Peritonitis In Patients Research Articles

Impact of Peritoneal Neutrophil Extracellular Traps on Peritoneal Characteristics and Technical Failure in Patients Undergoing Peritoneal Dialysis.

Peritoneal dialysis (PD) is an effective home therapy for end-stage kidney disease. However, continuous exposure to PD fluids with high glucose concentration and recurrent peritonitis may lead to the activation of cellular and molecular processes of peritoneal damage, including inflammation and fibrosis. In particular, recent studies have highlighted the role of neutrophils in chronic inflammation. This study explores how neutrophil extracellular traps (NETs) affect peritoneal membrane function and contribute to technical failures in PD patients. We conducted a prospective observational study involving 250 non-infectious and 30 acute peritonitis patients. NETs were measured using nucleosome and myeloperoxidase DNA levels in PD fluids. Monocyte chemoattractant protein-1 (MCP-1) and matrix metalloproteinase-8 (MMP-8) were also measured to assess peritoneal inflammation and damage. A significant increase in peritoneal NETs, as determined by nucleosome and myeloperoxidase DNA levels, was observed in patients with acute peritonitis compared to patients without peritonitis. Even in non-infectious samples, NET levels were widely distributed and closely correlated with levels of MCP-1 and MMP-8. Higher levels of peritoneal NETs were closely associated with increased 4-hour dialysate/peritoneal (D/P) creatinine ratio and 1-hour D/P sodium levels, indicating a higher prevalence of fast transport and limited free water transport. These factors were associated with a higher risk of technical failure. During a mean follow-up of 34 months, 39.2% (98 patients) switched from PD to hemodialysis, with higher NET levels significantly increasing the risk by 1.9 times (95% confidence interval 1.27-2.83, p=0.020). This study suggests the importance of peritoneal NETs not only as markers of acute inflammation but also as significant immunological predictors of chronic peritoneal membrane inflammation and dysfunction, and as potential risk factors for technical failure.

Frequency of Asymptomatic Spontaneous Bacterial Peritonitis in Patients with Chronic Liver Disease and Ascites

Chronic liver disease (CLD) contributes significantly to morbidity and mortality around the world. In Pakistan, it is due mainly to infections of Hepatitis B and C. One of the complications of CLD, which is often important for such patients, involves an infection of spontaneous bacterial peritonitis. Asymptomatic spontaneous bacterial peritonitis commonly develops in asymptomatic patients with ascites and is therefore preventable when it develops early. This study will determine the incidence of asymptomatic SBP in patients with CLD and ascites, providing potentially valuable data to support screening protocols for early intervention and improved outcomes. It was a cross-sectional study carried out for six months in the Gastroenterology Department of Sheikh Zayed Hospital, Lahore. A total of 121 CLD patients with ascites, meeting particular inclusion criteria, were assessed. The cases were categorized as asymptomatic SBP if the cultures were positive with more than 10⁵ colonies or more than 250/mm³ polymorphonuclear cells, without fever, pain, or tenderness. The patients were stratified according to age, gender, and Child-Pugh classification. The data were analyzed using SPSS version 24, along with the Chi-square test for correlation between the Child-Pugh class and SBP.The proportion of asymptomatic SBP was at 14.8 % among 121 patients. The patients were older: 66.1%, were mostly more than 50 years old, with a fair sex distribution ratio of 52.1 females against 47.9 males. Patients classified into Child-Pugh Class C constituted the highest proportions of patients with SBP cases of 14.8 % and significant association at p=0.000. Asymptomatic SBP in 14.8% of the patients with CLD and ascites forms the justification for routine screening on hospital admission. Critical importance is placed on detecting asymptomatic SBP because this leads to earlier intervention and a potential reduction in the risk of major complications, particularly in patients classified as Child Class C. Keywords- Frequency, Asymptomatic, Spontaneous Bacterial Peritonitis, Patients Chronic Liver Disease, Ascites

A predictive model of treatment effectiveness of refractory peritoneal dialysis-related peritonitis in patients with peritoneal dialysis: a single-center observational study in South China

