Prevention Of Peritonitis Research Articles

Risk factors of peritoneal dialysis-related peritonitis in the Japan Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).

Peritoneal dialysis (PD)-related peritonitis is a major complication of PD. Wide variations in peritonitis prevention, treatment strategies and consequences are seen between countries. These between-country differences may result from modifiable risk factors and clinical practices. A total of 1225 Japanese PD patients were included and prospectively followed in the Peritoneal Dialysis Outcomes and Practice Patterns Study phase 1 (2014-2018) and phase 2 (2018-2022). Associations between PD-related peritonitis and various risk factors were assessed by Cox proportional hazards survival models. During follow-up (median 1.52years), 539 peritonitis episodes were experienced by 364 patients. The country crude peritonitis rate was 0.27 episodes/patient-year. In the fully adjusted model, noticeable patient-level factors associated with experiencing any peritonitis included age {hazard ratio [HR] 1.07 per 5-year increase [95% confidence interval (CI) 1.01-1.14]}, serum albumin level [HR 0.63 per 1g/dl higher (95% CI 0.48-0.82)] and continuous ambulatory peritoneal dialysis (PD) [HR 1.31 versus automated PD (95% CI 1.05-1.63)]. The adoption of antibiotic prophylaxis practice at the time of PD catheter insertion [HR 0.63 (95% CI 0.51-0.78)] or when having complicated dental procedures [HR 0.74 (95% CI 0.57-0.95)] or lower endoscopy [HR 0.69 (95% CI 0.54-0.89)] were associated with lower hazards of any peritonitis, while a routine facility practice of having more frequent regular medical visits was associated with a higher hazard. Identification of risk factors in Japan may be useful for developing future versions of guidelines and improving clinical practices in Japan. Investigation of country-level risk factors for PD-related peritonitis is useful for developing and implementing local peritonitis prevention and treatment strategies.

Discontinuation of maintenance peritoneal dialysis in children-A 10-year review from a single center in a low resource setting.

In South Africa, only children considered eligible for transplantation are offered dialysis as bridge to kidney transplantation. Maintenance peritoneal dialysis (PD) is preferred and has several advantages over hemodialysis (HD). While awaiting transplantation, PD may be discontinued due to permanent transfer to HD or death while on PD, of which the occurrence and burden is not known in our setting. We investigated the rate of discontinuation of maintenance PD, and associated factors among children awaiting a kidney transplant under challenging socio-economic circumstances in a low resource setting. Single center retrospective analysis of children receiving maintenance PD. Outcomes included the proportion of children who discontinued PD before transplantation, associated factors and timing of discontinuation, and the proportion transplanted. Time to discontinuation or transplantation was displayed using a Kaplan-Meier curve. Sixty-seven children who received maintenance automated PD as initial dialysis modality were identified from the kidney transplant waiting list between January 2009 and December 2018. Complete data was available for 52 of the 67 children. Four children had prior failed kidney transplants. The median age was 11 years (interquartile range 6.0, 13.1). Overall, 17/52 (32.7%) children discontinued PD, with 13 (25%) transfers to HD and 4 deaths (7.7%), whereas 29/52 (55.8%) received a kidney transplant. Three of the deaths were PD related. Six children remained on maintenance PD at the end of the study period. Over a half of our patients discontinued PD by 12 months, and 80% by 30 months. Most PD discontinuations were associated with peritonitis. The proportion discontinuing PD was high, highlighting the need to optimize measures to improve retention rates, especially through prevention of peritonitis.

Effect of a Management Algorithm for Wet Contamination of Peritoneal Dialysis System on the Prevention of Peritonitis: A Prospective Observational Study

