Peritoneal dialysis catheter removal for acute peritonitis: a retrospective analysis of factors associated with catheter removal and prolonged postoperative hospitalization

Choi, P.; Nemati, E; Banerjee, Anindya; Preston, Emma; Levy, Jeremy; Brown, Edwina A.

doi:10.1053/j.ajkd.2003.08.046

Cited by 106 publications

(85 citation statements)

References 22 publications

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“…Peritonitis remains a major cause of patients discontinuing PD and switching to hemodialysis. Therefore, the PD community continues to focus attention on prevention and treatment of PD-related infections (1)(2)(3)(4)(5)(6)(7)(8)(9). Peritonitis treatment should aim for rapid resolution of inflammation and preservation of peritoneal membrane function.…”

mentioning

confidence: 99%

Peritoneal Dialysis-Related Infections Recommendations: 2010 Update

et al. 2010

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mentioning

confidence: 99%

Peritoneal Dialysis-Related Infections Recommendations: 2010 Update

et al. 2010

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“…P. aeruginosa infections in PD patients are associated with catheter loss, hospitalization, peritoneal membrane failure, and sometimes death (4,8 -15,28,29). Previous studies, including those from our center, show that morbidity and technique survival are seriously affected by P. aeruginosa infections in PD patients (7,17,30,31). Catheter removal was not a primary outcome in the present study; therefore, there was inadequate statistical power to examine catheter loss from infection.…”

Section: Discussionmentioning

confidence: 99%

Randomized, Double-Blind Trial of Antibiotic Exit Site Cream for Prevention of Exit Site Infection in Peritoneal Dialysis Patients

Bernardini¹,

Bender²,

Florio³

et al. 2005

Journal of the American Society of Nephrology

217

174

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Infection is the Achilles heel of peritoneal dialysis. Exit site mupirocin prevents Staphylococcus aureus peritoneal dialysis (PD) infections but does not reduce Pseudomonas aeruginosa or other Gram-negative infections, which are associated with considerable morbidity and sometimes death. Patients from three centers (53% incident to PD and 47% prevalent) were randomized in a double-blinded manner to daily mupirocin or gentamicin cream to the catheter exit site. Infections were tracked prospectively by organism and expressed as episodes per dialysis-year at risk. A total of 133 patients were randomized, 67 to gentamicin and 66 to mupirocin cream. Catheter infection rates were 0.23/yr with gentamicin cream versus 0.54/yr with mupirocin (P ‫؍‬ 0.005). Time to first catheter infection was longer using gentamicin (P ‫؍‬ 0.03). There were no P. aeruginosa catheter infections using gentamicin compared with 0.11/yr using mupirocin (P < 0.003). S. aureus exit site infections were infrequent in both groups (0.06 and 0.08/yr; P ‫؍‬ 0.44). Peritonitis rates were 0.34/yr versus 0.52/yr (P ‫؍‬ 0.03), with a striking decrease in Gram-negative peritonitis (0.02/yr versus 0.15/yr; P ‫؍‬ 0.003) using gentamicin compared with mupirocin cream, respectively. Gentamicin use was a significant predictor of lower peritonitis rates (relative risk, 0.52; 95% confidence interval, 0.29 to 0.93; P < 0.03), controlling for center and incident versus prevalent patients. Gentamicin cream applied daily to the peritoneal catheter exit site reduced P. aeruginosa and other Gram-negative catheter infections and reduced peritonitis by 35%, particularly Gram-negative organisms. Gentamicin cream was as effective as mupirocin in preventing S. aureus infections. Daily gentamicin cream at the exit site should be the prophylaxis of choice for PD patients.

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“…Bacterial peritonitis that fails to resolve after 5 days of appropriate antibiotic treatment in PD patients (so-called refractory peritonitis, see Appendix A) is unlikely to respond to continued medical management and often responds to removal of the catheter. Catheter removal in this situation is recommended as a means of protecting the peritoneal membrane for future use (265,266). The same recommendation holds true in the setting of refractory culture-negative peritonitis (57).…”

Section: Rationalementioning

confidence: 99%