Abstract Background To prevent loss of peritoneal function caused by persistent abdominal inflammation, the guidelines recommend early extubation in patients with refractory peritoneal dialysis-associated peritonitis (rPDAP). In attempt to pinpoint high-risk patient cohorts that did not respond to treatment for refractory peritonitis, we created a model to predict the effectiveness of peritonitis treatment. Methods This observational cohort study included peritoneal dialysis (PD) patients from January 1, 2011 to December 31, 2020. Multivariate logistic regression analysis was used to explore the factors affecting the occurrence and prognosis of rPDAP, and to construct a predictive model for the success of rPDAP treatment. Receiver operator characteristic (ROC) curve, calibration and decision curve were drawn to evaluate the predictive performance of the model. Results A total of 1, 397 cases of peritoneal dialysis-associated peritonitis (PDAP) occurred in our center during the study period, of which 558 cases were diagnosed as rPDAP. The incidence of refractory peritonitis was 0.047 cases/patient-year. In the study, 440 cases with rPDAP were included. Among them 304 cases (69.1%) had been successfully cured, while 136 cases (30.9%) were treatment failure, of which 19 cases (4.3%) died, 85 (19.3%) cases transferred to hemodialysis and 32 cases (7.2%) were relapse/recurrent peritonitis. Dialysate culture results showed 132 (30.0%) cases were infected with gram positive bacteria, 161 (36.6%) gram negative bacteria. Multivariate Logistic regression analysis showed that episodes of peritonitis previously ≤ 3 times were correlated with the better prognosis of rPDAP, but white blood cell (WBC) counts in peritoneal dialysate on the 3rd day of peritonitis or WBC counts on the 5th day ≥ 300 × 106/L, the pathogenic microorganism with gram-negative bacteria, as well as longer duration of PD were associated with poor outcomes. The C-statistical value of the training data set was 0.870 (95%CI: 0.821–0.918). The calibration curve and clinical decision-making curve also proved that this nomogram could accurately predict the success of treatment in patients with refractory peritonitis. Conclusion The nomogram model created through internal verification indicated a strong clinical application value and a high prognostic prediction accuracy for rPDAP.

COVID-19 Pandemic and Peritonitis in Patients with ESKD on Peritoneal Dialysis

COVID-19 Pandemic and Peritonitis in Patients with ESKD on Peritoneal Dialysis

Laparoscopic peritoneal lavage – a new treatment strategy in spontaneous bacterial peritonitis and liver cirrhosis

Introduction Bacterial infections in cirrhotic patients represent a major clinical problem, occuring 4-5 times more frequently compared to the general population and increasing mortality by leading to acute on chronic liver failure, subsequent decompensation, and multiorgan failure. The study’s purpose is to determine the possibilities of laparoscopy in the treatment of spontaneous bacterial peritonitis with decompensated liver cirrhosis. Materials and methods A retrospective descriptive study was conducted on 82 patients diagnosed with liver cirrhosis and spontaneous bacterial peritonitis, who were admitted to the Constantin Tibirna Surgery department No2, Holy Trinity Municipal Clinical Hospital and the Scientific Research Laboratory of Hepatic Surgery, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, between January 2012 and December 2021. Patients who underwent surgical drainage of the abdominal cavity by laparoscopy with postoperative peritoneal lavage with antibiotics were selected. All patients received standard treatment for the correction of liver function and complications of portal hypertension. The data were extracted from the medical records of the hospital archive, and the patient database was compiled. Data analysis was performed using simple statistical calculations. Results Positive ascitic fluid bacterial culture was in 29.2% (24 patients), while 70.7% (58 patients) had culture-negative ascites and peritonitis. The most frequent bacterial species was E. coli, present in 54.1% (13 patients). Mortality was 8.5% (7 patients) due to progressive liver failure. Recurrence of ascites and peritonitis at 1 month was 6.0% (5 patients). Conclusions The laparoscopic approach in spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis allows for better sanitation of the abdominal cavity, improves peritoneal absorption, and deserves establishment as clinical practice for patients with ascites and peritonitis and cirrhosis.

