Clinical features and risk factors of catheter removal among 1062 episodes of peritoneal dialysis‐associated peritonitis: A multicenter 7‐year study

Liu, Shichen; Yang, Li‐Ming; Zhu, Xueyan; Zhang, Xiaoxuan; Meng, Lingfei; Li, Xinyang; Zhao, Jing; Zhuang, Xiaohua; Cui, Wenpeng

doi:10.1111/1744-9987.13956

Cited by 3 publications

(3 citation statements)

References 29 publications

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“…The average peritonitis rate was 0.225 episodes/patient-year in our study from 2013 to 2019, and per the ISPD recommendations updated in 2022, the requirement is no more than 0.4 episodes per patient-year, indicating that the incidence of peritonitis was relatively well controlled in the hospitals where this study was conducted. Another study from our center pointed out that the incidence of PDAP has decreased in recent years ( 18 ), and our study also observed that the incidence of MDRO-PDAP was similarly decreasing between 2013–2019. However, MDRO-PDAP remains a serious challenge for clinicians because of increasing drug resistance among bacteria.…”

Section: Discussionsupporting

confidence: 81%

Multidrug-resistant organism-peritoneal dialysis associated peritonitis: clinical and microbiological features and risk factors of treatment failure

et al. 2023

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BackgroundMultidrug-resistant (MDR) bacterial infection causes difficulty in the therapy of peritoneal dialysis-associated peritonitis (PDAP); however, there are few studies on multidrug-resistant organism (MDRO)-PDAP. In view of growing concerns about MDRO-PDAP, the aim of this study was to investigate the clinical features, risk factors of treatment failure, and causative pathogens of MDRO-PDAP.MethodsIn total, 318 patients who underwent PD between 2013 and 2019 were included in this multicenter retrospective study. Clinical features, patient outcomes, factors related to treatment failure, and microbiological profiles associated with MDRO-PDAP were analyzed and risk factors for treatment failure associated with MDR-Escherichia coli (E. coli) were further discussed.ResultsOf 1,155 peritonitis episodes, 146 eligible episodes of MDRO-PDAP, which occurred in 87 patients, were screened. There was no significant difference in the composition ratio of MDRO-PDAP between 2013–2016 and 2017–2019 (p > 0.05). E. coli was the most prevalent MDRO-PDAP isolate, with high sensitivity to meropenem (96.0%) and piperacillin/tazobactam (89.1%). Staphylococcus aureus was the second most common isolate and was susceptible to vancomycin (100%) and linezolid (100%). Compared to non-multidrug-resistant organism-PDAP, MDRO-PDAP was associated with a lower cure rate (66.4% vs. 85.5%), higher relapse rate (16.4% vs. 8.0%), and higher treatment failure rate (17.1% vs.6.5%). Dialysis age [odds ratio (OR): 1.034, 95% confidence interval (CI): 1.016–1.052, p < 0.001] and >2 previous peritonitis episodes (OR: 3.400, 95% CI: 1.014–11.400, p = 0.047) were independently associated with treatment failure. Furthermore, longer dialysis age (OR: 1.033, 95% CI: 1.003–1.064, p = 0.031) and lower blood albumin level (OR: 0.834, 95% CI: 0.700–0.993, p = 0.041) increased the risk of therapeutic failure for MDR-E. coli infection.ConclusionThe proportion of MDRO-PDAP has remained high in recent years. MDRO infection is more likely to result in worse outcomes. Dialysis age and previous multiple peritonitis infections were significantly associated with treatment failure. Treatment should be promptly individualized based on local empirical antibiotic and drug sensitivity analyses.

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Section: Discussionsupporting

confidence: 81%

Multidrug-resistant organism-peritoneal dialysis associated peritonitis: clinical and microbiological features and risk factors of treatment failure

et al. 2023

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“…[ 15 ] and Liu et al. [ 12 ] reported that dialysate leukocyte count >100 × 10 6 /L on day 5 is a predictor of treatment failure and catheter removal in patients with PDAP. In the ISPD guideline 2022s, refractory peritonitis was defined as failure of the PD effluent to clear after 5 days of appropriate antibiotics, and PD catheter removal was recommended for this situation to prevent morbidity and mortality associated with treatment failure, although the evidence underpinning this recommendation is limited [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Association between dialysis effluent leukocyte count after initial antibiotic treatment and outcomes of patients with peritoneal dialysis-associated peritonitis: a retrospective study

