Background The incidence of elderly patients receiving peritoneal dialysis (PD) has increased. This study aimed to examine the clinical presentation and outcomes of peritonitis in elderly PD patients compared with younger PD patients. Methods This single-center, retrospective, observational cohort study included all adult PD patients who developed peritonitis between January 2011 and December 2014. Elderly was defined as ≥ 65 years old at PD initiation. The primary outcome was medical cure, defined as a peritonitis episode cured by antibiotics without being complicated by catheter removal, transfer to hemodialysis (HD), relapsing peritonitis, or death. The secondary outcomes were clinical manifestations (fever, cloudy dialysate) and complications (catheter removal, transfer to HD, relapse, hospitalization, and mortality). Peritonitis outcomes were compared using multivariable logistic regression. Results Overall, 377 peritonitis episodes occurred in 247 patients. Of these, 126 episodes occurred in 79 elderly patients and 251 episodes occurred in 168 younger patients. Baseline demographic data were comparable between the 2 groups, except that elderly patients were significantly more likely to have diabetes mellitus (66% vs 46%), diabetic nephropathy (55% vs 39%), and a lower serum albumin than younger patients. Medical cure was comparable between the 2 groups (71% vs 72%, respectively, p = 0.67, adjusted odds ratio [AOR] 0.89, 95% confidence interval [CI]: 0.52 – 1.53). Compared with younger patients, elderly patients experiencing peritonitis had lower odds of fever (OR 0.53, 95% CI: 0.30 – 0.94), cloudy dialysate (OR 0.45, 95% CI: 0.23 – 0.88), and catheter removal (AOR 0.50, 95% CI: 0.26 – 0.98), but similar odds of transfer to HD (AOR 0.70, 95% CI: 0.32 – 1.51), relapse (AOR 1.57, 95% CI: 0.46 – 5.40), hospitalization (AOR 1.55, 95% CI: 0.52 – 4.56), and all-cause mortality (AOR 1.88, 95% CI: 0.83 – 4.26). Conclusions Compared with younger patients, elderly PD patients with peritonitis achieved similar medical cure rates, a lower catheter removal rate, and comparable rates of HD transfer, relapse, hospitalization, and death. Elderly PD patients experiencing peritonitis were less likely to present with fever or cloudy dialysate.

Background Vancomycin therapeutic drug monitoring (TDM) is commonly performed to ensure safe and effective use of the antibiotic. Aim of Study To evaluate appropriateness of vancomycin TDM and its outcomes in Singapore General Hospital. Method A retrospective, cross-sectional study was conducted between 1 January 2014 and 28 February 2014 involving patients who received ≥ 1 dose of intravenous vancomycin with TDM. Patient demographics and relevant vancomycin TDM data were collected from medical records. Results Of 746 vancomycin troughs measured among 234 patients, 459 troughs (61.5%) were taken inappropriately, with a median time of 2.6 h (interquartile range 1.1-4.3) before the next scheduled dose. Inappropriate interpretation of vancomycin troughs resulted in 41 unnecessary dose suspensions, 24 dose changes, and 102 unchanged vancomycin doses. The cost incurred due to inappropriate interpretation and measurement after discontinuation of treatment was US$7286. No differences in rates of vancomycin related nephrotoxicity, ototoxicity, recurrent infection, development of infection secondary to vancomycin resistant microorganism and mortality were observed (p > 0.05). Conclusion This study highlighted a high incidence of inappropriate vancomycin TDM which has led to increased healthcare cost.

Introduction: Chronic kidney disease-mineral and bone disease (CKD-MBD) is a complication of chronic kidney disease (CKD) involving derangements in serum calcium and phosphate. This study aims to evaluate hypo- and hypercalcaemia and their associated outcomes among pre-dialysis CKD patients. Methods: A retrospective cohort study was performed and included all adult CKD stage 4–stage 5 patients who were on treatment for CKD-MBD between 2016 and 2017. Each patient was followed up for 3 years. Hypo- and hypercalcaemia were defined as serum corrected calcium (Ca2+) <2.10 and >2.46 mmol/L, respectively. Outcomes evaluated included all-cause mortality and cardiovascular events. Multivariate Cox regression analysis was done to evaluate the association of hypocalcaemia and/or hypercalcaemia with the clinical outcomes. Severity of hypocalcaemia episode was classified as ‘mild’ (Ca2+: between 1.90 and 2.10 mmol/L) and ‘severe’ (Ca2+: <1.90 mmol/L). Severity of hypercalcaemia was classified as ‘mild’ (Ca2+: between 2.47 and 3.00 mmol/L), moderate (Ca2+: between 3.01 and 3.50 mmol/L) and severe (Ca2+: >3.50 mmol/L). Results: Of the 400 patients, 169 (42.2%) and 94 (23.5%) patients experienced hypocalcaemia and hypercalcaemia, respectively. Severe hypocalcaemia was more prevalent in CKD stage 5 compared to CKD stage 4 (96 [40.5%] vs. 36 [25.9%], P = 0.004). Results from multivariate analyses after adjustment showed that hypocalcaemia and/or hypercalcaemia were not associated with all-cause mortality (P > 0.05) or the occurrence of cardiovascular events (P > 0.05). Conclusion: Hypocalcaemia and hypercalcaemia episodes were prevalent among pre-dialysis CKD patients. Studies with longer follow-up durations are required to assess the effects of calcium derangements on clinical outcomes.

Purpose Combination antibiotics consisting beta-lactam and aminoglycoside are commonly utilized in the treatment of neonatal septicaemia. The aims of this study were (1) to determine safety and efficacy of the revised gentamicin dosage regimen and (2) to compare intravascular (IV) versus intramuscular (IM) route of gentamicin administration, in term of attaining peak and trough serum concentration targets. Methods This was a retrospective study from 2012 to 2017. All neonates who received gentamicin with therapeutic drug monitoring performed were included in this study. Data for all eligible neonates were collected from electronic medical records and included demographics, serum creatinine levels, the complete gentamicin dosing and concentration history. Results A total of 737 neonates who received the correct institutional gentamicin dosage regimen (± 5% of the intended dose) were included in this study. There were 635 trough concentrations (within 30 minutes prior to subsequent dose) and 430 peak concentrations (60 to 90 minutes post administration) included in the comparison of IV and IM route of administration. With the revised dosage regimen, 91% of peak and 98% of trough concentrations were found within therapeutic range. There was no difference in terms of proportion of trough concentrations within therapeutic range for IV as compared to IM (97.8 vs 98.6%, p = 0.556) while IM resulted in a higher proportion of peak concentrations within therapeutic range (86.1 vs 97.0%, p < 0.001). Conclusions The current institutional gentamicin dosage regimen is safe and effective in attaining therapeutic targets. Intramuscular injection can be an alternative route of administration for gentamicin in neonates.