Speaker shares three steps to reduce peritonitis infections, maintain peritoneal dialysis
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Health care providers should try to decrease frequency of infections, which are the leading cause of technique failure, and increase a patient’s odds for successful treatment or return to peritoneal dialysis, according to a speaker.
“We’re essentially getting better at reducing the frequency of peritonitis caused by more indolent organisms with little reduction in peritonitis due to more virulent organisms,” Sharon Nessim, MD, of Jewish General Hospital at McGill University, said during ASN Kidney Week, which was held as a virtual event. “We can start to identify certain important problem bugs that we need to try to reduce the risk [for] in order to try and improve [peritoneal dialysis] PD outcomes after peritonitis.”
Nessim reviewed existing literature and found coagulase-negative staphylococci most frequently caused peritonitis and had the highest risk for catheter loss. Staphylococcus aureus most frequently caused exit site infections. Knowing which organisms most frequently lead to problems can help health care professionals take the first step to reducing risk.
“The first step would be to try to decrease the frequency of peritonitis, particularly for organism most likely to lead to a catheter loss,” Nessim said.
Reducing peritonitis rates begins with educating patients to call the clinic or contact a hospital ED as soon as they notice cloudy fluid or abdominal pain, according to Nessim.
Of course, it is not always possible to prevent infections.
“Step two would be that if a peritonitis occurs, we want to try to maximize our chance of successful treatments so that the patient can stay on [peritoneal dialysis] PD,” Nessim said.
In the event of an infection, Nessim said patients should begin taking broad spectrum antibiotics as early as possible. When prescribing, practitioners should remember to dose antibiotics appropriately according to the patient’s weight and the sensitivity of the organism.
In some cases, antibiotics may not be adequate to treat the peritonitis and the patient may need the catheter removed. However, this does not necessarily mean patients cannot return to peritoneal dialysis, according to Nessim.
“Step three is that if a catheter removal is required, we want to do whatever we can to try to maximize the chance of the patient successfully returning to [peritoneal dialysis] PD,” Nessim said.
She noted there are two studies that evaluated patients’ return to peritoneal dialysis after catheter removal due to infection. Catheter reinsertion was successful in 51 of 100 patients who had a catheter removed due to peritonitis between 1995 and 2000, according to Nessim. Among those 51 patients, technique survival rate was 31% at 24 months. Nessim said the risk of technique failure could be mitigated by removing the catheter if fluid does not clear after 5 days rather than 10 and reinserting the catheter laparoscopically rather than with an open surgical approach.
Patients in a more recent cohort of data collected from 2003 to 2011 had better outcomes, she said. Nessim said of the patients who transferred back to peritoneal dialysis that they “did not have inferior patient survival or technique survival when [researchers] compared them with others who either never required a hemodialysis transfer or who remained on hemodialysis permanently.”
Nessim said the results were “reassuring, because it tells us that for those patients who are able to return to [peritoneal dialysis] PD, their mortality and their technique survival seemed to be good.”
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Nessim S. Reducing PD loss from infection. Presented at: ASN Kidney Week. Oct. 22-25 (virtual meeting).
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