovementioned therapeutic changes. The risk of death for PD patients was in 2006/2007 4 times higher [SIR 4.08 (3.15–5.29)] and in 2014/15 3.7 times higher [SIR 3.65 (2.70–4.94)] than the general population, corresponding to a reduction of SIR by 11%. Conclusion During the last 10 years, there has been a gradual implementation of new and established evidence-based treatments in patients starting PD in Sweden. Although survival rates are improving compared to the general population, there were no clear differences in the rates of technique failure, MACE or death across PD patients over time. We observed, however, consistent improvements in peritonitis frequency and access to transplantation.

P1197ASSISTED APD IN ITALY: TRENTO EXPERIENCE

Abstract Background and Aims End-stage renal disease (ESRD) is common in elderly and fragile patients with several comorbidities. Dialysis (Hemodialysis-HD or Peritoneal Dialysis-PD) is often required. The choice between HD or PD is sometimes not easy. PD prevalence is significantly lower than HD prevalence in old and fragile patients because they are less likely to complete PD assessment, and due to stress over performing self-therapy. In the last years, in order to overcome these problems, assisted PD programs have spread out in several countries. Method Since 2008 in Trento Province (area of 541.399 people in the North East of Italy) we developed a program for elderly non-self sufficient patients requiring dialysis in nursing home. Admission criteria in nursing home were: age&amp;gt;65 years, living in the province, PD therapy, non-self patient, no acute complications, no home caregivers. This patient had a priority access to nursing home. We selected HomeChoice Baxter APD as PD technique. Our nurses gave specific training of 6 hours to nursing home nurses. The patients were on APD during the night. Every 45 days patients had a clinical visit by nephrologists and hospital PD nurses, with a particular emphasis on clinical data and dialysis performances. Results From 1.1.2008 to 12.31.2018 we enrolled 36 patients (16 male and 20 female) in a population of 226 PD incident patient, age (M±DS) at PD start was 78 ± 7.3 years (range 65-91); break-in was 27 ± 20.4 days and time in PD was 374 ± 347 days (range 15-1257). The cumulative incidence of peritonitis was 1/75-patient/month. During these eleven-year period we trained 19 nursing home nurses. Conclusion Assisted APD in nursing home could be an appropriate therapy choice for non-self sufficient elderly patients requiring renal replacement therapy. These option is safe for patients and could increase PD incidence.

The colonoscopic leakage model: a new model to study the intestinal wound healing at molecular level

We describe a novel, fast-track, innovative intestinal wound healing model developed in mice called the ‘colonoscopic leakage model’. This model uses a colonoscopic biopsy grasper to make a controlled transmural...

Improvement of multiple intraperitoneal nodules resembling peritoneal cancer that developed after peritoneal dialysis-related peritonitis caused by Mycobacterium abscessus with literature review: granuloma or carcinoma

IntroductionPeritonitis is a crucial complication that leads to hospitalization or even death in patients who are undergoing peritoneal dialysis (PD). The incidence of PD-related peritonitis associated with nontuberculous mycobacteria has increased in recent years. However, a well-established treatment for peritonitis is lacking, particularly in peritonitis caused by Mycobacterium abscessus which is a difficult to treat disease due to its inherent resistance to majority of available antibiotics. To the best of our knowledge, this case is the first to report on intraperitoneal multiple nodules that developed due to PD-related peritonitis caused by M. abscessus.Case presentationThis case reported a case of a 40-year-old female patient who was undergoing PD and who showed multiple intraperitoneal nodules that resembled peritoneal cancer on computed tomography (CT) and that developed after PD-related peritonitis and catheter removal. After multiantibiotic therapy, multiple nodules were found to have disappeared on CT. The nodules continued to disappear and the patient did not show signs of recurrent peritonitis, although there was a possibility of recurrence.ConclusionTo the best of our knowledge, this case is the first to report on nodules that resembled peritoneal cancer and that developed in the abdominal cavity due to PD-related peritonitis caused by M. abscessus. Positron emission tomography–CT was not useful in distinguishing peritoneal cancer from nodules caused by M. abscessus.

