Peritoneal Dialysis-related Infections Research Articles

The impact of shortening patient–doctor contact duration on early peritoneal dialysis-related infections

Early peritoneal dialysis (PD)-related infection is a severe complication. This study investigated the relationship between patient–doctor contact (PDC) duration and early PD-related infection. In the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) Korea, incident dialysis patients receiving PD were divided into two groups based on PDC duration (< 15 min versus ≥ 15 min), which was defined as the duration a nephrologist typically spends with a patient receiving PD during each visit according to the facility practice pattern. Early risks of PD-related infections, such as peritonitis and catheter-related infection (onset within 3 and 12 months of PD), were compared to the PDC duration using Cox regression. The study included 276 patients (184 [66.7%] in the shorter PDC group [< 15 min] and 92 [33.3%] in the longer PDC group [≥ 15 min]). The average age did not differ between the groups. The incidences of 3- and 12-month PD-related infections were significantly lower in the longer PDC group than in the shorter PDC group (3 months: 1.1% versus 9.8%, P = 0.007; 12 months: 9.8% versus 23.4%, P = 0.007). Longer PDC was independently associated with a lower risk of PD-related infections at 3 and 12 months (3 months: adjusted hazard ratio [aHR], 0.11; 95% confidence interval [CI], 0.02–0.85, P = 0.034; 12 months: aHR, 0.43; 95% CI 0.19–0.99, P = 0.048). Overall, a longer PDC duration was associated with a significantly lower risk of early PD-related infection.

Peritoneal dialysis-related infections in elderly patients.

This review outlines the epidemiology, characteristics, risk factors, and prognosis of peritoneal dialysis (PD)-related peritonitis, PD catheter-related infections, and the effects of assisted PD in elderly patients from the Japanese perspective. Based on the literature, the incidence of peritonitis is likely to be higher in elderly patients than in younger patients. The most frequent causative bacteria in elderly patients are Gram-positive bacteria, as in adult PD patients, most commonly due to transcatheter infection. However, elderly patients may have difficulty recognizing cloudy drainage fluid due to decreased visual acuity. Hypokalemia, the use of gastric acid suppressants, prophylactic antibiotic use before endoscopy, biocompatible fluids and hypoalbuminemia considered modifiable risk factors for peritonitis. However, the mechanism by which treatment of hypokalemia prevents peritonitis is unknown. Currently, the relationship between gastric acid suppression therapy and peritonitis in elderly patients is debatable, with no evidence to strongly recommend uniform discontinuation of gastric acid suppression therapy. Exit-site infection (ESI) is a major risk factor for the development of peritonitis, and appropriate prevention and management of ESI may reduce infection-related hospitalizations in PD patients. Currently, no randomized, controlled trials have verified the effectiveness of antibiotic application for ESI in Japan, but results from other countries are awaited. In assisted PD, it is extremely important that family members, caregivers, and nurses who support the procedure receive sufficient education and training from medical professionals familiar with PD. Early detection and treatment of PD-related infections are required because the risk of death increases in elderly patients.

#784 Peritoneal dialysis-related infections by Kocuria kristinae: cases from a Mexican hospital

Abstract Background and Aims Kocuria species, gram-positive actinobacteria, are typically found in the environment, on human skin and as oral flora. These microorganisms are considered saprophytes and non-pathogenic. They rarely cause infections. Patients generally have some compromise due to underlying conditions, including solid tumors, hematologic malignancies, or metabolic disorders. There are few cases in the literature of peritoneal dialysis-associated peritonitis due to these germs. Reports of exit site infections or tunnel infections are even rarer or doesn't exist. Method Retrospective description of 4 cases of exit site and/or tunnel infections due to Kocuria kristinae over a 3-year period in a single center. Results Four cases of exit site infection were evaluated, with an average age of 63.2 ± 8.8 years. Half of the patients were diabetic. No patient had a history of peritoneal dialysis-related infection. The dialysis modality for all patients was CAPD (Continuous Ambulatory Peritoneal Dialysis). All patients presented symptoms of exit site infection, such as erythema and purulent discharge, but none of them had peritonitis. Three cases were treated with quinolones, and one received linezolid. One case received two antibiotic treatment regimens without an adequate response, and tunnel infection developed, required the removal of the dialysis catheter and a change in modality to HD (hemodialysis). Conclusion Exit site infections due to Kocuria are extremely rare. Despite the absence of specific management guidelines, the response to treatment is usually adequate. Due to the theoretical ability to produce biofilm, Kocuria infections should be considered a potential risk for recurrence and refractory disease. To our knowledge, there are no reports of exit site infections due to Kocuria.

