Inconsistencies in ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment and the ISPD Catheter-Related Infection Recommendations: 2017 Update

Mancini, Ann; Todd, Lucy B

doi:10.3747/pdi.2018.00026

Cited by 11 publications

(12 citation statements)

References 10 publications

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“…This can lead to lower plasma and IP antibiotic concentrations, resulting in possible treatment failure, especially with intermittent dosing of predominantly renally cleared antibiotics. However, the 2016 ISPD recommendations have removed the recommendation of dose adjustments 4 based on the presence of RRF, as the proposed dose increment by 25% deemed necessary in RRF patients is controversial 35,59,60 and needs further studies.…”

Section: Resultsmentioning

confidence: 99%

Pharmacokinetics of culture-directed antibiotics for the treatment of peritonitis in automated peritoneal dialysis: A systematic narrative review

et al. 2021

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The objectives of this study were to provide a summary of the pharmacokinetic data of some intraperitoneal (IP) antibiotics that could be used for both empirical and culture-directed therapy, as per the ISPD recommendations, and examine factors to consider when using IP antibiotics for the management of automated peritoneal dialysis (APD)-associated peritonitis. A literature search of PubMed, EMBASE, Scopus, MEDLINE and Google Scholar for articles published between 1998 and 2020 was conducted. To be eligible, articles had to describe the use of antibiotics via the IP route in adult patients ≥18 years old on APD in the context of pharmacokinetic studies or case reports/series. Articles describing the use of IP antibiotics that had been recently reviewed (cefazolin, vancomycin, gentamicin and ceftazidime) or administered for non-APD-associated peritonitis were excluded. A total of 1119 articles were identified, of which 983 abstracts were screened. Seventy-three full-text articles were assessed for eligibility. Eight records were included in the final study. Three reports had pharmacokinetic data in patients on APD without peritonitis. Each of cefepime 15 mg/kg IP, meropenem 0.5 g IP and fosfomycin 4 g IP given in single doses achieved drug plasma concentrations above the minimum inhibitory concentration for treating the susceptible organisms. The remaining five records were case series or reports in patients on APD with peritonitis. While pharmacokinetic data support intermittent cefepime 15 mg/kg IP daily, only meropenem 0.5 g IP and fosfomycin 4 g IP are likely to be effective if given in APD exchanges with dwell times of 15 h. Higher doses may be required in APD with shorter dwell times. Information on therapeutic efficacy was derived from case reports/series in individual patients and without therapeutic drug monitoring. Until more pharmacokinetic data are available on these antibiotics, it would be prudent to shift patients who develop peritonitis on APD to continuous ambulatory peritoneal dialysis, where pharmacokinetic information is more readily available.

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Section: Resultsmentioning

confidence: 99%

Pharmacokinetics of culture-directed antibiotics for the treatment of peritonitis in automated peritoneal dialysis: A systematic narrative review

et al. 2021

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“…The routine evaluation of the ES is a common practice in the country and recommended as part of a good PD patient care by international guidelines and traditional textbooks. 1 –4,7,8 In Brazil, the five-component scale adapted by Schaefer is routinely used and was the reference for all clinics participating in the BRAZPD study. The clinical signs evaluated during the inspection of the ES were the presence of granuloma, scab, edema, hyperemia, purulent drainage, and pain during palpation.…”

Section: Discussionmentioning

confidence: 99%

“…1 –6 The diagnosis is made in the presence of purulent drainage according to the International Society for Peritoneal Dialysis (ISPD) recommendations. 7,8 However, local signs as hyperemia, pain, scab, and edema around the exit site (ES) frequently raise concerns for patients and the nephrology team that something is wrong and the possibility of an ESI is real.…”

