Seasonal variation in the incidence of peritoneal dialysis-related infections (PDRI) has been sparingly investigated, especially in the Mediterranean. Our aim was to explore this association in Malta. All PDRI occurring between Jan-2008 and Dec-2012 were retrospectively studied.A total of 137 patients were followed-up for a median time of 32.5 months (range: 2-81). During this time, 19% never had PDRI, 11.7% transferred permanently to hemodialysis and 6.6% received a kidney transplant. A total of 279 PDRI were identified, equating to 145 catheter-related infections (CRI) and 144 peritonitis episodes (including 10 catheter related peritonitis). A spring peak in the overall gram positive PDRI (0.61 vs. 0.34/patient-year-at-risk, P=0.05), together with a peak in gram negative peritonitis in the warm period (0.13 vs. 0.07/patient-year at risk, P=0.04) was identified. The incidence rate ratios (Confidence Interval) involving the overall gram positive PDRI, gram positive peritonitis, coagulase-negative Streptococci (CoNS) and Streptococci were 1.82 (1.18-2.82, P=0.007), 2.20 (1.16-4.16, P=0.02), 2.65 (1.17-6.02, P=0.02] and 3.18 (1.03-9.98, P=0.04) in spring when compared to winter. No significant difference in the overall PDRI, peritonitis or CRI rates between seasons or warm/cold period was identified.To our knowledge, this is the first study which examines the effect of seasons on the incidence of PDRI in the Mediterranean basin. Findings suggest that spring confers a higher risk for gram positive PDRIs, gram positive peritonitis, CoNS and Streptococcus, whilst the warm period was associated with a peak in the gram negative peritonitis.

Background and Aims Infections related to peritoneal dialysis (PD) are still a cause of morbidity and mortality. We describe an overview of PD peritonitis and catheter-related infections (CRI) in Malta over a period of eleven years. We also describe trends in dialysis modality over the years. Method All patients undergoing PD in Malta during 2008 and 2018 were analysed. Data from 2008-2012 was retrospective, shown as mean, that from 2013-2018 prospective. International Society for Peritoneal Dialysis (ISPD) definitions were used. Results for categorical responses were summarized using absolute numbers and percentages. Medians (range) were used to describe continuous non-normally distributed data. Results The total number of patients undergoing PD from 2008 till 2018 were 137 (2008-2012), 91, 80, 126, 117, 102, 103 respectively. There was an overall male predominance of 63.5% (61-67). Patient years at risk were 85.80, 85.25, 89.71, 83.70, 79.69, 72.88 since 2013 respectively. The overall incidence of diabetes mellitus was 45.3% (41.8-50), cardiovascular disease 34.2% (33.8-35), hypertension 79.3% (73.8-84.6). PD was used in 50% of dialysis modality prior to 2012, 39% in 2018. Initially 51% used Automated PD (APD), with 21% assisted PD, in 2018 39% used APD, with 6% assisted PD. PD peritonitis rates from 2008 were 0.38, 0.31, 0.35, 0.46, 0.43, 0.57, 0.54, 0.43, 0.39, 0.40, 0.46 episodes/patient year respectively There was marked dominance of Gram-positive peritonitis, mainly Staphylococcal, with a reduction of coagulase-negative-Staphylococcus from 0.26 episodes/patient in 2013 to 0.03 in 2017, 0.11 in 2018. Methicillin-resistant S. aureus (MRSA) peritonitis decreased from 0.03 episodes/patient to nil in 2016, 2017, 0.01 episodes/patient in 2018. Amongst Gram-negative peritonitis, Pseudomonas rates decreased from 0.06 to 0.03 episodes/patient in 2018, nil in 2016. Escherichia coli rates decreased from 0.02 episodes/patient to nil in the last three years. Fungal rates from 0.03 to 0.01 episodes/patient/year, with nil in 2016, 2017. Catheter-related infection rates were 0.39 (2008-2012), 0.35, 0.91, 0.37, 0.38, 0.25, 0.50 episodes/patient/year respectively. There was a higher incidence of recurrent infections in 2014, none in 2015 and 2016. Gram-negative organisms accounted for 57% of all CRI, predominantly Pseudomonas at 0.12 (2008-2012), 0.06, 0.09, 0.09, 0.14, 0.03, 017 episodes/patient/year respectively. Gram-positive CRI were mostly Staphylococcus aureus, peaking in 2014 at 0.38 episodes/patient/year. MRSA rates declined from 0.15 to 0.01 episodes/patient/year in 2018. Conclusion PD peritonitis rates in Malta between 2008 and 2018 were below the ISPD recommended threshold. There were no episodes of MRSA in 2016, 2017, no Pseudomonas in 2016, no E coli in the last three years and no fungal PD peritonitis in 2016, 2017. CRI rates also declined, with an overall predominance of Gram-negative infections.