#2650 A novel approach for exit site care reduces peritoneal dialysis catheter related infections

Abstract Background and Aims Peritoneal dialysis (PD) related infections, including peritonitis and catheter related infections, are associated with significant morbidity and technique failure. Various exit site care protocols are available, most allow to shower in running water after the exit site is well healed. Following an increase in exit site infections (ESI) in our dialysis unit, partially resulting from water derived organisms, we implemented a novel exit site care protocol. The protocol included complete avoidance of water exposure using stoma bag during shower; and change in antibiotic treatment from gentamycin to mupirocin. We aimed to evaluate its efficacy to decrease ESI episodes. Method A prospective single center trial. Study group included PD patients between June 2018 - May 2021 who implemented the new exit-site care protocol. They were compared to a historical control group that included all PD patients between January 2016 to May 2018. In the control group, exit-site care included a daily shower with a bactericidal cleanser containing chlorhexidine 4%, thereafter local gentamycin 0.1% was applied with sterile gauze dressing. In the study group, water exposure during daily wash was avoided using a stoma bag sealed around the catheter exit-site and the tubing. Thereafter, the exit-site was cleaned with a chlorhexidine 0.5%- alcohol 70% solution and local mupirocin 2% was applied with a sterile gauze cover. Primary outcome was catheter related infections, including ESI and tunnel infection. Secondary outcomes were peritonitis and technique loss. Results A total of 113 patients were included, 58 patients in control and 55 in study group. Mean follow up time was 13.28 ± 9.5 months in control and 16.4 12.7 months in study group. ESI rate was significantly lower in study group (0.11/patient year) compared to control group (0.71/ patient year), p&amp;lt;0.001. Time to first ESI was significantly longer in study group, χ² (1) = 25.104, p &amp;lt; 0.001 (Fig. 1). On multivariate logistic regression analysis confirmed the protective effect of the intervention on ESI risk (p &amp;lt;0.001). Longer PD vintage and active cancer predicted ESI (p = 0.01 and 0.02, respectively). There were no tunnel infections during study period compared to 3 episodes during control. Peritonitis rate was significantly lower in study group (0.19/patient years) compared to control group (0.40/patient years), p=0.011. There was no difference in time to first peritonitis episode between groups χ² (1)=2.32, p=0.128. Nine patients were lost to PD due to PD related infection in control group, compared to 5 in study group. Peritonitis related mortality occurred in one patient in control group. Conclusion Protection of exit site from water exposure in conjunction with local Mupirocin cream reduced significantly ESI and peritonitis episodes in peritoneal dialysis patients. This protocol may be more beneficial in areas of poor water quality.

Preporuke za dijagnostički i terapijski pristup infekcija povezanih sa peritonealnom dijalizom

Introduction: Patients with end-stage renal disease who start active treatment with peritoneal dialysis have an increased risk of developing infections. Methods: This paper will present information from relevant professional/scientific sources regarding modern diagnostic and therapeutic modalities for the treatment of infections in patients on peritoneal dialysis. Topic: Infections associated with peritoneal dialysis are: peritoneal catheter exit site infections, tunnel infections and peritonitis. The symptoms of the mentioned infections vary from mild ones such as erythema and secretion at the exit point of the peritoneal catheter to pronounced symptomatology in the development of peritonitis accompanied by abdominal pain and elevated body temperature. The most common cause of peritonitis is infection of the exit site of the catheter, and the two main causes of infection are Staphylococcus aureus and Pseudomonas aeruginosa. If the existence of an infection is suspected, it is necessary to sample the dialysate for cytological examination and culture and to take a swab of the exit site of the catheter. Treatment begins with empiric antibiotic therapy, then it is corrected according to the antibiogram, and the exit site is treated locally with an antibiotic. If there is no therapeutic response after five days of intraperitoneal therapy in peritonitis, it is recommended to remove the catheter. Conclusion: According to the current guidelines of the International Society for Peritoneal Dialysis (ISPD), timely prevention of infections, diagnosis and treatment of peritoneal dialysis-related infections are necessary to prolong patient survival.

Peritoneal Dialysis-Related Infections.