Introduction: Wet contamination was a common problem of peritoneal dialysis (PD) system. We developed a management algorithm for wet contamination of PD system (wet contamination) on the basis of the related research literature and clinical practice experience. The purpose of this study was to observe clinical effect of the management algorithm on the prevention of peritonitis. Methods: Patients treated wet contamination in a single PD center between October 2017 and September 2022 were included. A management algorithm was established to treat wet contamination. It comprised identification of the contamination type, addressing contaminated or aging catheters, prophylactic antibiotics, and retraining. Demographic data and clinical data about wet contamination were collected and compared. Results: One hundred and forty-one cases of wet contamination were included in this study. The mean age was 51.7 ± 14.1 years, and 49.6% were female. The proportion of diabetic nephropathy was 9.9%. The median PD duration was 27.0 (1.7–79.7) months. Eighteen episodes (12.8%) of wet contamination-associated peritonitis developed after wet contamination. The main pathogenic bacteria of peritonitis were Gram-positive bacteria (33.3%) and Gram-negative bacteria (27.8%). The incidence of wet contamination-associated peritonitis in the compliance with the management algorithm group was significantly lower than that in the non-compliance with the management algorithm group (0.9 vs. 48.6%; p < 0.001). Non-compliance with management algorithm (OR = 185.861, p < 0.001) together with advance age (OR = 1.116, p < 0.001) and longer distance from home to hospital (OR = 1.007, p < 0.001) were independent risk factors for wet contamination-associated peritonitis. Conclusion: The management algorithm for wet contamination of PD system could reduce the risk of peritonitis.

PERITONEAL DIALYSIS-ASSOCIATED PERITONITIS : A SYSTEMATIC REVIEW

Background: Peritoneal dialysis is infectious and non-infectious. Peritoneal dialysis causes catheter exit, tube tunnel, and peritonitis. Noninfectious consequences of peritoneal dialysis include catheter malfunction, external leakage, abdominal wall anomalies, scrotal edoema, pleural-peritoneal fistulas, failed ultrafiltration, and encapsulated sclerosis. PD complications include peritonitis. The International Society for Peritoneal Dialysis (ISPD) offers specific recommendations on PD-associated peritonitis prevention and treatment, however clinical practise differs greatly amongst dialysis units. Aim: This article examines the link between peritoneal dialysis and peritonitis and presents its findings. Methods: By evaluating the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 standards, this study demonstrated that it met all of the requirements. This enabled the researchers to ensure that the study was as up to date as feasible. Publications published between 2000 and 2023 were included in the search strategy, which included a variety of electronic reference databases (including Pubmed and SagePub). We did not consider review papers, duplicate publications, or half completed articles. Result: In the PubMed database, the results of our search brought up 133 articles, whereas the results of our search on SagePub brought up 69 articles. The results of the search conducted for the last year of 2000 yielded a total of 20 articles for PubMed and 8 articles for SagePub. In the end, we compiled a total of 21 papers, six of which came from PubMed and three of which came from SagePub. We included nine research that met the criteria. Conclusion: Gram-positive bacteria are the most common cause of Parkinson's disease-associated peritonitis. Despite the high frequency of PD-associated peritonitis, it has a high cure rate.

Assessment of potential peritonitis risk factors in pediatric patients receiving maintenance peritoneal dialysis.

Many recommendations regarding peritonitis prevention in international consensus guidelines are opinion-based rather than evidence-based. The aim of this study was to examine the impact of peritoneal dialysis (PD) catheter insertion technique, timing of gastrostomy placement, and use of prophylactic antibiotics prior to dental, gastrointestinal, and genitourinary procedures on the risk of peritonitis in pediatric patients on PD. We conducted a retrospective cohort study of pediatric patients on maintenance PD using data from the SCOPE collaborative from 2011 to 2022. Data pertaining to laparoscopic PD catheter insertion (vs. open), gastrostomy placement after PD catheter insertion (vs. before/concurrent), and no prophylactic antibiotics (vs. yes) were obtained. Multivariable generalized linear mixed modeling was used to assess the relationship between each exposure and occurrence of peritonitis. There was no significant association between PD catheter insertion technique and development of peritonitis (aOR = 2.50, 95% CI 0.64-9.80, p = 0.19). Patients who had a gastrostomy placed after PD catheter insertion had higher rates of peritonitis, but the difference was not statistically significant (aOR = 3.19, 95% CI 0.90-11.28, p = 0.07). Most patients received prophylactic antibiotics prior to procedures, but there was no significant association between prophylactic antibiotic use and peritonitis (aOR = 1.74, 95% CI 0.23-13.11, p = 0.59). PD catheter insertion technique does not appear to have a significant impact on peritonitis risk. Timing of gastrostomy placement may have some impact on peritonitis risk. Further study must be done to clarify the effect of prophylactic antibiotics on peritonitis risk. A higher resolution version of the Graphical abstract is available as Supplementary information.

Pediatric peritoneal dialysis training program andits relationship to peritonitis: a study of the International Pediatric Peritoneal Dialysis Network.

