Efficacy of a non‐vancomycin‐based peritoneal dialysis peritonitis protocol

Toussaint, Nigel D; Mullins, Kim; Snider, Jonathon; Murphy, Brendan; Langham, Robyn G; Gock, Hilton

doi:10.1111/j.1440-1797.2005.00379.x

Cited by 4 publications

(3 citation statements)

References 26 publications

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“…Some previous clinical studies have demonstrated that empirical therapy with first‐generation cephalosporin and gentamicin has a similar efficacy to regimens using second‐line antibiotics (22,23); however, some studies did not have such favorable results (14,24). In this study the efficacy of an empirical regimen with intermittent intraperitoneal first‐generation cephalosporin and gentamicin was poor.…”

Section: Discussionmentioning

confidence: 61%

Positive Dialysate Gram Stain Predicts Outcome of Empirical Antibiotic Therapy for Peritoneal Dialysis‐associated Peritonitis

et al. 2010

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Empirical antibiotic treatment with a first-generation cephalosporin plus gentamicin for peritoneal dialysis (PD)-associated peritonitis before culture results are available is still wildly used due to concerns regarding the economic burden and antibiotic-resistant bacterial infections. The aim of this study is to define the factors that predict the outcome of empirical antibiotic therapy for PD peritonitis. This is a retrospective study of patients with PD peritonitis over the last 10 years. Patients who had been treated empirically with intermittent intraperitoneal first-generation cephalosporin and gentamicin were enrolled. Eighty-three patients had 192 episodes of PD peritonitis. In total, 159 peritonitis episodes were treated with intraperitoneal antibiotics combined with first-generation cephalosporin and gentamicin empirically. Twenty-five peritonitis episodes had no pathogens identified by dialysate culture. In total, 122 (122/159, 76.7%) PD peritonitis episodes were caused by bacteria, 9 (9/159, 5.7%) were fungal, and 3 (3/159, 1.9%) were Mycobacterium tuberculosis peritonitis. Sixty-four (64/159, 40.3%) peritonitis episodes were successfully cured by empirical intraperitoneal antibiotic therapy. Empirical antibiotic treatment failed in 95 episodes (95/159, 59.7%). The positive rates of dialysate Gram stain in the empirical treatment success and failure groups were 15.6% and 40.0%, respectively (P = 0.001). The odds ratio of empirical treatment failure with a positive bacteria Gram stain was 3.60 (95% CI: 1.65-7.82). The dialysate Gram staining result was a significant predictor of empirical antibiotics treatment outcome for PD-associated peritonitis. Therefore, using an empirical antibiotic regimen for patients with an initial positive bacterial Gram stain of the dialysate should be introduced cautiously.

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Section: Discussionmentioning

confidence: 61%

Positive Dialysate Gram Stain Predicts Outcome of Empirical Antibiotic Therapy for Peritoneal Dialysis‐associated Peritonitis

et al. 2010

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“…This resolution rate was significantly higher than initial treatment with a first generation cephalosporin plus aminoglycosides (pooled proportion of 66%, 95%CI: 0.57-0.75) from 14 studies [25][26][27][28][29][30][31][32][33][34][35][36][37][38] with a total of 1438 total episodes (Figure 1). Initial treatment with ceftazidime plus a glycopeptide also showed a higher resolution rate than a glycopeptide plus aminoglycosides (pooled proportion of 75%, 95%CI: 0.69-0.80), which was used in 16 studies [29][30][31][38][39][40][41][42][43][44][45][46][47][48][49][50] For treatment of episodes due to gram-positive rods, the pooled resolution rate from 13 [23,39,40,48,49,[51][52][53][54][55][56][57][58] studies with a total of 917 episodes was 78% (95%CI: 0.66-0.88) for a glycopeptide, while the rates from five studies [26,…”