Peritoneal dialysis (PD) represents an important treatment choice for patients with kidney failure. It allows them to dialyze outside the hospital setting, facilitating enhanced opportunities to participate in life-related activities, flexibility in schedules, time and cost savings from reduced travel to dialysis centers, and improved quality of life. Despite its numerous advantages, PD utilization has been static or diminishing in parts of the world. PD-related infection, such as peritonitis, exit-site infection, or tunnel infection, is a major concern for patients, caregivers, and health professionals-which may result in hesitation to consider this as treatment or to cease therapy when these complications take place. In this review, the definition, epidemiology, risk factors, prevention, and treatment of PD-related infection on the basis of the contemporary evidence will be described.

WCN23-0700 Peritoneal Dialysis-related Infections and Key performance indicators in Patients on Long-Term Peritoneal Dialysis

WCN23-0700 Peritoneal Dialysis-related Infections and Key performance indicators in Patients on Long-Term Peritoneal Dialysis

POS-091 A STUDY OF EPIDEMIOLOGY AND MICROBIOLOGY OF PERITONITIS IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS

Peritonitis is a common and serious complication of peritoneal dialysis (PD). Although less than 5% of peritonitis episodes result in death, peritonitis is the direct or major contributing cause of death in around 16% of PD patients. The longevity of Peritoneal Dialysis is markedly reduced by the risk of PD related infections. In CAPD, by the end of 6 months of treatment the probability of developing at least one episode of Peritonitis is 30%; 50% by the end of 1 year; 70% by 2 years and 80% by 3 years of uninterrupted therapy.

High body mass index is a risk factor for transition to hemodialysis or hybrid therapy and peritoneal dialysis-related infection in Japanese patients undergoing peritoneal dialysis.

Obesity may negatively impact the clinical outcomes of patients undergoing peritoneal dialysis (PD). However, the impact of obesity on PD-related outcomes remains unclear. We herein examined the association of high body mass index (BMI) with complete hemodialysis (HD) transfer, transition to HD and PD/HD hybrid therapy, peritonitis, catheter exit-site and tunnel infection (ESI/TI), and heart failure-related hospitalization. This retrospective cohort study included 120 patients who underwent PD-catheter insertion between January 2008 and June 2018. BMI ≥ 25kg/m2 at the time of PD-catheter insertion was defined as high BMI, and its association with outcomes was analyzed using the log-rank test and Cox proportional hazards models. The follow-up duration was 46.2 (23.3-75.3) months. The time until transfer to HD and hybrid therapy was significantly shorter in the high BMI group than that in the low BMI group, whereas the time until HD transfer was not significantly different between the two groups (P < 0.001 and 0.18, respectively). Peritonitis-free and ESI/TI-free survivals were significantly shorter in the high BMI group than those in the low BMI group (P = 0.006 and 0.03, respectively). After adjusting for age, sex, diabetes mellitus, and estimated glomerular filtration rate, high BMI remained a significant risk factor for transferring to HD and hybrid therapy, peritonitis, and ESI/TI (hazard ratio [HR] 2.60, P < 0.001; HR 2.08, P = 0.01; HR 2.64, P = 0.02, respectively). BMI ≥ 25kg/m2 is a risk factor for transition to HD and hybrid therapy, peritonitis, and ESI/TI, but not for complete HD transfer in Japanese patients with PD.

Predictors and outcomes of peritoneal dialysis-related infections due to filamentous molds (MycoPDICS).

We sought to evaluate the predictors and outcomes of mold peritonitis in patients with peritoneal dialysis (PD). This cohort study included PD patients from the MycoPDICS database who had fungal peritonitis between July 2015-June 2020. Patient outcomes were analyzed by Kaplan Meier curves and the Log-rank test. Multivariable Cox proportional hazards model regression was used to estimating associations between fungal types and patients' outcomes. The study included 304 fungal peritonitis episodes (yeasts n = 129, hyaline molds n = 122, non-hyaline molds n = 44, and mixed fungi n = 9) in 303 patients. Fungal infections were common during the wet season (p <0.001). Mold peritonitis was significantly more frequent in patients with higher hemoglobin levels, presentations with catheter problems, and positive galactomannan (a fungal cell wall component) tests. Patient survival rates were lowest for non-hyaline mold peritonitis. A higher hazard of death was significantly associated with leaving the catheter in-situ (adjusted hazard ratio [HR] = 6.15, 95%confidence interval [CI]: 2.86-13.23) or delaying catheter removal after the diagnosis of fungal peritonitis (HR = 1.56, 95%CI: 1.00-2.44), as well as not receiving antifungal treatment (HR = 2.23, 95%CI: 1.25-4.01) or receiving it for less than 2 weeks (HR = 2.13, 95%CI: 1.33-3.43). Each additional day of antifungal therapy beyond the minimum 14-day duration was associated with a 2% lower risk of death (HR = 0.98, 95%CI: 0.95-0.999). Non-hyaline-mold peritonitis had worse survival. Longer duration and higher daily dosage of antifungal treatment were associated with better survival. Deviations from the 2016 ISPD Peritonitis Guideline recommendations concerning treatment duration and catheter removal timing were independently associated with higher mortality.