The guidelines for training of patients and caregivers to perform home peritoneal dialysis (PD) uniformly include recommendations pertaining to the prevention of peritonitis. The objective of this study conducted by the International Pediatric Peritoneal Dialysis Network (IPPN) was to investigate the training practices for pediatric PD and to evaluate the impact of these practices on the peritonitis and exit-site infection (ESI) rate. A questionnaire regarding details of the PD program and training practices was distributed to IPPN member centers, while peritonitis and ESI rates were either derived from the IPPN registry or obtained directly from the centers. Poisson univariate and multivariate regression was used to determine the training-related peritonitis and ESI risk factors. Sixty-two of 137 centers responded. Information on peritonitis and ESI rates were available from fifty centers. Training was conducted by a PD nurse in 93.5% of centers, most commonly (50%) as an in-hospital program. The median total training time was 24hours, with a formal assessment conducted in 88.7% and skills demonstration in 71% of centers. Home visits were performed by 58% of centers. Shorter (< 20hours) training duration and lower number of training tools (both p < 0.02) were associated with higher peritonitis rate, after adjustment for proportion of treated infants and income of country of residence. An association between training duration and the number of training tools represent potentially modifiable risk factors to reduce peritonitis rates within the pediatric PD population. A higher resolution version of the Graphical abstract is available as Supplementary information.

Survival Rates in Elderly Patients on Continuous Ambulatory Peritoneal Dialysis.

The present study aimed at evaluating the survival rate, its associated factors, and the causes of death in elderly patients undergoing continuous ambulatory peritoneal dialysis (CAPD) in Vietnam. This is a retrospective, observational study conducted among patients aged ≥65 years who underwent CAPD at Thong Nhat Hospital, Ho Chi Minh City, Vietnam, from April 2012 to December 2020. The Kaplan-Meier method was used to calculate the cumulative survival rate, and the Log rank test was used to analyze the factors associated with the survival rate of patients. This study enrolled a total of 68 patients with a mean age of 71.93 ± 7.44 years at the initiation of CAPD. The most common complication among kidney failure patients was diabetic nephropathy (39.71%). The rate of concomitant cardiovascular diseases was 58.82%. The average survival rate was 45.59 ± 4.01 months. Peritonitis was the most common factor causing death (31.25%), followed by cardiovascular diseases (28.12%) and malnutrition (25%). The factors that impacted the survival rate included concomitant cardiovascular diseases, low serum albumin (<35 g/dL), and an indication of CAPD due to exhausted vascular access for hemodialysis at baseline. The main factor associated with a shorter survival time was concomitant cardiovascular diseases. It is necessary to improve the survival time beyond 5 years for elderly patients undergoing CAPD, especially for those with concomitant cardiovascular diseases. Besides the prevention of peritonitis, adequate measures to protect from cardiovascular diseases and malnutrition will reduce the mortality rate in patients on CAPD.

WCN23-1198 Pre-training peritonitis prevention in patients in Peritoneal Dialysis

WCN23-1198 Pre-training peritonitis prevention in patients in Peritoneal Dialysis

Effect of different dialysis duration on the prognosis of peritoneal dialysis-associated peritonitis: a single-center, retrospective study

Background Peritoneal dialysis (PD)-associated peritonitis is a serious complication observed in peritoneal dialysis patients. Herein, we investigated the clinical characteristics and treatment outcomes of PD peritonitis in patients with different PD durations. Methods All peritonitis episodes from January 2007 to December 2020 at Peking University People’s hospital PD center were retrospectively analyzed and divided into the long-dialysis duration (≥60 months, LDD) and short-dialysis duration (<60 months, SDD) groups. Clinical characteristics and outcomes were compared between these groups. The risk factors for treatment failure were analyzed using a logistic regression model. Results During 14 years, 156 patients had 267 peritonitis episodes. There were 83 (31.1%) peritonitis episodes in the LDD group and 184 (68.9%) in the SDD group. No statistical difference was noted in peritonitis causes and the composition of causative pathogens between the two groups. The hospitalization, treatment failure, and transfer-to-hemodialysis rates, and peritonitis-related mortality were significantly higher in the LDD group than in the SDD group (all p < .05). Logistic regression analysis revealed that PD duration was an independent risk factor for PD-associated hospitalization, treatment failure and peritonitis-related death (p < .05). The receiver operating characteristic curve analysis results showed that when the cutoff value of PD duration was 5.5 years, the sensitivity of predicting PD peritonitis treatment failure was 51.1%, specificity was 78.8%, and the area under the curve was 0.679 (95% confidence interval: 0.594–0.765, p < .001). Conclusions PD duration is an independent risk factor for poor prognosis in PD peritonitis. Careful and active attention should be paid to the prevention of peritonitis in PD patients with long PD duration.

