Empirical aminoglycosides for peritonitis do not affect residual renal function

Baker, Richard J.; Senior, Heather; Clemenger, Michelle; Brown, Edwina A.

doi:10.1053/ajkd.2003.50129

Cited by 76 publications

(52 citation statements)

References 16 publications

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“…Aminoglycosides have previously been a component of empiric therapy; however, the potential development of ototoxicity, vestibular toxicity, and nephrotoxicity, with the possible accompanying loss of residual renal function, prompted their replacement by a third-generation cephalosporin in empiric treatment guidelines, even when combined with a first-generation cephalosporin. [23][24][25][26] The bacterial resistance patterns collected in this study revealed that 88% of Gram-negative organisms were sensitive to the aminoglycosides as compared with 80% ceftazidime sensitivity; the best overall susceptibility results were evident with testing against either a first-generation cephalosporin or a glycopeptide combined with an aminoglycoside. These findings emphasize the importance of considering modification of current empiric antibiotic therapy recommendations.…”

Section: Discussionmentioning

confidence: 80%

Peritonitis in Children Who Receive Long-Term Peritoneal Dialysis

Warady¹,

Feneberg

Verrina³

et al. 2007

Journal of the American Society of Nephrology

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In children who are on chronic peritoneal dialysis, peritonitis is the primary complication compromising technique survival, and the optimal therapy of peritonitis remains uncertain. An Internet-based International Pediatric Peritonitis Registry was established in 47 pediatric centers from 14 countries to evaluate the efficacy and safety of largely opinion-based peritonitis treatment guidelines in which empiric antibiotic therapy was stratified by disease severity. Among a total of 491 episodes of nonfungal peritonitis entered into the registry, Gram-positive organisms were cultured in 44%, Gram-negative organisms were cultured in 25%, and cultures remained negative in 31% of the episodes. In vitro evaluation revealed 69% sensitivity of Grampositive organisms to a first-generation cephalosporin and 80% sensitivity of Gram-negative organisms to a third-generation cephalosporin. Neither the risk factors assumed by the guidelines nor the choice of empiric therapy was predictive of either the early treatment response or the final functional outcome of the peritonitis episodes. Overall, 89% of cases achieved full functional recovery, a portion after relapsing peritonitis (9%). These data serve as the basis for new evidence-based guidelines. Modification of empiric therapy to include aminoglycosides should be considered.

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Section: Discussionmentioning

confidence: 80%

Peritonitis in Children Who Receive Long-Term Peritoneal Dialysis

Warady¹,

Feneberg

Verrina³

et al. 2007

Journal of the American Society of Nephrology

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“…In our hands, this regimen has proven to be efficacious (14). Empirical aminoglycoside use for PD peritonitis has been shown to be safe with respect to both residual renal function (15) and ototoxicity (16 Continuous data are expressed as mean ± standard deviation (SD) or median with interquartile range (IQR). Comparisons were performed using Student's t-tests or Mann-Whitney U tests, as appropriate.…”

Section: Peritonitis Treatment Protocolmentioning

confidence: 99%

Similar Peritonitis Outcome in Capd and APD Patients with Dialysis Modality Continuation during Peritonitis

et al. 2011

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♦ ♦ ♦ ♦ ♦ Background: As few data exist on treatment of peritonitis in patients on automated peritoneal dialysis (APD), and as pharmacokinetics of several antibiotics are reported to be unfavorable in APD, some favor switching to continuous ambulant PD (CAPD) while treating APD-related peritonitis. We explored whether treating peritonitis with patients continuing their usual PD modality had an effect on outcome.

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“…A retrospective examination of a cohort of 72 patients revealed a greater decrease in kidney function in patients using aminoglycosides compared with other antibiotics (33). However, in a larger, more recent study of 205 PD patients, there was no difference in the slope of kidney function decline in patients treated with or without aminoglycosides (34). The current recommendations by the International Society of Peritoneal Dialysis (ISPD) are that short-term aminoglycoside use (Ͻ3 days) is safe but repeated or prolonged courses of aminoglycoside therapy is not advisable (35).…”

Section: Other Factorsmentioning

confidence: 98%

Strategies for Improving Long-Term Survival in Peritoneal Dialysis Patients

Kendrick

Teitelbaum

2010

Clinical Journal of the American Society of Nephrology

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The incidence and prevalence of ESRD in the United States continues to increase. Currently there are over 26,000 patients maintained on peritoneal dialysis. Mortality rates have fallen over the past several years, but long-term survival remains poor, with only 11% of peritoneal dialysis patients surviving past 10 years. Cardiovascular disease accounts for most deaths, and dialysis patients have many traditional and nontraditional cardiovascular risk factors. Lowering of these risk factors has not resulted in reduced cardiovascular morbidity and mortality in dialysis patients. Maneuvers to improve long-term peritoneal dialysis patient survival must therefore focus on modifiable risk factors including residual renal function, peritoneal membrane integrity, rate of infections, and peritoneal dialysis center size. This article reviews strategies for preserving residual renal function and peritoneal membrane integrity as well as strategies for reducing the rate of infections to enhance long-term survival in peritoneal dialysis patients.Clin J Am Soc Nephrol 5: 1123-1131, 2010. doi: 10.2215/CJN.04300709T he incidence and prevalence of ESRD continues to increase worldwide. In the United States alone there are over 480,000 patients on dialysis and the number of incident dialysis patients each year exceeds 100,000 (1). Peritoneal dialysis (PD) is an established treatment modality for patients with ESRD. Currently, 26,082 patients are maintained on PD in the United States (1). Mortality rates in ESRD patients have declined significantly over the past 20 years, but longterm survival remains poor, with the overall survival for all dialysis patients [hemodialysis (HD) and PD] being only 11%. These data were not censored for modality change, the effect of which is difficult to gauge. On a proportional basis, a greater percentage of PD than HD patients switch modality; however, in absolute numbers, more HD patients transition to PD than the reverse. Nevertheless, the overall adjusted probability of survival in incident PD patients at 1 year is 86.8%, but only 11.3% at 10 years (1). The reason for this dramatic decrease in patient survival over time is multifactorial and depends on several patient and dialysis center factors.There are several patient factors that affect survival on PD, most of which are nonmodifiable. Age, presence of diabetes, ESRD etiology, and ESRD vintage are all independent predictors of patient survival (2). For each 1-year increase in age, the risk of death increases by 4% [adjusted hazard ratio (HR) 1.04, P Ͻ 0.0001]. Patients with diabetes have a 30% increased risk of death compared with nondiabetic patients, and dialysis-naive patients have a 28% decreased risk of death compared with patients transferred from HD (2). Cardiovascular disease (CVD) accounts for most deaths in dialysis patients (approximately 50%). The genetics of the patient may be another nonmodifiable determinant of CVD. For example, a recent study of 1200 HD patients found an increased risk of CVD in patients with a specific complemen...

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Empirical aminoglycosides for peritonitis do not affect residual renal function

Cited by 76 publications

References 16 publications

Peritonitis in Children Who Receive Long-Term Peritoneal Dialysis

Peritonitis in Children Who Receive Long-Term Peritoneal Dialysis

Similar Peritonitis Outcome in Capd and APD Patients with Dialysis Modality Continuation during Peritonitis

Strategies for Improving Long-Term Survival in Peritoneal Dialysis Patients

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