Are USPD patients suitable for incremental peritoneal dialysis: Yes or no?

Incremental peritoneal dialysis (IPD) is the practice of initiating PD exchange less than 4 times a day in consideration of residual renal function (RRF). This study determined whether IPD could be used for urgent-start peritoneal dialysis (USPD) patients when starting dialysis, and when compared to full-dose PD, could IPD affect the RRF in USPD patients. 169 USPD patients with eGFR between 4 and 6 mL/min/1.73m2 were retrospectively analyzed. The duration of follow-up was 1 year. Patients were divided into an incremental PD (i-PD) group (dialysis dose ≤ 6,000 mL) and a full-dose PD (f-PD) group (dialysis dose ≥ 8,000 mL). The demographics, clinical indices, peritoneal transport function, dialysis adequacy, and complications of peritoneal dialysis were compared between both groups. (1) 111 patients (average age 45.01 ± 12.84 years) were included in the i-PD group and 58 patients (average age 43.5 ± 15.62 years) in the f-PD group. The demographics and clinical indices of both groups before PD were similar (p < 0.05). (2) During the follow-up period, the dialysis dose in the f-PD group exceeded that of the i-PD group (p < 0.05). The dialysis adequacy of both groups was as expected. (3) During the follow-up period, peritoneal transport function, the RRF, the blood pressure control, correction of anemia, and correction of calcium and phosphorus abnormalities were similar in both groups. (4) The peritoneal dialysis-related infection, mechanical complications, and technical survival rate were similar between groups. Incremental PD did not cause a rapid decline of RRF in USPD patients. The dialysis effect and complications from it, were similar to full-dose peritoneal dialysis. Thus, USPD patients can be treated by IPD.

POS-699 The relationship between staphylococcus aureus nasal carriage and peritoneal dialysis-related Infection

Peritoneal dialysis-related infections are main complications of peritoneal dialysis, and Staphylococcus aureus is common pathogen, which is related to higher hospitalization rate, failure rate of peritoneal dialysis and mortality. This study is to explore the nasal carriage of Staphylococcus aureus in the peritoneal dialysis population of our center and its relationship with the occurrence of peritonitis.

Comparative Effectiveness of Local Application of Chlorhexidine Gluconate, Mupirocin Ointment, and Normal Saline for the Prevention of Peritoneal Dialysis-related Infections (COSMO-PD Trial): a multicenter randomized, double-blind, controlled protocol

BackgroundCurrent international guidelines recommend the use of a daily topical exit-site antimicrobial to prevent peritoneal dialysis (PD)-related infections. Although nonantibiotic-based therapies are appealing because they may limit antimicrobial resistance, no controlled trials have been conducted to compare topical antimicrobial agents with usual exit-site care for the prevention of PD-related infections among the Thai PD population. We propose a controlled three-arm trial to examine the efficacy and safety of a daily chlorhexidine gluconate-impregnated patch versus mupirocin ointment versus usual exit-site care with normal saline for the prevention of PD-related infections.Methods/DesignsThis study is a randomized, double-blind, multicenter, active-controlled, clinical trial. Adult patients aged 18 years or older who have end-stage kidney disease and are undergoing PD will be enrolled at three PD Centers in Thailand. A total of 354 PD patients will be randomly assigned to either the 2% chlorhexidine gluconate-impregnated patch, mupirocin ointment, or usual exit-site care with normal saline dressing according to a computer-generated random allocation sequence. Participants will be followed until discontinuation of PD or completion of 24 months. The primary study outcomes are time to first PD-related infection (exit-site/tunnel infection or peritonitis) event and the overall difference in PD-related infection rates between study arms. Secondary study outcomes will include (i) the rate of infection-related catheter removal and PD technique failure, (ii) rate of nasal and exit-site Staphylococcus aureus colonization, (iii) healthcare costs, and (iv) skin reactions and adverse events. We plan to conduct a cost-utility analysis alongside the trial from the perspectives of patients and society. A Markov simulation model will be used to estimate the total cost and health outcome in terms of quality-adjusted life years (QALYs) over a 20-year time horizon. An incremental cost-effectiveness ratio in Thai Baht and U.S. dollars per QALYs gained will be illustrated. A series of probabilistic sensitivity analyses will be conducted to assess the robustness of the cost-utility analysis findings.DiscussionThe results from this study will provide new clinical and cost-effectiveness evidence to support the best strategy for the prevention of PD-related infections among the Thai PD population.Trial registrationClinicalTrials.gov, NCT02547103. Registered on September 11, 2015.