Report of Laparoscopic Findings of PD Catheter Replacement after Catheter Removal Due to Refractory Peritonitis in Patients on PD

Report of Laparoscopic Findings of PD Catheter Replacement after Catheter Removal Due to Refractory Peritonitis in Patients on PD

ОСОБЕННОСТИ КЛИНИЧЕСКОЙ КАРТИНЫ ОСТРОГО ПЕРИТОНИТА У ПАЦИЕНТОВ С ВИЧ-ИНФЕКЦИЕЙ

Background. The clinical picture of acute peritonitis in HIV-positive patients has its own specific features and is characterized by a blurred and multifaceted character, which significantly complicates the diagnosis of this disease. Purpose. To identify the features and specifics of the clinical picture of acute peritonitis in patients with HIV infection. Materials and methods. An analysis of the literature data was carried out, based on the outcome of which three syndromes were selected, which maximally included the known symptoms of acute peritonitis: abdominal pain syndrome, intestinal insufficiency syndrome and systemic inflammatory response syndrome (SIRS). The study included 158 patients with HIV infection who had a preliminary diagnosis of acute peritonitis. All patients underwent diagnostic laparoscopy, according to the results of which they were divided into the main and control groups. In the main group, 83 patients with a confirmed diagnosis of acute peritonitis were selected . The control group included 75 patients whose diagnosis of acute peritonitis was not confirmed. The analysis of the symptoms of acute peritonitis in HIV-infected patients was carried out within the framework of individual syndromes and their combination. Results. In the main group, abdominal pain syndrome was found in 20.5% of the patients, intestinal insufficiency syndrome was detected in 59%, and SIRS — in 61.4%. The following results were obtained in the control group: abdominal pain syndrome — 14.7% of the patients, intestinal insufficiency syndrome — 48%, SIRS — 33.3%. The study shows that a combination of “classic” criteria for acute peritonitis occurs in a small number of HIV-infected patients with acute peritonitis and is not always an absolute sign of the diagnosis. It was also noted that the presence of acute peritonitis in patients with HIV infection is possible even in the absence of all the “classic” criteria for this disease. Conclusion. The clinical picture of acute peritonitis in HIV-infected patients is atypical, characterized by mild or no “classic” symptoms, masked by the manifestation of opportunistic infections and HIV-indicative diseases, and requires further study to improve diagnosis and treatment.

Association between serum potassium, risk and prognosis of peritonitis in peritoneal dialysis patients-results from the Peritoneal Dialysis Telemedicine-assisted Platform Cohort (PDTAP) Study.

Hypokalemia has been associatedwith an increased risk of peritoneal dialysis (PD)-associated peritonitis. However, hypokalemia is commonly associated with malnutrition, inflammation, and severe coexisting comorbidities, which thus are suspected of being potential confounders. This study was aimed at testingwhether hypokalemia was independently associated with the occurrence and prognosis of PD-associated peritonitis. A national-level dataset from the Peritoneal Dialysis Telemedicine-assisted Platform Cohort (PDTAP) Study was used to explore the independent association of serum potassium with PD-associated peritonitis. Unmatched and propensity score-adjusted multivariate competing risk models, as well as univariate competing risk models following 1:1 propensity score matching, were conducted to balance potential biases between patients with and without hypokalemia. The association between potassium levels prior to peritonitis and treatment failure due to peritonitis was also investigated. During a median follow-up of 25.7months in 7220 PD patients, there was a higher incidence of peritonitis in patients with serum potassium below 4.0mmol/L compared to those withhigher serum levels (677 [0.114/patient-year] vs. 914 [0.096/patient-year], P = 0.001). After adjusting for demographics, laboratory tests, residual renal function, and medication use, baseline potassium levels below 4.0mmol/L were not linked to an increased risk of peritonitis, with a hazard ratio of 0.983 (95% CI 0.855-1.130, P = 0.810). This result remained consistent in both the propensity score adjusted multivariate competing risk regression (HR = 0.974, 95% CI 0.829-1.145, P = 0.750) and the univariate competing risk regression after 1:1 propensity score matching (Fine-Gray test, P = 0.218). The results were similar when analyzing patients with serum potassium level above or below 3.5mmol/L. Lastly, hypokalemia before the occurrence of peritonitis was not independently associated with treatment failure. Hypokalemia was not found to be an independent risk factor for PD-associated peritonitis or treatment failure of peritonitis in China.