Overview of ISPD 2022 guideline recommendations for peritonitis prevention and treatment.

This article is a summary of the new ISPD recommendations for peritonitis prevention and treatment. The latter recommendations bring definition clarifications, and new targets with respect to the rates of peritonitis. It also brings new recommendations on the prevention and the management of peritonitis with new guidelines regarding empirical use of antibiotics, dosage, and treatment of peritonitis due to specific microorganisms. In case of doubt or need of precisions, the original article (https://doi.org/10.1177/08968608221080586) and the exhaustive list of references that it contains should be consulted.

MO682TAILORING AI-BASED REFERRAL TO INTENSIFIED INTERVENTION PROGRAMS FOR PERITONITIS PREVENTION WITH COST-EFFECTIVENESS SIMULATION

Abstract Background and Aims Peritonitis is a common and potentially severe complication for peritoneal dialysis (PD) patients. It is associated with mortality and technique failure risk and contributes significantly to their healthcare cost. Despite several peritonitis prevention programs based on education and training have been implemented worldwide, it has been reported a large variability of efficacy across patients groups and healthcare settings. In order to avoid unnecessary treatment of low risk patients, healthcare prevention programs should be personalized based on accurate patients’ risk profiling, so that high risk patients may be addressed with intensified prevention programs. However, referral strategy (i.e. defining when risk is too much and deserves special attention) depends the availability, efficacy and cost of medical interventions. In this study, we demonstrate through a program implementation simulator, how different referral strategies to inform peritonitis prevention program among PD patients informed by AI-based risk stratification tools, produce different healthcare and health economics outcomes. In particular, the simulation considers a prevention program characterized by standard of care, which affects all patients as well as an intensive intervention for a subset of high-risk patients (e.g. special training or medical treatment). Method The Peritonitis Risk Score model was trained and validated among 9325 PD patients treated in FMC network (Model accuracy, AUC=0.86). The pharmaco-economic model simulation was performed considering a cohort of 22,900 adult PD patients, treated in Fresenius Medical Care dialysis network between January 1, 2011 and December 31, 2018, for which the Peritonitis Risk Score was computed at a given date. The occurrence of an acute peritonitis in the month after prediction has been registered. We simulated the program outcomes in terms of proportion of referrals to the intensified prevention program, false omission rate, peritonitis risk reduction, overall cost-savings, number needed to treat. We considered the following scenario based on previous cost-effectiveness analysis on peritonitis risk prevention: Results Given the action threshold selected, 5.3% of patients entered the intensified intervention program (PPV=9.5%); the false omission rate was 2.2%. Cost savings for the intensified healthcare where generated when the effect size of the intensified intervention exceeded 1.4 (figure 1A). For that effect size the number needed to treat for each prevented peritonitis was NNT=23.4. Overall, 162 peritonitis/month could be prevented in the whole network (peritonitis with no intervention=592; Peritonitis after intervention=430). When a less conservative threshold was selected, 12.2% of patients entered the intensified prevention program (PPV=7.3%), generating a false omission rate=1.9%. Cost savings were never generated (i.e. the intensified program needed investment to be sustained) but with the same effect size of 1.4 additional 24 peritonitis/months could be saved in the whole network (peritonitis with no intervention=592; Peritonitis after intervention=406). The number needed to treat for the intensified program was NTT=30.4 (figure 1B). Conclusion Cost-effectiveness simulating tool provides a rational evaluation framework for AI-based referral to peritonitis preventive programs. This tool can be easily adapted for any healthcare program based on patient risk score.

Comparative effectiveness of lactulose and sennosides for the prevention of peritoneal dialysis-related peritonitis: an open-label, randomized, active-controlled trial