Background and Aims Peritoneal dialysis (PD)-related infections are still associated with an increased risk of morbidity and mortality. We describe an overview of PD peritonitis and catheter-related infection (CRI) rates in Malta over a period of thirteen years. Method All patients undergoing PD in Malta from 2008 to 2020 were included. Data from 2008 to 2012 was retrospective (shown as mean), whilst data from 2013 to 2020 was prospective. ISPD guidelines and definitions were followed. Results Study population sizes from 2008 to 2020 were as follows: 137 (2008-2012), 91, 80, 126, 117, 102, 103, 101, and 101 respectively. PD peritonitis rates from 2008 to 2020 were 0.38, 0.31, 0.35, 0.46, 0.43, 0.57, 0.54, 0.43, 0.39, 0.40, 0.46, 0.37, and 0.29 episodes/patient/year respectively. Gram-positive peritonitis episodes predominated, the majority of which were Staphylococcal infections. Methicillin-resistant Staphylococcus aureus (MRSA) rates have overall decreased from 0.03 episodes/patient in 2008–2012 to 0.01 episodes/patient in 2020, to no cases in 2016, 2017 and 2019. Coagulase-negative Staphylococcal (CNS) rates also decreased from 0.26 episodes/patient in 2013 to 0.03 in 2017, 0.11 in 2018, 0.04 in 2019, and 0.08 in 2020. With regards to Gram-negative peritonitis, Pseudomonas rates declined from 0.06 episodes/patient in 2008–2012 to 0.03 in 2018. No cases were recorded in 2016, 2019 and 2020. The rate of Escherichia coli-associated peritonitis was 0.03 episodes/patient/year in 2020, and no cases were found in 2016, 2017, 2018, and 2019. Fungal peritonitis rates varied from 0.03 in 2008–2012 to 0.01 episodes/patient/year in 2013, 2018, 2019 and 2020 with no cases being recorded in 2016 and 2017. CRI rates were as follows: 0.39 (2008-2012), 0.35, 0.91, 0.37, 0.38, 0.25, 0.50, 0.29, and 0.22 episodes/patient/year respectively. The incidence of Gram-negative infections from 2013 to 2020 was 49, 51, 52, 65, 58, 66, 48, 41% respectively, with an average rate of 54%. Gram-positive CRIs were mostly Staphylococcal, peaking in 2014 at 0.38 episodes/patient, down to 0.14 in 2019, and 0.10 in 2020. MRSA rates decreased from 0.15 episodes/patient/year in 2014 to 0.01 in 2018, no cases in 2019, and 0.04 in 2020. CRI Pseudomonas rates have overall improved from 0.12 (2008-2012), to 0.06, 0.09, 0.09, 0.14, 0.03, 0.17, 0.06, 0.04 episodes/patient/year from 2013 to 2020. Conclusion The Maltese PD cohort has been achieving ISPD target requirements. Both PD peritonitis and catheter-related infection rates declined over the last thirteen years. There was no MRSA peritonitis in 2016, 2017 and 2019, no Pseudomonas peritonitis in 2016, 2019 and 2020, no E. coli in 2016,2017, 2018 and 2019 and no fungal PD peritonitis in 2016 and 2017. Overall CRIs were predominantly Gram-negative, but not in 2019 and 2020.

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