Comprehensive Approach to Peritoneal Dialysis-Related Peritonitis by Enteric Microorganisms. Comparison between Single Organism and Polymicrobial Infections

Ribera-Sánchez, Roi; Pérez‐Fontán, Miguel; López-Iglesias, Antía; García-Enríquez, Alba; Rodríguez‐Carmona, Ana

doi:10.3747/pdi.2017.00184

Cited by 8 publications

(6 citation statements)

References 17 publications

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“…363 In other words, the higher hospitalisation rate, surgical intervention requirement and mortality of polymicrobial peritonitis appear to be limited to those episodes with isolation of enteric bacteria, fungus and/or E. faecium. 364 …”

Section: Subsequent Management Of Peritonitismentioning

confidence: 99%

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

et al. 2022

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Peritoneal dialysis (PD)-associated peritonitis is a serious complication of PD and prevention and treatment of such is important in reducing patient morbidity and mortality. The ISPD 2022 updated recommendations have revised and clarified definitions for refractory peritonitis, relapsing peritonitis, peritonitis-associated catheter removal, PD-associated haemodialysis transfer, peritonitis-associated death and peritonitis-associated hospitalisation. New peritonitis categories and outcomes including pre-PD peritonitis, enteric peritonitis, catheter-related peritonitis and medical cure are defined. The new targets recommended for overall peritonitis rate should be no more than 0.40 episodes per year at risk and the percentage of patients free of peritonitis per unit time should be targeted at >80% per year. Revised recommendations regarding management of contamination of PD systems, antibiotic prophylaxis for invasive procedures and PD training and reassessment are included. New recommendations regarding management of modifiable peritonitis risk factors like domestic pets, hypokalaemia and histamine-2 receptor antagonists are highlighted. Updated recommendations regarding empirical antibiotic selection and dosage of antibiotics and also treatment of peritonitis due to specific microorganisms are made with new recommendation regarding adjunctive oral N-acetylcysteine therapy for mitigating aminoglycoside ototoxicity. Areas for future research in prevention and treatment of PD-related peritonitis are suggested.

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Section: Subsequent Management Of Peritonitismentioning

confidence: 99%

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

et al. 2022

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“…We neither observed any significant diference among polymicrobial PDrP with or without isolation of streptococci. Previous studies have underlined that the isolation of GNB [31], intestinal anaerobics and Enterococcus faecium [40] may represent better markers of a complicated outcome of polymicrobial PDrP.…”

Section: Discussionmentioning

confidence: 99%

Long-term trends in the incidence of peritoneal dialysis-related peritonitis disclose an increasing relevance of streptococcal infections: A longitudinal study

et al. 2020

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Background The selective impact of strategies for prevention of PD-related peritonitis (PDrP) may have modified, in the long term, the causal spectrum, clinical presentation and outcomes of these infections. Objectives To compare trends in the incidence of PDrP by different microorganisms during a 30-year period, with a particular focus on streptococcal infections. To analyze the clinical presentation and outcomes of these infections. Secondarily, to investigate how the isolation of different species of streptococci can influence the clinical course of PDrP by this genus of bacteria. Method Following a retrospective, observational design we investigated 1061 PDrP (1990–2019). We used joinpoint regression analysis to explore trends in the incidence of PDrP by different microorganisms, and compared the risk profile (Cox), clinical presentation and outcomes (logistic regression) of these infections. Main results Our data showed a progressive decline in the incidence of PDrP by staphylococci and Gram negative bacteria, while the absolute rates of streptococcal (average annual percent change +1.6%, 95% CI -0.1/+3.2) and polymicrobial (+1.8%, +0.1/+3.5) infections tended to increase, during the same period. Remarkably, streptococci were isolated in 58.6% of polymicrobial infections, and patients who suffered a streptococcal PDrP had a 35.8% chance of presenting at least one other infection by the same genus. The risk profile for streptococcal infections was comparable to that observed for PDrP overall. Streptococcal PDrP were associated with a severe initial inflammatory response, but their clinical course was generally nonaggressive thereafter. We did not observe a differential effect of different groups of streptococci on the clinical presentation or outcome of PDrP. Conclusions Time trends in the incidence of PDrP by different microorganisms have granted streptococci an increasing relevance as causative agents of these infections, during the last three decades. This behaviour suggests that current measures of prevention of PDrP may not be sufficiently effective, in the case of this genus of microorganisms.

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“…8 On the other hand, polymicrobial peritonitis episodes due to multiple Gram-positive organisms have a better prognosis and are expected to respond to antibiotic therapy alone. [65][66][67][68] Alternatively, hospital-acquired PD-related peritonitis 69 is associated with a worse prognosis, including lower primary medical cure rate and higher mortality. A review of 371 episodes of peritonitis that occurred during the hospital stay (admitted for another reason) showed a higher rate of ceftazidime-resistant bacterial isolates and worse outcomes.…”

Section: Treatmentmentioning

confidence: 99%

“…8 On the other hand, polymicrobial peritonitis episodes due to multiple Gram-positive organisms have a better prognosis and are expected to respond to antibiotic therapy alone. 65–68…”

Section: Treatmentmentioning

confidence: 99%

Peritoneal Dialysis–Related Infections

Cho

Chow

et al. 2023

CJASN

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Peritoneal dialysis represents an important treatment choice for patients with kidney failure. It allows them to dialyze outside the hospital setting, facilitating enhanced opportunities to participate in life-related activities, flexibility in schedules, time and cost savings from reduced travel to dialysis centers, and improved quality of life. Despite its numerous advantages, the peritoneal dialysis utilization has been static or diminishing in parts of the world. Peritoneal dialysis-related infections, such as peritonitis, exit-site infection or tunnel infection, is a major concern for patients, caregivers, and health professionals – which may result in hesitation to consider this as treatment or to cease therapy when these complications take place. In this review, the definition, epidemiology, risk factors, prevention, and treatment of peritoneal dialysis-related infection based on the contemporary evidence will be described.

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Comprehensive Approach to Peritoneal Dialysis-Related Peritonitis by Enteric Microorganisms. Comparison between Single Organism and Polymicrobial Infections

Abstract: A comprehensive approach to peritoneal infections by intestinal microorganisms may provide a focused perspective of the clinical presentation and outcomes of these complications of peritoneal dialysis.

Cited by 8 publications

References 17 publications

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

Long-term trends in the incidence of peritoneal dialysis-related peritonitis disclose an increasing relevance of streptococcal infections: A longitudinal study

Peritoneal Dialysis–Related Infections

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