Pos-701 Characteristics and Outcomes of Hospital-Acquired and Community-Acquired Peritonitis in Patients on Peritoneal Dialysis

Ling, Chau Wei; Sud, Kamal; Peterson, Gregory M.; Van, Connie; Zaidi, Syed Tabish Razi; Patel, Rahul P.; Castelino, Ronald L.

doi:10.1016/j.ekir.2022.01.735

Cited by 2 publications

(7 citation statements)

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“…Troidle et al 3 reported increasing age, hypoalbuminemia, and prolonged hospitalization stays as the risk factors for developing HaP. We also recently reported lower serum albumin levels in patients with HaP compared with those developing peritonitis in the community 7 . Notably, in the analysis of Szeto et al, 5 admission diagnoses for hospitalizations of patients on PD who developed HaP were medical conditions in 89.5% (including cardiovascular diseases in 46.6% and other infections in 20.2%), with surgical diagnosis in only 5.3% patients.…”

Section: Figuresupporting

confidence: 61%

“…Consequently, of all the HaP episodes, 90.3% developed this complication in the general medical wards, 8.1% in the non‐medical wards, and only 1.6% in the renal ward. In our analysis, 7 76.2% patients who developed HaP were admitted for medical conditions (including 10.7% for cardiovascular causes, 10.7% for other infections and 8.3% for gastrointestinal causes), and 20.2% were admitted for surgical causes. These figures suggest that not only are medical causes the commonest reasons for admission in patients developing HaP, but any intervention for the prevention of HaP also needs to occur in medical wards of hospitals.…”

Section: Figurementioning

confidence: 86%

“…We also found that despite lower peritoneal fluid leucocyte and polymorphonuclear cell counts, bacterial isolates of patients with HaP were more likely to grow Pseudomonas spp. and vancomycin‐resistant Enterococcus 7 . Similarly, Szeto et al 5 reported that bacterial isolates of patients with HaP were more likely to be resistant to cloxacillin, gentamicin, fluoroquinolones, and ceftazidime.…”

Section: Figurementioning

confidence: 96%

“…and vancomycin-resistant Enterococcus. 7 Similarly, Szeto et al 5 reported that bacterial isolates of patients with HaP were more likely to be resistant to cloxacillin, gentamicin, fluoroquinolones, and ceftazidime.…”

mentioning

confidence: 99%

“…We also recently reported lower serum albumin levels in patients with HaP compared with those developing peritonitis in the community. 7 Notably, in the analysis of Szeto et al, 5 admission diagnoses for hospitalizations of patients on PD who developed HaP were medical conditions in 89.5% (including cardiovascular diseases in 46.6% and other infections in 20.2%), with surgical diagnosis in only 5.3% patients. Consequently, of all the HaP episodes, 90.3% developed this complication in the general medical wards, 8.1% in the non-medical wards, and only 1.6% in the renal ward.…”

mentioning

confidence: 99%

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Hospital‐acquired peritonitis in patients on peritoneal dialysis: A call to action

Ling

Castelino

Sud

2023

Seminars in Dialysis

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Peritonitis remains a significant complication of peritoneal dialysis (PD), and severe episodes of peritonitis lead to structural and functional alterations of the peritoneal membrane, which can result in a permanent transfer to hemodialysis. Although PD is designed primarily to be delivered in the community setting, patients on PD get hospitalized for a number of reasons. In this commentary, we highlight the enormous risks each hospitalization has on the occurrence of peritonitis in patients on PD and the need to understand factors that predispose patients to hospital-acquired peritonitis. Furthermore, we suggest directions on several strategies that could not only reduce the risks of developing peritonitis but also improve outcomes of patients on PD who get hospitalized for an unrelated illness.Peritonitis remains a significant complication of peritoneal dialysis (PD), and severe episodes of peritonitis lead to structural and functional alterations of the peritoneal membrane, which can result in a permanent transfer to hemodialysis. While PD is designed primarily to

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Section: Figuresupporting

confidence: 61%

Section: Figurementioning

confidence: 86%

Section: Figurementioning

confidence: 96%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Hospital‐acquired peritonitis in patients on peritoneal dialysis: A call to action

Ling

Castelino

Sud

2023

Seminars in Dialysis

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Linking clinical manifestations and causative organisms may provide clues for the treatment of peritoneal dialysis-associated peritonitis

Ren,

Pan,

Nie

et al. 2024

Preprint

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Introduction: Different initial manifestations of peritoneal dialysis-associated peritonitis (PDAP) may depend on the type of pathogenic organism. We investigated the association between the clinical characteristics of PDAP and susceptibility to vancomycin and investigated the possibility of using vancomycin monotherapy alone as an initial treatment regimen for some PDAP patients to avoid unnecessary antibiotic exposure and secondary infection. Methods Patients with culture-positive PDAP were retrospectively analyzed and divided into two groups: those who presented with only cloudy effluent (PDAP-cloudy) or those who presented with cloudy effluent, abdominal pain and/or fever (PDAP-multi). The bacterial culture of PD effluent and antibiotic sensitivity test results were compared between groups. Logistic regression was used to investigate factors predicting susceptibility to vancomycin. Results Of the 162 patients who had a positive bacterial culture of PD fluid, 30 patients were in the PDAP-cloudy group, and 132 patients were in the PDAP-multifroup group. Thirty (100%) patients in the PDAP-cloudy group had gram-positive bacterial infections, which was significantly greater than that in the PDAP-multifroup group (51.5%) (P < 0.001). Twenty-nine (96.7%) peritonitis patients in the PDAP-cloudy group were susceptible to vancomycin, compared to 67 (50.8%) in the PDAP-multi group (P < 0.001). The specificity of PDAP-cloudy for vancomycin-sensitive peritonitis was 98.48%. Only one patient (3.3%) in the PDAP-cloudy group experienced vancomycin-resistant peritonitis caused by Enterococcus gallinarum, which could neither be covered by vancomycin nor by the initial antibiotic regimen recommended by the current ISPD guidelines. The presence of only cloudy effluent was an independent predictor of susceptibility to vancomycin according to multivariate analysis (OR = 21.893, 95% CI 2.803-171.004, p = 0.003), in addition to PD effluent WBC counts (OR = 0.988, 95% CI 0.980–0.996, p = 0.004) and concomitant diabetes mellitus (OR = 2.878, 95% CI 1.347–6.129, p = 0.006). The specificity of presenting with only cloudy effluen for vancomycin-sensitive peritonitis was 98.48%. Conclusions Cloudy dialysate, as the only symptom at PDAP onset, was an independent predictor of vancomycin-sensitive PDAP, which is an important new insight that may guide the choice of initial antibiotic treatment.

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Pos-701 Characteristics and Outcomes of Hospital-Acquired and Community-Acquired Peritonitis in Patients on Peritoneal Dialysis

Cited by 2 publications

References 0 publications

Hospital‐acquired peritonitis in patients on peritoneal dialysis: A call to action

Hospital‐acquired peritonitis in patients on peritoneal dialysis: A call to action

Linking clinical manifestations and causative organisms may provide clues for the treatment of peritoneal dialysis-associated peritonitis

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