Background To the best of our knowledge, the effectiveness and safety of lactulose in comparison to sennosides, for the prevention of peritoneal dialysis (PD)-related peritonitis, has never been tested in a randomized study. Methods We conducted an open-label, randomized, active-controlled trial in a PD-center in Northern Thailand. Adult patients on PD were enrolled and randomly assigned in a 1:1 ratio into two groups; one group received lactulose 15 mL once daily (n = 50) and the other group received sennosides two tablets daily (n = 50). The primary outcome was time-to-first bacterial peritonitis. The secondary outcomes included a composite of bacterial peritonitis and all-cause mortality. Cox proportional hazards regression was calculated and presented as hazard ratios (HRs) with 95% confidence intervals (CIs). Results One hundred PD patients were recruited (50.0% men; mean age 55.5 ± 13.0 years) in this study. The baseline characteristics of the study participants were similar in both groups. No significant trend towards a higher risk of PD-related peritonitis was observed in the lactulose group (HR, 2.32 [95% CI, 0.92–5.83]; p = .051) compared to the sennosides group. Nevertheless, the secondary outcome was significantly higher in the lactulose group (HR, 2.77 [95% CI, 1.20–6.41]; p = .010). The incidence of adverse events was not substantially different between the two groups; however, diarrhoea was more frequent in the lactulose group (38.0% vs. 18.0%; p = .030) than in the sennosides group. Conclusions Treatment with lactulose is not more effective than sennosides and cannot be routinely recommended for the prevention of peritonitis among the PD population. TRIAL REGISTRATION Thai Clinical Trial Registry (clinicaltrials.in.th); ID: TCTR20171012001 KEY MESSAGE To the best of our knowledge, no randomized controlled trial that compares the efficacy and safety profiles of lactulose versus sennosides for the prevention of PD-related peritonitis among the PD population has been conducted. In this open-label, randomized, active-controlled trial, treatment with lactulose is not more effective than sennosides in the prevention of PD-related peritonitis, and it could increase the risk of bacterial PD-related peritonitis. Further studies with a larger sample size by incorporated real-world evidence are needed to confirm our findings and to explore strategies to prevent peritonitis among PD patients.

Relationship between initial peritoneal dialysis modality and risk of peritonitis

Peritonitis is a critical complication of peritoneal dialysis (PD). Investigators have reported the risk of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) versus automated peritoneal dialysis (APD), but the available evidence is predominantly based on observational studies which failed to report on the connection type. Our understanding of the relationship between peritonitis risk and PD modality thus remained insufficient. We studied 285 participants who began PD treatment between 1997 and 2014 at three hospitals in Nara Prefecture in Japan. We matched 106 APD patients with 106 CAPD patients based on their propensity scores. The primary outcome was time to first episode of peritonitis within 3 years after PD commencement. In total, PD peritonitis occurred in 64 patients during the study period. Patients initiated on APD had a lower risk of peritonitis than did those initiated on CAPD in both the unadjusted and adjusted models. The hazard ratio (HR) and 95% confidence interval (CI) for the primary endpoint were 0.30 (0.17–0.53) in the fully adjusted model including connection type. In the matched cohort, APD patients had a significantly lower risk of peritonitis than did CAPD patients (log-rank: p < 0.001, HR 0.32, 95% CI 0.16–0.59). The weighting-adjusted analysis of the inverse probability of treatment yielded a similar result (HR 0.35, 95% CI 0.18–0.67). In conclusion, patients initiated on APD at PD commencement had a reduced risk of peritonitis compared with those initiated on CAPD, suggesting APD may be preferable for prevention of peritonitis among PD patients.

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.

Factors influencing occurrence of peritonitis in Saudi children on peritoneal dialysis

BackgroundThe peritonitis rate among children treated with peritoneal dialysis (PD) has not been widely reported in Saudi Arabia. The study aim was to estimate the peritonitis rate per patient-year and investigate the factors associated with higher peritonitis rates in a sample of PD children at King Abdullah Specialist Children’s Hospital-Riyadh (KASCH-R), Saudi Arabia.MethodsThis retrospective cohort study included 27 PD children treated between September 2007 and December 2017 at KASCH-R. We recorded the children’s demographic and clinical data, and the frequency of peritonitis.ResultsThe 27 PD children reviewed (63% girls; mean age = 7.32 years old; range, 1–14 years), resulted in 86 peritonitis diagnoses in which the overall recurrence rate (in at least one episode) was 58/86 (67.4%) with a 95% confidence interval (CI), 56.5 to 77.2%. The rate of peritonitis episodes per patient-year was 0.76 (1 episode per 1.31 patient-year). The generalized Poisson model identified older children (age > 10 years) (adjusted rate ratios [aRR] = 7.273, 95% CI: 1.562–33.860), congenital nephrosis (aRR = 4.677, 95% CI: 1.443–15.155), height below 3rd percentile (aRR = 4.689, 95% CI: 1.874–11.735), weight below 3rd percentile (aRR = 5.388, 95% CI: 1.678–17.302), low albumin level (aRR = 4.041, 95% CI: 2.053–7.956), two-week duration of antibiotic therapy (aRR = 2.947, 95% CI: 1.163–7.468), which were independently associated with a high peritonitis rate.ConclusionsThis study showed a high peritonitis rate in our center. Older children, congenital nephrosis, height and weight below the 3rd percentile, low albumin level, and long duration of antibiotic therapy were associated with a higher rate of peritonitis. An optimal peritonitis prevention strategy or best-practice guideline is needed to reduce and prevent peritonitis occurrence in our center.

