Seasonal Variation in the Peritoneal Dialysis‐Related Infections: A Single Center Experience in the Mediterranean

Abstract

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.

The influence of seasonal factors on the incidence of peritoneal dialysis-associated peritonitis

“…However, seasonal variations have been reported to have no significant effects on the occurrence of PDAP associated with specific microorganisms [ 17 , 18 ]. Therefore, our study analyzed the causative microorganisms associated with PDAP cases.…”

Gram-negative central line-associated bloodstream infection incidence peak during the summer: a national seasonality cohort study

“…Multiple previous studies have identified seasonal variation with summer increases in gram-negative BSI, but not fully examined HABSI nor BSI per infectious focus 14 , 15 . Peritoneal dialysis catheter-related peritonitis have demonstrated increased gram-negative IRRs during warmer months and gram-positive bacteria during the spring 16 , 17 . Other studies have shown summer increases in gram-negative outpatient healthcare-associated BSI, among which a large proportion were associated with intravascular catheters 13 , 14 , 32 , 33 .…”

“…Infection seasonality has been well documented for influenza and more recently among bacterial infections. Increased summer incidence has been documented for gram-negative infections 5 , 6 , BSI 7 – 15 , hospital-acquired infections 5 , 6 , peritoneal dialysis-related infections 16 , 17 , intra-abdominal 18 and surgical site infections 19 , 20 . One study has identified seasonality for in-hospital CLABSI rates 21 .…”