Frequency of Asymptomatic Spontaneous Bacterial Peritonitis in Patients of Chronic Liver Disease with Ascites

Frequency of Asymptomatic Spontaneous Bacterial Peritonitis in Patients of Chronic Liver Disease with Ascites

Does the Use of Gastric-Acid Suppressants Increase the Risk of Peritonitis in Patients Undergoing Peritoneal Dialysis? A Meta-Analysis.

Gastric-acid suppressants (GASs) are commonly prescribed to patients undergoing peritoneal dialysis for various gastrointestinal disorders. However, long-term GAS use has been linked with the risk of enteric peritonitis in this patient population. To assess the association between the enteric peritonitis risk and GAS use in patients undergoing peritoneal dialysis for end-stage renal disease, we conducted a systematic search for relevant articles published until December 2023 in PubMed, Embase, and the Cochrane Library databases. We included 11 articles on the association between GAS use and enteric peritonitis risk in patients undergoing peritoneal dialysis. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) using fixed and random-effects models to obtain overall effect estimates. We also explored potential sources of heterogeneity through subgroup analyses. We qualitatively analyzed data from 11 studies (n = 1993 participants), out of which, nine studies were included in meta-analysis. The overall results revealed a significant association between the enteric peritonitis risk and the use of GASs (OR, 1.61; 95% CI, 1.26-2.05; p < 0.00001). The analysis of study design subgroups showed a significant association in retrospective cohort studies (OR, 1.70; 95% CI, 1.42-2.03; p < 0.00001) but not in case-control studies. Histamine-2 receptor antagonist (H2RA) use was significantly associated with enteric peritonitis (OR, 1.49; 95% CI, 1.05-2.11, p = 0.03), whereas proton pump inhibitor use was not (OR, 1.13; 95% CI, 0.72-1.77, p = 0.28). Our findings suggest a significant association between the development of enteric peritonitis and GAS use in patients undergoing peritoneal dialysis. However, the observed heterogeneity in study characteristics warrants caution in interpreting the results.

Increased Intra-Abdominal Pressure as One of the Links in the Pathogenesis of Secondary Diffuse Purulent Peritonitis

Aim: to present literature data on the importance of intra-abdominal hypertension in the pathogenesis of peritonitis. Key points. Secondary purulent peritonitis is a severe and fairly common form of abdominal infection with high mortality. According to statistics, hospitalization of patients with signs of local or diffuse peritonitis is more than 15 % among patients with acute surgical pathologies. One of the factors in the development of complications and an unfavorable prognosis for this disease is increased intra-abdominal pressure. To measure this indicator, a Foley catheter inserted into the bladder is used in medical practice. According to reference values, the optimal level of intra-abdominal pressure does not exceed 5 mmHg. A persistent increase in pressure of 12 mmHg and above indicates the development of intra-abdominal hypertension. An increase in the level of intra-abdominal pressure indicates the progression of the inflammatory destructive process in the abdominal cavity and contributes to the development of multiple organ failure with subsequent fatal outcome with untimely treatment. With an indicator exceeding 20 mmHg, there is a risk of developing abdominal compartment syndrome. This condition is characterized by increased pressure in two or more anatomical areas, which leads to decreased blood flow and subsequent tissue hypoxia. Intra-abdominal hypertension also increases the risk of developing postoperative peritonitis in patients who have undergone laparotomy. Conclusion. To predict the course of secondary diffuse purulent peritonitis, reduce the risk of complications and mortality, it is necessary to focus on measuring intra-abdominal pressure as a mandatory manipulation in surgical patients. Despite its general availability and ease of implementation, this technique allows assessing the severity of organ dysfunctions.