Hong,

Wang,

et al. 2023

Renal Failure

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Background Among patients with peritoneal dialysis-associated peritonitis (PDAP), It has been regarded as an indicator of deterioration of clinical condition that peritoneal dialysis effluent leukocyte count (PDELC) cannot be restored to normal after initial antibiotic therapy. However, the precise relationship between PDELC on day 5 and the clinical outcomes of PDAP episodes remains uncertain. Aims To explore the association between PDELC on day 5 and clinical outcomes of PDAP episodes. Methods This retrospective study was based on the medical chart database of the Affiliated Hospital of Guangdong Medical University. Multivariable regressions were used to evaluate the association between PDELC on day 5 and 60-day mortality, half-year mortality, treatment failure, and the length of stay in hospital with adjustment for confounding factors. Results A total of 549 PDAP episodes in 309 patients were enrolled. The total 60-day mortality, half-year mortality, and rate of treatment failure was 6.0%, 9.8%, and 14.2%, respectively. Compared with patients with normal PDELC, those with PDELC ≥2000 × 10 6 /L on day 5 had significantly higher 60-day mortality (31.1% vs 2.7%), half-year mortality (35.6% vs 5.6%), and treatment failure (46.7% vs 5.7%). In multivariate adjusted regression, the ORs (95%CI) were 6.99 (2.33, 20.92; p = 0.001), 4.97(1.93, 12.77; p = 0.001), and 5.77 (2.07, 16.11; p = 0.001), respectively. Patients with PDELC were 100–2000 × 10 6 /L on day 5 had a higher rate of treatment failure than those with normal PDELC (26.9% vs 5.7%) (OR = 3.03, 95%CI 1.42, 6.46; p = 0.004). After sensitivity analysis, the results remained robust. Conclusions Among patients with PDAP, increased PDELC on day 5 was associated with a greater risk of 60-day mortality, half-year mortality, and treatment failure.

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“…While prior literature has suggested a potential reduction in peritonitis risk in APD patients, our research uncovered a statistically significant difference, with 56.0% of cases occurring in APD compared to 44.0% in CAPD (p < 0.001). The observed variation prompts further inquiry into factors that may contribute to these differences, including patient demographics, adherence to aseptic techniques, and the potential impact of the automated nature of APD [28,29]. Understanding and addressing these nuances in peritonitis risk across peritoneal dialysis modalities is crucial for optimizing patient care and outcomes in the long-term management of end-stage renal disease.…”

Section: Discussionmentioning

confidence: 99%

Ten-Year Single-Center Study Examining Patient Survival after Commencing Long-Term Peritoneal Dialysis

Venegas-Ramírez,

Barrios-Mora,

Ríos-Bracamontes

et al. 2023

JCM

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In patients with end-stage kidney disease (ESKD), peritoneal dialysis (PD) is increasingly being adopted in developing nations due to its cost-effectiveness and advantages as a home-based treatment. However, the survival outcomes of chronic PD patients in Mexico, where the burden of ESKD is high, remain poorly understood. This study aimed to assess the survival experience of long-term PD patients and evaluate its determinants. A single-center cohort study collected clinical and epidemiological data for long-term PD initiations between February 2013 and January 2023. The analysis, which utilized Kaplan–Meier and Cox proportional hazard regression methods, included data from 370 patients. The overall mortality rate was 4.7 per 1000 person-months, with a significant decrease in survival rates observed between months 24 and 36 post-PD initiation. Older age at PD initiation and the use of continuous ambulatory peritoneal dialysis, as compared to the automated modality, were associated with an increased risk of mortality. The study provides valuable insights into the survival outcomes of chronic PD patients in Mexico and suggests the need to optimize treatment strategies to enhance long-term prognoses for patients with ESKD. Further research is needed to better understand the factors influencing survival in this population.

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Clinical features and risk factors of catheter removal among 1062 episodes of peritoneal dialysis‐associated peritonitis: A multicenter 7‐year study

Cited by 3 publications

References 29 publications

Multidrug-resistant organism-peritoneal dialysis associated peritonitis: clinical and microbiological features and risk factors of treatment failure

Multidrug-resistant organism-peritoneal dialysis associated peritonitis: clinical and microbiological features and risk factors of treatment failure

Association between dialysis effluent leukocyte count after initial antibiotic treatment and outcomes of patients with peritoneal dialysis-associated peritonitis: a retrospective study

Ten-Year Single-Center Study Examining Patient Survival after Commencing Long-Term Peritoneal Dialysis

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