SUN-076 DRESSING VS NON-DRESSING OF EXIT SITE IN PERITONEAL DIALYSIS PATIENTS: A 5-YEARS EXPERIENCE

Exit site care in peritoneal dialysis (PD) patients is an important practice to prevent PD related infections. Our centre initiated a non-dressing technique of exit site as an alternative to the standard practice of exit site dressing. The study aim to assess the difference between dressing vs non-dressing of exit site in PD related infections over a 5-year period.

Peritoneal dialysis related infections in a tertiary care hospital in Riyadh, Saudi Arabia.

Objectives:To detect the incidence of and risk factors for infections among patients with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD).Methods:A retrospective cohort study was conducted at the PD unit of King Fahad Medical City. End-stage renal disease patients above the age of 12 years who were undergoing PD management between January 2006 and March 2016 were included.Results:One hundred PD patients were enrolled in the study and examined over a total observation period of 2,553 patient-months. The leading ESRD etiology was hypertension (26.3%). The mean duration of PD was 28.05 months. A total of 45 patients developed 101 episodes of technique-related infections (TRIs). Peritonitis represented the majority of these episodes (90 episodes), with an overall rate of one episode per 28.3 patient-months. TRIs were mostly caused by coagulase-negative staphylococci. A total of 12 patients developed non-technique related infections (NTRIs). There was a statistically significant difference between patients with TRI and non-infected patients regarding the presence of diabetes and duration of dialysis. No peritonitis-related deaths were noted. In total, 21 patients continued on PD and 18 patients were shifted to hemodialysis (HD).Conclusion:In our setting, ESRD patients undergoing PD are more susceptible to TRIs than NTRIs. Diabetes increases the risk of developing TRIs. The high incidence of coagulase-negative staphylococcal TRI suggests touch contamination.

Microbiology of peritoneal dialysis-related infection and factors of refractory peritoneal dialysis related peritonitis: A ten-year single-center study in Taiwan.

Peritoneal dialysis (PD)-related infection is a serious complication of patients with PD. Refractory peritonitis may lead to failure of PD, shift to hemodialysis (HD) or death. Besides, microbiologic resistance increased worldwide that might impact the treatment choice for such infections. Investigating the causative pathogens and risk factors of PD-related infections in Taiwan was warranted. This is a retrospective study involving patients with PD from 2007 to 2016 in a southern Taiwan hospital. Patient characteristics, microbiological data, outcomes, and factors associated with refractory peritonitis were analyzed. There were 190 episodes of PD-related peritonitis in 110 patients from this cohort. Gram-positive organisms were the leading cause of PD-related peritonitis, but gram-negative organisms, esp. Pseudomonas aeruginosa, were predominant for exit site infection and tunnel infection. The incidence of peritonitis was 0.25 episode per patient-year (1 episode per 47.69 months). The refractory rate was 14.2% (27/190). Methicillin resistance was noted in 2 (13.3%) of 15 Staphylococcus aureus isolates. Of 114 isolates, 72.8% (83) were susceptible to either cefazolin or gentamicin. Staphylococcus spp. and Escherichia coli infections were significantly associated with refractory peritonitis. Baseline hyponatremia (<130mmol/L) was independently associated with refractory peritonitis. Gram-positive organisms remained major cause of PD-related peritonitis. About three quarters of causative pathogens were susceptible to the recommended empirical treatment for PD-related peritonitis. Baseline hyponatremia (<130mmol/L) was independently associated with refractory peritonitis. Staphylococcus spp. and E. coli infections had important roles for refractory peritonitis.