Development and validation of a nomogram for predicting refractory peritoneal dialysis related peritonitis

Objective To identify the risk factors of refractory peritoneal dialysis related peritonitis (PDRP) and construct a nomogram to predict the occurrence of refractory PDRP. Methods Refractory peritonitis was defined as the peritonitis episode with persistently cloudy bags or persistent dialysis effluent leukocyte count >100 × 109/L after 5 days of appropriate antibiotic therapy. The study dataset was randomly divided into a 70% training set and a 30% validation set. Univariate logistic analysis, LASSO regression analysis, and random forest algorithms were utilized to identify the potential risk factors for refractory peritonitis. Independent risk factors identified using multivariate logistic analysis were used to construct a nomogram. The discriminative ability, calibrating ability, and clinical practicality of the nomogram were evaluated using the receiver operating characteristic curve, Hosmer–Lemeshow test, calibration curve, and decision curve analysis. Results A total of 294 peritonitis episodes in 178 patients treated with peritoneal dialysis (PD) were enrolled, of which 93 were refractory peritonitis. C-reactive protein, serum albumin, diabetes mellitus, PD duration, and type of causative organisms were independent risk factors for refractory peritonitis. The nomogram model exhibited excellent discrimination with an area under the curve (AUC) of 0.781 (95% CI: 0.716–0.847) in the training set and 0.741 (95% CI: 0.627–0.855) in the validation set. The Hosmer–Lemeshow test and calibration curve indicated satisfactory calibration ability of the predictive model. Decision curve analysis revealed that the nomogram model had good clinical utility in predicting refractory peritonitis. Conclusion This nomogram can accurately predict refractory peritonitis in patients treated with PD.

Ascitic ENDOCAN as a Useful Marker in the Diagnosis of Spontaneous Bacterial Peritonitis

Abstract Background Spontaneous bacterial peritonitis (SBP) is a serious, recurrent, and life-threatening condition developing in cirrhotic patients with a high mortality rate. Its diagnosis is based on ascitic fluid polymorphonuclear leukocytes (PMNs) to be more than 250/μL. Endocan is a proteoglycan (PG) secreted by vascular endothelium, its serum level is elevated with an inflammatory or a malignant process. Aim of the Work to evaluate the potential role of ascitic fluid levels of endocan as an appropriate marker for prediction and early diagnosis of spontaneous bacterial peritonitis in patients with liver cirrhosis. Patients and Methods This was Prospective cohort study, was conducted in hepatology Unit of Ain Shams University Hospital over 100 patients with liver cirrhosis classified into two groups: (Non-SBP): included 50 patients of decompensated cirrhosis with sterile (non SBP) ascites, (SBP): included 50 Adult patients with liver cirrhosis and SBP, during a Period 6 months. All patients were subjected to: Full history taking, Clinical examination, Routine investigations, Radiology investigations, Determination of ascitic endocan levels by ELISA. Result The main results of the study revealed that: There was no statistically significant difference between the studied groups as regard personal data. There was a high statistically significant difference between the studied groups as regardsChild-Pugh score. There was no statistically significant difference between the studied groups as regard LFT. There was statistically significant difference between the studied groups as regard WBCs. There was statistically significant difference between the studied groups as regard INR. There was no statistically significant difference between the studied groups as regard creatinine. There was statistically significant difference between the studied groups as regard Ascetic endocan. Conclusion In conclusion, this study demonstrates that ascitic endocan level is an independent risk factor for SBP and has a high diagnostic value for detecting SBP in patients with decompensated cirrhosis.

