Excessive risk and poor outcome of hospital-acquired peritoneal dialysis-related peritonitis

Background Peritoneal dialysis (PD) is a home-based renal replacement therapy. Since hospital staff are not often familiar with PD and its complications, PD patients may have an excess risk of developing PD-related peritonitis during hospital admission for unrelated reasons, and the outcome may be a...

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Published in:Clinical kidney journal 2022-11, Vol.15 (11), p.2107-2115
Main Authors: Szeto, Cheuk-Chun, Ng, Jack Kit-Chung, Fung, Winston Wing-Shing, Chan, Gordon Chun-Kau, Cheng, Phyllis Mei-Shan, Law, Man-Ching, Pang, Wing-Fai, Li, Philip Kam-Tao, Leung, Chi-Bon, Chow, Kai-Ming
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Comparative analysis
Health aspects
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Peritonitis
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creator Szeto, Cheuk-Chun
Ng, Jack Kit-Chung
Fung, Winston Wing-Shing
Chan, Gordon Chun-Kau
Cheng, Phyllis Mei-Shan
Law, Man-Ching
Pang, Wing-Fai
Li, Philip Kam-Tao
Leung, Chi-Bon
Chow, Kai-Ming
description Background Peritoneal dialysis (PD) is a home-based renal replacement therapy. Since hospital staff are not often familiar with PD and its complications, PD patients may have an excess risk of developing PD-related peritonitis during hospital admission for unrelated reasons, and the outcome may be affected. Methods We reviewed 371 episodes of hospital-acquired PD peritonitis in our center from 2000 to 2019. Their clinical characteristics and outcomes were compared with 825 episodes that required hospital admission and 1964 episodes that were treated as outpatient. Results Hospitalized PD patients had a significantly higher risk of developing peritonitis than outpatients [incident rate ratio 4.41 (95% confidence interval 3.95–4.91]. Hospital-acquired peritonitis episodes were more commonly culture negative. Bacterial isolates from the hospital-acquired episodes were more likely resistant to ceftazidime (P
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Since hospital staff are not often familiar with PD and its complications, PD patients may have an excess risk of developing PD-related peritonitis during hospital admission for unrelated reasons, and the outcome may be affected. Methods We reviewed 371 episodes of hospital-acquired PD peritonitis in our center from 2000 to 2019. Their clinical characteristics and outcomes were compared with 825 episodes that required hospital admission and 1964 episodes that were treated as outpatient. Results Hospitalized PD patients had a significantly higher risk of developing peritonitis than outpatients [incident rate ratio 4.41 (95% confidence interval 3.95–4.91]. Hospital-acquired peritonitis episodes were more commonly culture negative. Bacterial isolates from the hospital-acquired episodes were more likely resistant to ceftazidime (P &lt; .0001) than the other groups. The primary response rate, complete cure rate and overall mortality of the hospital-acquired episodes were 66.6%, 62.0%, and 23.2%, respectively, all worse than episodes that developed outside the hospital (P &lt; .0001 for all). Conclusion PD patients admitted to the hospital had a 4-fold increase in the risk of developing peritonitis. Hospital-acquired peritonitis episodes were more likely culture negative and resistant to antibiotics. They also had a lower primary response rate, a lower complete cure rate and higher mortality than episodes that developed outside the hospital. Lay Summary Peritoneal dialysis (PD) is a home-based therapy. We hypothesize that PD patients have an excess risk of developing PD-related peritonitis during hospital admission for unrelated reasons and the outcome may be affected. We reviewed 371 episodes of hospital-acquired PD peritonitis. Their clinical characteristics and outcomes were compared with 825 episodes that required hospital admission and 1964 episodes treated as outpatient. We found that hospitalized PD patients had a 4-fold higher risk of developing peritonitis than outpatients. Hospital-acquired peritonitis episodes were more likely culture negative and the bacterial isolates were more likely resistant to ceftazidime. The primary response rate, complete cure rate and overall mortality of the hospital-acquired episodes were all significantly worse than the others. Our result highlights the importance of staff education on early identification and treatment of PD-related peritonitis. Clinicians should be mindful of antibiotic resistance in hospital-acquired PD-related peritonitis and consider early adjustment of treatment according to the clinical response. 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Published by Oxford University Press on behalf of the ERA. 2022</rights><rights>COPYRIGHT 2022 Oxford University Press</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c456t-21ceaee7ee4105f007cdec3bfe328193b26e375b54ada0d2d22d134ad99cf5913</citedby><cites>FETCH-LOGICAL-c456t-21ceaee7ee4105f007cdec3bfe328193b26e375b54ada0d2d22d134ad99cf5913</cites><orcidid>0000-0001-7676-7628 ; 0000-0002-9549-9611</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9613437/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9613437/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,1604,27924,27925,53791,53793</link.rule.ids></links><search><creatorcontrib>Szeto, Cheuk-Chun</creatorcontrib><creatorcontrib>Ng, Jack Kit-Chung</creatorcontrib><creatorcontrib>Fung, Winston Wing-Shing</creatorcontrib><creatorcontrib>Chan, Gordon Chun-Kau</creatorcontrib><creatorcontrib>Cheng, Phyllis Mei-Shan</creatorcontrib><creatorcontrib>Law, Man-Ching</creatorcontrib><creatorcontrib>Pang, Wing-Fai</creatorcontrib><creatorcontrib>Li, Philip