Prophylactic Antibiotics for Endoscopy-Associated Peritonitis in Peritoneal Dialysis Patients

Abstract

IntroductionContinuous ambulatory peritoneal dialysis (CAPD) peritonitis may develop after endoscopic procedures, and the benefit of prophylactic antibiotics is unclear. In the present study, we investigated whether prophylactic antibiotics reduce the incidence of peritonitis in these patients.Patients and methodsWe retrospectively reviewed all endoscopic procedures, including esophagogastroduodenoscopy (EGD), colonoscopy, sigmoidoscopy, cystoscopy, hysteroscopy, and hysteroscopy-assisted intrauterine device (IUD) implantation/removal, performed in CAPD patients at Chang Gung Memorial Hospital, Taiwan, between February 2001 and February 2012.ResultsFour hundred and thirty-three patients were enrolled, and 125 endoscopies were performed in 45 patients. Eight (6.4%) peritonitis episodes developed after the examination. Antibiotics were used in 26 procedures, and none of the patients had peritonitis (0% vs. 8.1% without antibiotic use; p = 0.20). The peritonitis rate was significantly higher in the non-EGD group than in the EGD group (15.9% [7/44] vs. 1.2% [1/81]; p<0.005). Antibiotic use prior to non-EGD examinations significantly reduced the endoscopy-associated peritonitis rate compared to that without antibiotic use (0% [0/16] vs. 25% [7/28]; p<0.05). Peritonitis only occurred if invasive procedures were performed, such as biopsy, polypectomy, or IUD implantation, (noninvasive procedures, 0% [0/20] vs. invasive procedures, 30.4% [7/23]; p<0.05). No peritonitis was noted if antibiotics were used prior to examination with invasive procedures (0% [0/10] vs. 53.8% [7/13] without antibiotic use; p<0.05). Although not statistically significant, antibiotics may play a role in preventing gynecologic procedure-related peritonitis (antibiotics, 0% [0/4] vs. no antibiotics, 55.6% [5/9]; p = 0.10).ConclusionAntibiotic prophylaxis significantly reduced endoscopy-associated PD peritonitis in the non-EGD group. Endoscopically assisted invasive procedures, such as biopsy, polypectomy, IUD implantation/removal, and dilatation and curettage (D&C), pose a high risk for peritonitis. Prophylactic antibiotics for peritonitis prevention may be required in colonoscopic procedures and gynecologic procedures.

Regional variation in the treatment and prevention of peritoneal dialysis-related infections in the Peritoneal Dialysis Outcomes and Practice Patterns Study

“…The use of periprocedural antibiotics is predicated on the observation that a number of procedures have been associated with an increased risk of peritonitis [26,27]. For example, there have been several reports of peritonitis due to enteric organisms following a lower gastrointestinal Number of facilities 18 20 28 22 17 65 Antibiotics at home prior to seeking medical attention, % Yes, all patients 6 10 0 0 0 40 Yes, some patients 0 20 15 5 6 11 No patients 94 70 85 96 94 49 After-hours nurse provides care at PD facility, % 7 25 33 55 12 endoscopy procedure [26,28]. The significant variation that we observed in the use of periprocedural antibiotics may relate to the limited evidence that exists to support these recommendations.…”

Current guidelines in peritoneal dialysis – Part I

“…Since some invasive procedures are associated with a higher risk of peritonitis, it is recommended that invasive procedures should be accompanied by antibiotic prophylaxis (Renal Association: Evi dence 1C; ISPD: Evidence 2C prior to colonoscopy and 2D prior to invasive gynaecologic procedures) 56,68 . One retrospective observa tional study showed a lower peritonitis rate associated with antibiotic prophylaxis before most endoscopic interventions (colonoscopy, sigmoidoscopy, cystoscopy, hysteroscopy, and hysteroscopy assisted intrauterine device implantation or removal) 88 . However, the best choice for antibiotic prophylaxis is unknown, as there are no studies analysing this question.…”

Update: Infektiöse Komplikationen der Peritonealdialyse

“…Allerdings sollten biokompatible Lösungen heutzutage aus anderen Gründen (Erhalt der Restnierenfunktion, Inzidenz der enkapsulierenden peritonealen Sklerose (EPS)) bevorzugt eingesetzt werden [15,16]. Vor einer Koloskopie beziehungsweise bei invasiven gynäkologischen Eingriffen sollte ebenfalls eine Antibiotikaprophylaxe durchgeführt werden [17].…”