Long-term clinical outcomes of peritoneal dialysis patients: 9-year experience of a single centre in Turkey

Background/aim The aim of this study was to evaluate the clinical outcomes and identify the predictors of mortality in peritoneal dialysis patients.Materials and methods Medical records of all incident peritoneal dialysis (PD) patients followed up between January 2011 and May 2019 were reviewed retrospectively. All patients were followed up until death, renal transplantation, transfer to haemodialysis or the end of the study. Results A total of 242 patients were included in the study. The incidence of peritonitis was 0.18 (ranging from 0 to 14.9) episodes per patient year. Death occurred in 28% (n: 68) of cases. Age, diabetes mellitus, malignancy and refractory heart failure were independent risk factors for all-cause mortality according to multivariate analysis. The presence of comorbid disease and diabetes mellitus and patients aged > 65 years were associated with increased risk of mortality and decreased patient survival. Peritonitis history was associated with increased risk of mortality. Between peritonitis and peritonitis-free group, there was no significant difference in Kaplan-Meier curves in terms of patient survival. Conclusion This is the first study to define 9-year mortality predictors in PD patients in our centre. Although peritonitis is the most feared complication of PD, our study showed that peritonitis did not reduce patient survival.

Acute peritonitis: A clinical study

In this study we have tried to find out the incidence of acute peritonitis in relation to age group and sex of the patient and evaluate the relative incidence of various causes of acute peritonitis including trauma. We have also found out the relative incidence of complications and its relation to the primary cause and analyzed the various causes of mortality and morbidity and the factors influencing it. Methods: 50 cases of acute peritonitis due to traumatic and non-traumatic causes admitted in tertiary care center was included in this study. After detailed medical history and clinical examination the patients were taken up for treatment as per the proforma for acute peritonitis. Results: In this series maximum number of cases was seen between the age group of 15-50 years with male patients accounting for 80% of cases. Mean age of patients was 36 years. Pain abdomen (100%), vomiting (56%) and fever (50%) were most common presenting symptoms in all cases of peritonitis. Tenderness and rigidity were present in all the cases. In this series duodenal perforation was the most common cause of acute peritonitis followed by appendicular perforation (16%), ileal (8%), intestinal gangrene (8%), jejunal perforation (6%), gastric perforation (4%) and colonic perforation (2%). All the patients were taken for surgery. Wound infection was must commonest complication (10%) seen in the post-operative period. This was followed by fecal fistula (6%) and pelvic abscess (4%). In general complications septicemia (12%) was the most common. Mortality rate was (12%) in this study with septicemia and multi organ failure being the commonest cause of mortality. Mean age of patients who expired was 51 years. Mortality was clearly more in patients who presented more than 24 hours duration after the onset of symptoms. Conclusion: Duodenal perforation was the most common cause of acute peritonitis, having male predominance. Laparotomy was the treatment of choice.

Transabdominal ultrasound as a screening stage for the diagnosis of tuberculous peritonitis