Spontaneous bacterial peritonitis in patients with portal hypertension

Background. Spontaneous bacterial peritonitis (SBP) is a life-threatening infection in patients with portal hypertension (PH) and ascites. Its prevention and treatment are vital to improve the prognosis in decompensated PH. Alterations in gut microbiota, gut permeability, and systemic immune dysfunction are cornerstones in the development of SBP in patients with PH. This contributes to the translocation of bacteria from the intestinal lumen to the mesenteric lymph nodes, and then to the portal and systemic circulation from where the ascitic fluid can be colonized with the subsequent development of peritonitis. The purpose was to monitor the course of the disease and determine the possibility of correcting pathological factors of SBP such as bacterial contamination and volume of ascitic fluid, nature of bacterial contamination, increased intra-abdominal pressure, hypoalbuminemia, and to evaluate the role of antibacterial therapy, paracentesis in the treatment of patients with SBP in decompensated PG. Materials and methods. Examination and treatment of 242 patients with ascites who were admitted for emergency medical care were carried out. Diagnostic paracentesis was performed to examine ascitic fluid, which allowed to detect neutrophilia &gt; 250 cells in 1 mm3 in 194 (80.2 %) patients and indicated the presence of SBP. These patients made up the first group of observation. In the second group, there were 48 (19.8 %) patients with no clinical and laboratory signs of SBP at the time of hospitalization. Methodology of analysis of actual research material: to find a statistical difference between the distribution of nominal data of patients in this study, we used Pearson’s χ2 test. To establish the strength of the relationship between variables, we determined the polychoric correlation coefficient. When a statistically significant difference was detec-ted, a stratification analysis was performed with determination of the 95% confidence interval of the odds ratio (Clopper-Pearson method) and the risk ratio for the development of complications in PH. Results. Empiric antibacterial therapy, which was carried out from the moment of receiving information about SBP and began with the use of broad-spectrum antibiotics, was successful in 41 % of cases that was confirmed by repeated examination of ascitic fluid. In antibiotic resistance, determining the sensitivity of ascitic microflora led to a delay in an effective anti-inflammatory treatment and affected the results. In the first group, 39 (20.1 %) patients died, in the second group, 22 (50 %), total mortality was 25.2 %. Conclusions. Diagnostic paracentesis combined with the assessment of bacterial contamination of ascitic fluid, evaluation of intra-abdominal pressure, state of osmoregulation based on albumin concentration is a safe and informative method of diagnosing the severity of pathological process in patients with complicated PH. Treatment of SBP requires urgent care, both in terms of elimination of the infectious factor, and normalization of the disturbed mechanisms of reabsorption regulation by peritoneal and hepatorenal processes. High mortality in patients with SBP is due to the development of inflammation in the abdominal cavity against the background of progressive hepatorenal insufficiency and the inability to correct decompensated PH.

Ascitic Fluid Calprotectin as a Diagnostic Marker of Spontaneous Bacterial Peritonitis in Patients with Liver Cirrhosis

Ascitic Fluid Calprotectin as a Diagnostic Marker of Spontaneous Bacterial Peritonitis in Patients with Liver Cirrhosis

Microbiological Profiles of the Anatomical Sites of Perforation Peritonitis: A Cross-Sectional Study.

Introduction One of the most frequent emergencies that a general surgeon deals with is perforation peritonitis. The anatomical site of the perforation, which in turn affects the source of infection, has a major impact on the mortality rate due to perforation peritonitis. Early and suitable antibiotic therapy can be started in the postoperative period with the aid of knowledge about the microbiological profile and sensitivity of peritoneal fluid culture with respect to the anatomical sites of perforation peritonitis. Methods A cross-sectional study was conducted from June 2021 to November 2021 where peritoneal fluid samples were collected intraoperatively from patients with perforation peritonitis. This was subjected to culture and sensitivity, and results were analyzed with respect to anatomical sites of perforation. Results Forty cases were investigated. The ileum (30%) was the most common site of perforation, followed by the stomach (22.5%), appendix (20%), duodenum (12.5%), caecum (5%), jejunum (5%), transverse colon (2.5%), and rectum (2.5%). Escherichia coli (E. coli) and Klebsiella spp. were the most frequently found organisms in all sites of perforation peritonitis. The most sensitive antibiotics covering all isolated organisms were amikacin and meropenem. Sensitivity to amikacin was found in 85.18% of cases of E. coli and 84.6% of cases of Klebsiella. Sensitivity to meropenem was found in 76.9% of cases of E. coli and 80% of cases of Klebsiella. Conclusion In patients with perforation peritonitis, the peritoneal fluid cultures did not reflect the major differential normal flora according to the region of the gastrointestinal tract. The most prevalent organism isolated among all the sites of perforation peritonitis was E. coli. Antimicrobial activity against organisms isolated from perforation peritonitis patients was significantly demonstrated by aminoglycosides, piperacillin and tazobactam, and meropenem and colistin, with considerable resistance to third-generation cephalosporins.