Retraining for prevention of peritonitis in peritoneal dialysis patients: A randomized controlled trial.

Peritonitis is more common in peritoneal dialysis (PD) patients nonadherent to the PD exchange protocol procedures than in compliant patients. We therefore investigated whether regular testing of PD knowledge with focus on infection prophylaxis could increase the time to first peritonitis (primary outcome) and reduce the peritonitis rate in new PD patients. This physician-initiated, open-label, parallel group trial took place at 57 centers in Sweden, Denmark, Norway, Finland, Estonia, Latvia, the Netherlands, and the United Kingdom from 2010 to 2015. New peritonitis-free PD patients were randomized using computer-generated numbers 1 month after the start of PD either to a control group (n = 331) treated according to center routines or to a retraining group (n = 340), which underwent testing of PD knowledge and skills at 1, 3, 6, 12, 18, 24, 30, and 36 months after PD start, followed by retraining if the goals were not achieved. In all, 74% of the controls and 80% of the retraining patients discontinued the study. The groups did not differ significantly regarding cumulative incidence of first peritonitis adjusted for competing risks (kidney transplantation, transfer to hemodialysis and death; hazard ratio 0.84; 95% confidence interval (CI) 0.65-1.09) nor regarding peritonitis rate per patient year (relative risk 0.93; 95% CI 0.75-1.16). In this randomized controlled trial, we were unable to demonstrate that regular, targeted testing and retraining of new PD patients increased the time to first peritonitis or reduced the rate of peritonitis, as the study comprised patients with a low risk of peritonitis, was underpowered, open to type 1 statistical error, and contamination between groups.

SUN-079 INTERNATIONAL VARIATION IN PERITONEAL DIALYSIS-RELATED PERITONITIS RATES AND CLINICAL OUTCOMES: THE PERITONEAL DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY (PDOPPS)

Peritoneal dialysis (PD)-associated peritonitis is a significant source of morbidity, dialysis-related treatment costs, and is the leading cause of permanent transfer to hemodialysis (HD). Here, we sought to understand if the risks of peritonitis and peritonitis-related outcomes differ by country and to identify patient and clinic/facility predictors of peritonitis. Peritonitis infection data from PDOPPS 1 (2015-2018) in Australia/New Zealand, Canada, Japan, Thailand, the UK, and the US were analyzed. Infections occurring within 21 days of a previous case, or infection by the same organism within 50 days of initial presentation were excluded per ISPD guidelines. We investigated several facility and patient factors associated with peritonitis using covariate-adjusted proportional-rates models. We estimated the proportion of events with cure, hospitalization, re-infection, catheter removal, permanent HD transfer, or death within 50 days of initial presentation using covariate-adjusted logistic regression models. Adjustment variables included age, sex, black race (US only), ESRD vintage, serum albumin, residual Kt/V, and 13 summary comorbidities. During 7455 patient-years of observation, we observed 1677 peritonitis events among 4618 patients across 143 facilities. Peritonitis rates (episodes per patient-year) varied from 0.19 in Japan to 0.27 in Australia/ New Zealand (TABLE). Gram-positive peritonitis rates ranged from 0.06 in Thailand to 0.11 in Australia/New Zealand and Canada. Gram-negative peritonitis rates ranged from 0.03 in Japan to 0.07 in Thailand. Culture negative peritonitis rates were highest in Thailand (0.07). The proportion of cases cured with antibiotics ranged from 55% in Thailand to 68% in Japan. The proportion of cases complicated by technique failure or death ranged from 16% in Japan to 27% in Thailand (TABLE). In adjusted analyses, lower peritonitis rates were observed in patients with higher serum albumin (HR=0.89 per 1 g/dl; 95% CI=0.80, 0.98), higher residual Kt/V (HR=0.79; 95% CI=0.65, 0.98); higher peritonitis rates were observed in patients with GI bleeding (HR=1.45; 95% CI=1.04, 2.02). Lower peritonitis rates were associated with facility use of antibiotic prophylaxis during catheter insertion (HR=0.68, 95% CI=0.52, 0.88) and use of exit-site gentamicin prophylaxis (HR=0.86, 95% CI=0.59, 1.25) or exit-site mupirocin prophylaxis (HR=0.83, 95% CI=0.61, 1.12) compared to none.View Large Image Figure ViewerDownload Hi-res image Download (PPT) In the largest international cohort of PD patients to date, we have demonstrated significant variations in peritonitis incidence and outcomes by country. In Thailand, a PD-first country with more limited resources, peritonitis incidence was comparable to other countries. However, a higher culture-negative peritonitis rate and significantly higher peritonitis-related adverse outcomes in Thailand compared to other countries (higher death, lower cure) suggest opportunities to improve peritonitis diagnosis and treatment. As a clinical practice, exit-site antimicrobial prophylaxis remains a mainstay of peritonitis prevention. Further investigation into the optimal exit site antimicrobial agent will be explored in PDOPPS along with other peritonitis prevention strategies.