In recent years, the incidence of tuberculous peritonitis increased. Peritoneal tuberculosis is difficult to diagnose, and often the diagnosis is verified with significant delay. In clinical practice, a quick and affordable diagnostic radiology method, ultrasonography (USG), is proposed for patients with suspected tuberculous peritonitis. The study was aimed to describe the sonographic semiology of tuberculous peritonitis, to create the integrated scale for the individual peritoneal tuberculosis sonographic symptoms significance assessment, and to determine the role of ultrasound imaging in the diagnosis verification. Retrospective study of the invasive and ultrasound investigation results of 37 patients with confirmed tuberculous peritonitis was carried out in 2009–2019. Similar data obtained by investigation of 28 patients with the disorders which often mimic the tuberculous peritonitis (peritoneal carcinomatosis and sarcoidosis, non-specific ascites) were used as a comparison group. Direct and indirect signs of peritoneal lesion in patients with tuberculosis were identified. On the basis of that, an integral scale for the individual sonographic symptoms significance assessment was created. Each sonographic symptom received a 0–3 score. Assessment of those sonographic signs visualization allowed us to evaluate the probability of the disorder’s tuberculous etiology. The following data were obtained: score under 4 corresponded to low probability, score 5–8 corresponded to medium probability, and score over 9 corresponded to high probability of tuberculous peritonitis based on the visualization of all described songraphic symptoms. The proposed integrated scale for the sonographic signs assessment allows the clinician to verify the tuberculous peritonitis diagnosis based on the ultrasound imaging data or to select the further tactics of diagnosis.

Topical application of mupirocin to exit sites in patients on peritoneal dialysis: a systematic review and meta-analysis of randomized controlled trials

BackgroundThe International Society for Peritoneal Dialysis guidelines recommends the topical application of antibiotics on the exit site for the prevention of peritoneal dialysis (PD)-related infections. However, the recommendation is based on meta-analyses on applying nasal mupirocin ointment or observational or retrospective studies. Here, we evaluated the efficacy of topical application of mupirocin on the exit site for the prevention of PD-related infections.MethodsWe searched the databases, MEDLINE and CENTRAL, documenting the topical application of antibiotics on the exit site in PD patients in April 2017. We included only randomized controlled trials (RCTs) with adult patients wherein the effects of mupirocin were examined. Exit site infection (ESI), peritonitis, and technical failure were assessed as the main outcomes.ResultsOverall, six RCTs were included in this study. It was uncertain whether the application of mupirocin ointment prevents ESI (rate ratio (RR), 0.36; 95% CI, 0.13–1.05), peritonitis (RR 0.78, 95% CI 0.50–1.21), and technical failure (RR, 1.35; 95% CI, 0.25–7.21). Moreover, a comparison between mupirocin and gentamicin showed no difference in the incidence of ESI (RR, 1.14; 95% CI, 0.27–4.81), peritonitis (RR, 0.85; 95% CI, 0.32–2.26), and technical failure (RR, 0.58; 95% CI, 0.28–1.20).ConclusionsIt remains unclear whether topical application of mupirocin on the exit site has any significant effects on PD-related infection or technical failure. Large-scale RCTs with high methodological quality are required to confirm the efficacy of topical application of antibiotics on the exit site.Trial registrationUMINR000039267