Section: Systematic Reviewsmentioning

confidence: 99%

“…The only third generation cephalosporin we analyzed Comparisons of episodes due to gram-negative rods showed that the pooled proportion resolution rate from nine studies [39,40,49,57,[60][61][62][63] with a total of 138 episodes was 68% (95%CI: 0.50-0.85) for a quinolone. For ceftazidime, the resolution rate was 61% (95%CI: 0.53-0.70) from three studies [33,63,64] with a total of 117 episodes, and for aminoglycosides the resolution rate was 65% (95%CI: 0.51-0.77) from nine studies [23,26,31,39,40,49,55,60,61] with a total of 211…”

Section: Proportional Meta-analysismentioning

confidence: 99%

Evidence-based medicine: An update on treatments for peritoneal dialysis-related peritonitis

Barretti

Doles

Pinotti

et al. 2015

WJN

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Peritonitis continues to be a major complication of peritoneal dialysis (PD), and adequate treatment is crucial for a favorable outcome. There is no consensus regarding the optimal therapeutic regimen, and few prospective controlled studies have been published. The objective of this manuscript is to review the results of PD peritonitis treatment reported in narrative reviews, systematic reviews, and proportional meta-analyses. Two narrative reviews, the only existing systematic review and its update published between 1991 and 2014 were included. In addition, we reported the results of a proportional metaanalysis published by our group. Results from systematic reviews of randomized control trials (RCT) and quasi-RCT were not able to identify any optimal antimicrobial treatment, but glycopeptide regimens were more likely to achieve a complete cure than a first generation cephalosporin. Compared to urokinase, simultaneous catheter removal and replacement resulted in better outcomes. Continuous and intermittent IP antibiotic use had similar outcomes. Intraperitoneal antibiotics were superior to intravenous antibiotics in reducing treatment failure. In the proportional meta-analysis of RCTs and the case series, the resolution rate (86%) of ceftazidime plus glycopeptide as initial treatment was significantly higher than first generation cephalosporin plus aminoglycosides (66%) and glycopeptides plus aminoglycosides (75%). Other comparisons of regimens used for either initial treatment or treatment of gram-positive rods or gramnegative rods did not show statistically significant differences. The superiority of a combination of a glycopeptide and a third generation cephalosporin was also reported by a narrative review study published in 1991, which reported an 88% resolution rate. Core tip: This manuscript revised the data from narrative and systematic review, as well as those from a proportional meta-analysis study, regarding comparisons between antibiotic regimens used to peritoneal dialysis-related treatment, empathizing protocols for initial treatment. There is no consensus on the best treatment and the only published systematic review and its recent update have failed to find superiority of any regimen. This type of analysis, commonly excludes several studies, some of them with a great number of cases. Therefore, this review intends to contribute in this issue analyzing the results from different types of reviews. MINIREVIEWSBarretti P, Doles JVP, Pinotti DG, El Dib RP. Evidence-based medicine: An update on treatments for peritoneal dialysis-related peritonitis. World J Nephrol 2015; 4(2): 287-294 Available from:

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Comparison of biochemical, haematological and volume parameters in two treatment schedules of nocturnal home haemodialysis

et al. 2006

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The authors conclude that NHHD6 offers the optimum biochemical, volume and clinical outcome, but NHHD3.5 has additional appeal to providers seeking home-based therapy cost advantages and consumable expenditure control. A flexible dialysis programme should offer all the time and frequency options of NHHD but in particular, should support NHHD at a frequency sympathetic to the clinical rehabilitation and lifestyle aspirations of individual patients.

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Efficacy of a non‐vancomycin‐based peritoneal dialysis peritonitis protocol

Abstract: We advocate initial treatment of PD peritonitis with non-vancomycin-based therapy given similar efficacy and the potential for reduction of resistant organisms.

Cited by 4 publications

References 26 publications

Positive Dialysate Gram Stain Predicts Outcome of Empirical Antibiotic Therapy for Peritoneal Dialysis‐associated Peritonitis

Positive Dialysate Gram Stain Predicts Outcome of Empirical Antibiotic Therapy for Peritoneal Dialysis‐associated Peritonitis

Evidence-based medicine: An update on treatments for peritoneal dialysis-related peritonitis

Comparison of biochemical, haematological and volume parameters in two treatment schedules of nocturnal home haemodialysis

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