Section: Introductionmentioning

confidence: 99%

Clinical utility of a traditional score system for the evaluation of the peritoneal dialysis exit-site infection in a national multicentric cohort study

et al. 2020

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Introduction: Exit-site infection (ESI) is an important risk factor for peritonitis in patients under chronic peritoneal dialysis (PD). The International Society for Peritoneal Dialysis (ISPD) recommend its diagnosis as the presence of purulent drainage in the exit site (ES) but time-consuming scores using others skin signs are routinely used. Objective: To investigate the correlation between the diagnosis of ESI with a score based on five clinical signs obtained from ES inspection, and also if there are interaction with patient’s race. Methods: Multicenter and prospective cohort. We included adult patients from 122 clinics, incident on PD and with a 12-month stay in therapy. The event of interest was ESI, defined as purulent drainage. The clinical score used was composed of hyperemia, edema, pain, scab, and granuloma. Statistical analysis was performed using multilevel logistic regression model, likelihood test, and Cohen concordance analysis. Results: A total of 35,354 ES assessments were performed during the first year of dialysis in 3297 patients. There was a rate of 10.1 (9.1–11.2) episodes of ESI per 1000 patients/month. In patients with ESI, the prevalence of hyperemia was 55.9%, edema 67.3%, pain 31.8%, and scab 23.2%. The agreement with the score was 60.6% and showed differences according to the patient’s race, being 53.2% for African Americans descendants and 65.4% for others. The use of scales for the diagnosis of ESI does not add much information in addition to the presence of purulent secretion as currently recommended by the ISPD.

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“…Peritonitis is a major complication of PD and is the one that may dissuade end-stage renal disease patients from choosing this form of renal replacement therapy [ 1 ]. The incidence of C .…”

Section: Discussionmentioning

confidence: 99%

Clostridium difficilePeritonitis: An Emerging Infection in Peritoneal Dialysis Patients

Chaughtai

Gandhi

Chaughtai

et al. 2018

Case Reports in Medicine

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Recently, the incidence of Clostridium difficile- (C. difficile-) associated infection has increased significantly in hospital and ambulatory care settings in parallel to the increasing use of inappropriate antibiotics. According to the CDC, approximately 83,000 patients who developed C. difficile experienced at least one recurrence and 29,000 died within 30 days of the initial diagnosis. Patients on dialysis (particularly peritoneal dialysis) are predisposed to this infection due to an inherent immunocompromised state and transmural translocation of the bacteria due to the close association of gastrointestinal tract and peritoneal cavity. C. difficile infection in peritoneal dialysis patients is problematic from two aspects: (1) because dialysis patients are immunocompromised, the infection can be devastating and (2) infection directly interferes with their renal replacement therapy. In this article, we present a case of peritoneal dialysis (PD)-related peritonitis caused by C. difficile-associated diarrhea and colitis. In this patient, the peritonitis was caused by transmural translocation of the enteric bacteria. While the peritoneal fluid culture did not grow the organism (possibly because of prior empiric broad-spectrum antibiotics use), the positive PCR on stool analysis suggested C. difficile-related peritonitis, along with the rapid clinical improvement induced by C. difficile-directed therapy (metronidazole) and discontinuation of broad-spectrum antibiotics. The patient was successfully treated with metronidazole without PD catheter removal. C. difficile infection is common and frequently internists are the first contact with such patients. This article highlights C. difficile infection in a PD patient and raises awareness of this infection in dialysis patients.

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Inconsistencies in ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment and the ISPD Catheter-Related Infection Recommendations: 2017 Update

Cited by 11 publications

References 10 publications

Pharmacokinetics of culture-directed antibiotics for the treatment of peritonitis in automated peritoneal dialysis: A systematic narrative review

Pharmacokinetics of culture-directed antibiotics for the treatment of peritonitis in automated peritoneal dialysis: A systematic narrative review

Clinical utility of a traditional score system for the evaluation of the peritoneal dialysis exit-site infection in a national multicentric cohort study

Clostridium difficilePeritonitis: An Emerging Infection in Peritoneal Dialysis Patients

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