Peritoneal dialysis-related peritonitis from Burkholderia pseudomallei infection (Melioidosis) of northeast Thailand

Objectives: Melioidosis is an uncommon cause of peritonitis in patients with end-stage renal disease who are receiving continuing peritoneal dialysis. This study aims to investigate the prevalence and outcome of peritoneal dialysis-related peritonitis due to Burkholderia pseudomallei infection. Materials and Methods: A retrospective cohort study of melioidosis infection between 2018 and 2022, peritoneal dialysis-related peritonitis in cases with end-stage renal failure was collected. The patients’ demographics, clinical characteristics, and treatments were described. Results: Of the 194 cases diagnosed with peritoneal dialysis-related peritonitis, there were 7 patients (3.6%) with melioidosis peritonitis. The patients’ mean age was 51.1 ± 9.44 years old, range of 40–65. Diabetes (5 cases, 71.4%) and hypertension (7 cases, 100%) were the most common co-morbidities. Six cases (85.7%) had fever, 5 (71.4%) had hazy dialysate, and everyone had abdominal pain as clinical signs. Associated septicemia was observed in 5 (71.4%) cases. As part of their antibiotic therapy, meropenem was given to 1 (14.3%) and ceftazidime to 6 (85.7%) cases. Six cases (85.7%) received intravenous antibiotics, whereas 1 (14.3%) case received both intravenous and intraperitoneal routes. The catheters were removed; then, hemodialysis sessions of 5 (71.4%) cases were initiated. Hemodialysis mode was switched permanently in 3 (42.9%) cases and temporarily in one case, thereafter, peritoneal dialysis was resumed. 3 (42.9%) cases died. No significant relations were found about risk factors between survivor and non-survivor group (P &lt; 0.05). Conclusion: Peritoneal dialysis-related peritonitis due to melioidosis is uncommon. However, it may be accompanied by catheter loss and can be lethal if untreated as systemic melioidosis.

Interobserver agreement of peritoneal dialysis exit site scoring: Results from the Standardizing Care to Improve Outcomes in Pediatric End Stage Kidney Disease (SCOPE) collaborative.

Exit site infections are a risk factor for the development of peritonitis in patients on long-term peritoneal dialysis. Visual assessments of an exit site utilising currently available tools (Twardowski and Mid-European Pediatric Peritoneal Dialysis Study Group (MEPPS)) are necessary to objectively characterise the appearance of an exit site. The aim of this study was to assess the interobserver agreement of exit site evaluations utilising both exit site scoring tools. Exit site evaluations were independently performed by two evaluators during outpatient visits at 13 sites within the Standardizing Care to Improve Outcomes in Pediatric End Stage Kidney Disease collaborative. The frequency and percentage of evaluations where both reviewers agreed were calculated. A sub-analysis was performed looking at evaluations where disagreement occurred. A total of 371 paired exit site evaluations were collected over 6 months. For the majority of evaluations (range: 78%-97% Twardowski, 78%-97% MEPPS), both reviewers agreed that no abnormality was present across all domains. When the analysis was restricted to evaluations where at least one reviewer noted an abnormality, interobserver agreement fell across all domains (range: 31%-61% Twardowski, 56%-66% MEPPS). Disagreements more commonly occurred regarding the presence versus absence of an abnormality, rather than a difference in the severity of an abnormality. Whereas interobserver agreement is high when the appearance of a peritoneal dialysis catheter exit site is characterised as 'normal', interobserver disagreement is common when the appearance of the exit site is 'abnormal'. Further work is warranted to improve interobserver agreement of exit site assessments and to identify domains conferring an increased risk of infection.

#665 Comparison of outcomes between kidney transplant-naïve and post-transplant graft failure peritoneal dialysis patients