Peritonitis Due to Rothia dentocariosa in Iran: A Case Report

Rothia dentocariosa (R. dentocariosa) is a gram-positive bacterium, which is a microorganism that normally resides in the mouth and respiratory tract. R. dentocariosa is known to involve in dental plaques and periodontal diseases. However, it is considered an organism with low pathogenicity and is associated with opportunistic infections. Originally thought not to be pathogenic in humans, R. dentocariosa was first described to cause infections in a 19-year-old female with periappendiceal abscess in 1975. The most prevalent human infections caused by R. dentocariosa include infective endocarditis, bacteremia, endophthalmitis, corneal ulcer, septic arthritis, pneumonia, and peritonitis associated with continuous ambulatory peritoneal dialysis. Three main factors have been reported to increase the risk of the cardiac and extra-cardiac infections caused by R. dentocariosa, including immunocompromised conditions, pre-existing cardiac disorders, and poor oral hygiene. Peritoneal dialysis (PD) may induce peritonitis presumably due to hematogenous spread from gingival or periodontal sources. This case study aimed to describe a former PD patient presenting with peritonitis. Oral hygiene is a basic principle in PD patients for the prevention of peritonitis. It is speculated that our patient might have had an occult oral source of R. dentocariosa.

Peritoneal Dialysis Access Associated Infections.

Infection is a significant driver of morbidity and mortality in patients with end-stage renal disease undergoing maintenance dialysis. In the United States, septicemia and other infections account for 8% deaths in patients undergoing dialysis. In patients undergoing peritoneal dialysis (PD), PD-related peritonitis remains the most frequent treatment-related infection and is the greatest contributor to infection-related morbidity, including risk for hospitalization, and temporary or permanent transfer to hemodialysis. In the 4 decades since the introduction of ambulatory PD in clinical practice, a large number of treatment innovations have been shown to be effective in reducing the risk for exit site infection and PD-related peritonitis. Notwithstanding the evidence for efficacy of these innovations and the numerous adverse health consequences with PD-related peritonitis, the uptake of these interventions in clinical practice around the world remains inconsistent. This article reviews current knowledge with regards to prevention of PD-associated infections, and the diagnosis and management of exit site infections and peritonitis.

Role of Rifaximin in Spontaneous Bacterial Peritonitis Prevention.

Cirrhosis affects millions of people around the world and is associated with increased morbidity and mortality. Spontaneous bacterial peritonitis (SBP) is a common complication of liver disease with cirrhosis and accounts for up to 30% of infections in patients with cirrhosis. Patients with a history of SBP and those deemed to be at high risk often are prescribed antibiotics to reduce the incidence of SBP. Fluoroquinolones and sulfamethoxazole-trimethoprim are commonly used antibiotics for long-term prevention for these specified populations; however, these antibiotics are associated with several adverse effects and interactions that may be harmful to patients. In addition, resistance development may decrease the efficacy of SBP treatment and prophylaxis. Given these limitations, rifaximin, a nonabsorbable, broad-spectrum antibiotic that is used for hepatic encephalopathy, may serve as a prophylactic alternative to conventional therapy. This review discusses guideline-recommended therapy and the evidence for using rifaximin for SBP prophylaxis.