#5871 Peritoneal Dialysis Infections in Malta: An Overview of Thirteen Years

Abstract

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.