A153 INCIDENCE OF DEEP VEIN THROMBOSIS (DVT) &amp; PROPHYLAXIS PRACTICES IN DECOMPENSATED CIRRHOSIS INPATIENTS

Abstract Background The coagulation cascade is disturbed in cirrhosis. Patients are at risk for bleeding and coagulation through an imbalance of pro and anticoagulant factors. Aims We evaluated the incidence of DVTs and prevalence of DVT prophylaxis in hospitalized patients with decompensated cirrhosis. Methods A retrospective study of decompensated cirrhotic patients admitted to a tertiary care hospital. We evaluated the incidence of DVTs and use of DVT prophylaxis in this cohort. We also evaluated differences in patient characteristics in those who received DVT prophylaxis and between patients who did or did not develop DVTs. Results This study consisted of 520 cirrhotic patients, of which 258 patients (49.6%) received DVT prophylaxis. Of the remaining 262 patients who did not receive DVT prophylaxis, 199 (75.9%) had a documented contraindication to prophylaxis (bleeding, thrombocytopenia, both, or other). Compared to patients without DVT prophylaxis, patients who received prophylaxis were older (61.2 ± 11.2 vs 56.6 ± 10.9, p= 0.00001), had less varices (16.2% vs. 46%, p=0.0048), had more severe liver disease (MELD-Na 21 ± 6.5 vs 19.7 ± 7.3, p = 0.032), and fewer incidents of variceal (3.4% vs. 35.1%, p &amp;lt;0.001) and non-variceal (5.4% vs. 17.1%, p &amp;lt;0.001) gastrointestinal bleeding. DVT prophylaxed patients also had higher mean platelet values (149 ± 89 vs 112 ± 84, p &amp;lt;0.001), but similar baseline INRs (1.6 ± 0.4 vs 1.7 ± 0.8, p= 0.16), and were more likely to be admitted for non-bleeding complications of liver disease, including incidence of hepatic encephalopathy (37.9% vs 25.1%, p = 0.002) and spontaneous bacterial peritonitis (12.1% vs 6.5%, p=0.029). The incidence of radiographically identified DVT events in cirrhotic patients receiving DVT prophylaxis and those not receiving DVT prophylaxis was similar at 1.1 and 0.7%, respectively (OR 1.52, 95% CI 0.254 to 9.1, p = 0.65). There was no difference in liver disease severity between those with DVTs to those who did not develop DVTs, including similar MELD-Na, INR, platelets and hemoglobin values. Compared to patients without DVTs, those who developed DVTs had a higher bilirubin (95.8 ± 78.0 vs. 64.1 ± 24, p = 0.202) and INR (2.1 ± 0.7 vs. 1.6 ± 0.6, p = 0.07), as well as lower platelets (81.8 ± 23.3 vs. 131.4 ± 88.9). These groups had comparatively similar MELD-Na, albumin, creatinine, and hemoglobin levels. Conclusions DVT prevalence in this cohort of decompensated liver disease patients was overall low. DVT prophylaxis rates were moderate overall, however taking into account perceived contraindications such as thrombocytopenia or bleeding, patients appeared to be appropriately prophylaxed when indicated. Further study is required to identify which cirrhotic patients are at highest risk for DVTs and the safety of prophylaxis among patients with deranged lab values such as low platelets and elevated INR. Funding Agencies None

Application of multidisciplinary network management oriented by nurse specialists in peritoneal dialysis patients

Objective To explore the effects of multidisciplinary network management oriented by nurse specialists on nutritional status and peritonitis in peritoneal dialysis (PD) patients. Methods From February to August 2018, a total of 78 PD patients with regular visit in Department of Nephrology of Henan Province People's Hospital were selected as subjects by convenience sampling. All of patients were divided into control group and observation group with the method of random number table, 36 cases in each group. Control group carried out the routine PD management model, while observation group implemented the multidisciplinary network management oriented by PD nurse specialists for 6 months. We compared the nutritional indicators [Modified Subjective Global Assessment (SGA) , hemoglobin, albumin and phosphate]and incidence of peritonitis of patients between two groups. Results After intervention, the score of modified SGA and phosphate of observation group were lower than those of control group; the hemoglobin and albumin of observation group were higher than those of control group with statistical differences (P<0.05) . In observation group, the score of modified SGA and phosphate after intervention were lower than those before intervention; the hemoglobin and albumin after intervention were higher than those before intervention with statistical differences (P<0.05) . The incidence of peritonitis of observation group was 0.02 (4/216) times a patient·month within 6 months during observation period lower than that [0.06 (12/216) times a patient·month]of control group with a statistical difference (χ2=4.154, P<0.05) . Conclusions Multidisciplinary network management model oriented by PD nurse specialists can effectively improve PD patients' nutritional status, incidence of peritonitis which provides a new thinking for clinical management for PD patients. Key words: Peritoneal dialysis; Multidisciplinary collaboration; Network management; Specialist nurse; Malnutrition; Peritonitis

Incidence, Microbiological Spectrum and Outcomes of Infective Peritonitis in Chronic Peritoneal Dialysis Patients

Incidence, Microbiological Spectrum and Outcomes of Infective Peritonitis in Chronic Peritoneal Dialysis Patients