Frequent patient retraining at home reduces the risks of peritoneal dialysis-related infections: A randomised study

The present study, entitled Trial on Education And Clinical outcomes for Home PD patients (TEACH), investigated the effect of frequent retraining at home on the outcomes of peritoneal dialysis (PD). TEACH is a multicentre, open-label, randomised, controlled trial with parallel arms. Patients starting PD were randomized into either the conventional retraining group (CG) or the frequent retraining group (FG). Patients in the FG were given more frequent home visits for retraining. The primary endpoint was exit site infection (ESI). Secondary endpoints were peritonitis, any PD-related infections, hospitalization, technique failure, and patient survival. A generalised estimating equations (GEE) approach was employed for the adjusted effect of training level on the outcomes. Cox regression was employed for peritonitis and other secondary outcomes. The subjects were randomised to either the FG (n = 51) or the CG (n = 53). Although the time of initial training did not differ between the 2 groups, the total time of training was longer and the frequency of training visits was higher in the FG. In the GEE model, the p-values for interactions between groups and time were significant for both ESI and any PD-related infections, suggesting that the event rates of the two groups significantly changed over time. The event rates for the FG decreased over time, and the event rates for the CG increased after month 12. In the older subgroup (age ≥ 60), frequent retraining had a significant effect in the risk reduction of the first episode of peritonitis (adjusted HR 0.01 [0.001–0.35], p = 0.01). Frequent retraining at home reduced the risk of PD-related infections.

Oral Colonization of Staphylococcus Species in a Peritoneal Dialysis Population: A Possible Reservoir for PD-Related Infections?

Peritoneal dialysis-related infections are important morbidity/mortality causes, being staphylococci the most prevalent agents. Since Staphylococcus aureus nasopharynx carriage is a known risk factor for PD infections and the oral cavity is a starting point for systemic diseases development, we aimed at comparing the oral staphylococci colonization between PD patients and controls and studying the association with PD-related infections. Saliva samples were plated in Mannitol salt, and isolates were identified by DnaJ gene sequencing. Staphylococci PD-related infections were recorded throughout the 4-year period following sample collection. Staphylococcus colonization was present in >90% of the samples from both groups (a total of nine species identified). PD patients presented less diversity and less prevalence of multispecies Staphylococcus colonization. Although all patients presenting Staphylococcus epidermidis PD-related infections were also colonized in the oral cavity by the same agent, only 1 out of 7 patients with ESI caused by S. aureus presented S. aureus oral colonization. Staphylococci are highly prevalent in the oral cavity of both groups, although PD patients presented less species diversity. The association between oral Staphylococcus carriage and PD-related infections was present for S. epidermidis but was almost inexistent for S. aureus, so, further studies are still necessary to evaluate the infectious potential of oral Staphylococcus carriage in PD.

Regional variation in the treatment and prevention of peritoneal dialysis-related infections in the Peritoneal Dialysis Outcomes and Practice Patterns Study.

Peritoneal dialysis (PD)-related infections lead to significant morbidity. The International Society for Peritoneal Dialysis (ISPD) guidelines for the prevention and treatment of PD-related infections are based on variable evidence. We describe practice patterns across facilities participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). PDOPPS, a prospective cohort study, enrolled nationally representative samples of PD patients in Australia/New Zealand (ANZ), Canada, Thailand, Japan, the UK and the USA. Data on PD-related infection prevention and treatment practices across facilities were obtained from a survey of medical directors'. A total of 170 centers, caring for >11 000 patients, were included. The proportion of facilities reporting antibiotic administration at the time of PD catheter insertion was lowest in the USA (63%) and highest in Canada and the UK (100%). Exit-site antimicrobial prophylaxis was variably used across countries, with Japan (4%) and Thailand (28%) having the lowest proportions. Exit-site mupirocin was the predominant exit-site prophylactic strategy in ANZ (56%), Canada (50%) and the UK (47%), while exit-site aminoglycosides were more common in the USA (72%). Empiric Gram-positive peritonitis treatment with vancomycin was most common in the UK (88%) and USA (83%) compared with 10-45% elsewhere. Empiric Gram-negative peritonitis treatment with aminoglycoside therapy was highest in ANZ (72%) and the UK (77%) compared with 10-45% elsewhere. Variation in PD-related infection prevention and treatment strategies exist across countries with limited uptake of ISPD guideline recommendations. Further work will aim to understand the impact these differences have on the wide variation in infection risk between facilities and other clinically relevant PD outcomes.

Peritoneal dialysis-related infections in pediatric patients: diagnosis and treatment review

Peritoneal dialysis-related infections are the main complication in pediatric patients undergoing this renal replacement therapy, associating a high rate of morbidity, generating also a decreasing survival of the peritoneal membrane and worsening the patient outcome. We describe the recommended diagnostic and therapeutic modalities to treat dialysis-related in children.