Abstract Background and Aims Despite progress in kidney transplant medicine, there are still patients experiencing graft failure and returning to dialysis therapy. Data regarding the prognosis of these patients remain conflicting. This study was conducted to compare clinical outcomes between transplant-naïve peritoneal dialysis (PD) patients and those returning to PD after a failed allograft. Method In this retrospective cohort study during 2006 and 2016, we included a total of 786 patients on chronic PD. Of them 679 were transplant-naïve, 76 patients underwent a successful transplantation, and 32 patients returned to PD after a failed kidney allograft. Baseline demographics and clinical characteristics were analyzed in relation to the outcomes of all-cause mortality and peritonitis rate. We employed the Kaplan-Meier method and Cox proportional hazards model to evaluate survival, while Poisson regression was utilized to estimate rate ratios for peritonitis. Results During a median follow-up of 6.37 years, 56.68 % death and 146.62 episodes of peritonitis/patient-year were observed. Compared with patients who received a kidney graft, transplant-naïve patients were older, more with diabetes and having higher mortality (58.6 ± 15.8, 40.5% and 57.73%, p &amp;lt; 0.0001). After accounting for age, gender, and comorbidities, the adjusted hazards ratios were 0.26 (95% CI 0.13-0.53) in patients with a functioning graft and 1.12 (95% CI 0.61-2.06) in patients returning to PD after graft failure, compared respectively with concurrent PD patients without kidney transplant. The adjusted relative risk of peritonitis in patients resuming PD after graft failure was comparable to those without kidney transplant (95% CI 0.22-1.14). Conclusion Successful kidney transplant reduced the risk of overall mortality among patients on long-term PD. Patients returning to PD after graft loss showed outcomes similar to transplant-naïve counterparts. These data support reactivation of PD as a viable option for patients with a failed kidney transplant.

#2355 Eradication of Staphylococcus aureus carriage in patients undergoing peritoneal dialysis

Abstract Background and Aims Peritonitis is a common and serious complication of peritoneal dialysis (PD). A single episode of severe peritonitis or multiple peritonitis episodes frequently leads to diminished peritoneal ultrafiltration capacity, hospitalization, and a switch to hemodialysis. Prevention of infection is the mainstay for the reduction of peritonitis rate. According to the current guidelines, we use nasal antibiotic prophylaxis if patients are identified as nasal Staphylococcus aureus carriers on screening prior to PD beginning. Eradication of S. aureus Regular with nasal mupirocin reduces the rate of exit-site infections but has uncertain effects on the risk of peritonitis. The aim of this study was to evaluate the rate of S. aureus peritonitis in our cohort of patients receiving PD. Method A retrospective single-center study was conducted in a large Italian PD center. We reviewed all cases of bacterial peritonitis from 1999 to 2023. Demographic and clinical characteristics of the patients and microbiological features of the bacteria identified in cultures were extracted from electronic health record. From 2011, all patients were screened before surgery for Methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) with nares swabs. All patients with positive nasal colonization for MSSA and MRSA were treated with nasal mupirocin (nasal ointment twice daily for 5 consecutive days every 4 weeks) until eradication was confirmed by a nasal swab. According to our protocol, from 2011, screening for S. aureus carriage along peritoneal fluid culture was performed in all patients on PD with an episode of peritonitis to verify nasal colonization with S. aureus. The study was approved by the regional ethical committee of Emilia Romagna (507/2021/OSS/AOUMO SIRER ID 2845). Results Overall, 345 cases of peritonitis were reviewed in 214 patients who received peritoneal dialysis. In our center, the rate of peritonitis was 0.23 episodes/patient-year. After the introduction of nasal screening for S. aureus carriage, the episodes of S. aureus peritonitis decreased in frequency (0.0093 episodes/patient-year vs. 0.034 episodes/patient-year) and as absolute number (17.8% vs 3.6%; p = 0.001). No differences were observed in the rate of catheter removal in the two populations (p = 0.99). The age of 109 patients screened for S. aureus carriage was 64.1 ± 17 years. Males accounted for 58.9% and automated PD (APD) was chosen by 66% of the subjects. After an average period of 1.6 years from the start of PD, 7 patients experienced S. aureus peritonitis in the absence of exit-site or tunnel catheter infection. Nasal screening at the time of peritonitis showed that half of them were carriers of S. aureus and half were negative (one patient was not screened). Colonization from S. aureus was found in another 9 patients whose peritonitis was caused by a different type of bacteria (44% S. epidermidis, 33.3% Enterobacteriaceae, 11.1% Acinetobacter, and 11.1% culture-negative peritonitis). Conclusion Our data document that screening for S. aureus, along with other preventive measures, contributes to significantly reducing the rate of S. aureus peritonitis in patients screened and treated for S. aureus carriage at the time of PD start. Routine screening and the use of a mask during connection are required because recolonization occurs frequently in this population.