Kam-Tao</creatorcontrib><creatorcontrib>Leung, Chi-Bon</creatorcontrib><creatorcontrib>Chow, Kai-Ming</creatorcontrib><title>Excessive risk and poor outcome of hospital-acquired peritoneal dialysis-related peritonitis</title><title>Clinical kidney journal</title><description>Background Peritoneal dialysis (PD) is a home-based renal replacement therapy. Since hospital staff are not often familiar with PD and its complications, PD patients may have an excess risk of developing PD-related peritonitis during hospital admission for unrelated reasons, and the outcome may be affected. Methods We reviewed 371 episodes of hospital-acquired PD peritonitis in our center from 2000 to 2019. Their clinical characteristics and outcomes were compared with 825 episodes that required hospital admission and 1964 episodes that were treated as outpatient. Results Hospitalized PD patients had a significantly higher risk of developing peritonitis than outpatients [incident rate ratio 4.41 (95% confidence interval 3.95–4.91]. Hospital-acquired peritonitis episodes were more commonly culture negative. Bacterial isolates from the hospital-acquired episodes were more likely resistant to ceftazidime (P &lt; .0001) than the other groups. The primary response rate, complete cure rate and overall mortality of the hospital-acquired episodes were 66.6%, 62.0%, and 23.2%, respectively, all worse than episodes that developed outside the hospital (P &lt; .0001 for all). Conclusion PD patients admitted to the hospital had a 4-fold increase in the risk of developing peritonitis. Hospital-acquired peritonitis episodes were more likely culture negative and resistant to antibiotics. They also had a lower primary response rate, a lower complete cure rate and higher mortality than episodes that developed outside the hospital. Lay Summary Peritoneal dialysis (PD) is a home-based therapy. We hypothesize that PD patients have an excess risk of developing PD-related peritonitis during hospital admission for unrelated reasons and the outcome may be affected. We reviewed 371 episodes of hospital-acquired PD peritonitis. Their clinical characteristics and outcomes were compared with 825 episodes that required hospital admission and 1964 episodes treated as outpatient. We found that hospitalized PD patients had a 4-fold higher risk of developing peritonitis than outpatients. Hospital-acquired peritonitis episodes were more likely culture negative and the bacterial isolates were more likely resistant to ceftazidime. The primary response rate, complete cure rate and overall mortality of the hospital-acquired episodes were all significantly worse than the others. Our result highlights the importance of staff education on early identification and treatment of PD-related peritonitis. Clinicians should be mindful of antibiotic resistance in hospital-acquired PD-related peritonitis and consider early adjustment of treatment according to the clinical response. 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Since hospital staff are not often familiar with PD and its complications, PD patients may have an excess risk of developing PD-related peritonitis during hospital admission for unrelated reasons, and the outcome may be affected. Methods We reviewed 371 episodes of hospital-acquired PD peritonitis in our center from 2000 to 2019. Their clinical characteristics and outcomes were compared with 825 episodes that required hospital admission and 1964 episodes that were treated as outpatient. Results Hospitalized PD patients had a significantly higher risk of developing peritonitis than outpatients [incident rate ratio 4.41 (95% confidence interval 3.95–4.91]. Hospital-acquired peritonitis episodes were more commonly culture negative. Bacterial isolates from the hospital-acquired episodes were more likely resistant to ceftazidime (P &lt; .0001) than the other groups. The primary response rate, complete cure rate and overall mortality of the hospital-acquired episodes were 66.6%, 62.0%, and 23.2%, respectively, all worse than episodes that developed outside the hospital (P &lt; .0001 for all). Conclusion PD patients admitted to the hospital had a 4-fold increase in the risk of developing peritonitis. Hospital-acquired peritonitis episodes were more likely culture negative and resistant to antibiotics. They also had a lower primary response rate, a lower complete cure rate and higher mortality than episodes that developed outside the hospital. Lay Summary Peritoneal dialysis (PD) is a home-based therapy. We hypothesize that PD patients have an excess risk of developing PD-related peritonitis during hospital admission for unrelated reasons and the outcome may be affected. We reviewed 371 episodes of hospital-acquired PD peritonitis. Their clinical characteristics and outcomes were compared with 825 episodes that required hospital admission and 1964 episodes treated as outpatient. We found that hospitalized PD patients had a 4-fold higher risk of developing peritonitis than outpatients. Hospital-acquired peritonitis episodes were more likely culture negative and the bacterial isolates were more likely resistant to ceftazidime. The primary response rate, complete cure rate and overall mortality of the hospital-acquired episodes were all significantly worse than the others. Our result highlights the importance of staff education on early identification and treatment of PD-related peritonitis. Clinicians should be mindful of antibiotic resistance in hospital-acquired PD-related peritonitis and consider early adjustment of treatment according to the clinical response. 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Health aspects
Original
Peritonitis
title Excessive risk and poor outcome of hospital-acquired peritoneal dialysis-related peritonitis
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