Effects of a Statewide Protocol for the Management of Peritoneal Dialysis-Related Peritonitis on Microbial Profiles and Antimicrobial Susceptibilities: A Retrospective Five-Year Review

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Abstract

BACKGROUND: Peritonitis is a major complication of peritoneal dialysis (PD) and is associated with significant morbidity and mortality. Early empirical antibiotic therapy is recommended, with the choice of agents guided by local resistance patterns. As routine use of specific antimicrobial agents can drive resistance, regular assessment of causative organisms and their susceptibility to empirical therapy is essential. 

METHODS: We conducted a retrospective review of all PD peritonitis cases and positive PD fluid cultures obtained over a 5-year period in Western Australia following the introduction of a statewide protocol for the initial management of PD peritonitis with intraperitoneal vancomycin and gentamicin. 

RESULTS: The incidence of PD peritonitis decreased from 1 in 16 patient months (0.75/year at risk) to 1 in 29 patient months (0.41/year at risk) over the 5 years. There were 1,319 culture-positive samples and 1,069 unique isolates identified. Gram-positive bacteria accounted for 69.9% of positive cultures, with vancomycin resistance averaging 2% over the study period. Gram-negative bacteria accounted for 25.4% of positive cultures, with gentamicin resistance identified in an average of 8% of organisms. No increase in antimicrobial resistance to vancomycin or gentamicin occurred over the 5 years and there was no change in the proportion of gram-positive (69.9%), gram-negative (25.4%) or fungal (4.4%) organisms causing PD peritonitis. 

CONCLUSIONS: Over time, the peritonitis rates have dramatically improved although the profile of causative organisms remains similar. Empirical treatment of PD peritonitis with intraperitoneal vancomycin and gentamicin remains efficacious, with high levels of susceptibility and no evidence that the introduction of this statewide empirical PD peritonitis treatment protocol is driving resistance to these agents.

Original languageEnglish
Pages (from-to)722-728
Number of pages7
JournalPeritoneal Dialysis International
Volume35
Issue number7
DOIs
Publication statusPublished - Dec 2015

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Peritoneal Dialysis
Peritonitis
Gentamicins
Vancomycin Resistance
Vancomycin
Western Australia
Ascitic Fluid
Gram-Positive Bacteria
Clinical Protocols
Anti-Infective Agents
Gram-Negative Bacteria
Therapeutics
Anti-Bacterial Agents
Morbidity
Mortality
Incidence

Cite this

@article{ca6729c4343241459b3c7e9cf4344bb8,
title = "Effects of a Statewide Protocol for the Management of Peritoneal Dialysis-Related Peritonitis on Microbial Profiles and Antimicrobial Susceptibilities: A Retrospective Five-Year Review",
abstract = "BACKGROUND: Peritonitis is a major complication of peritoneal dialysis (PD) and is associated with significant morbidity and mortality. Early empirical antibiotic therapy is recommended, with the choice of agents guided by local resistance patterns. As routine use of specific antimicrobial agents can drive resistance, regular assessment of causative organisms and their susceptibility to empirical therapy is essential. METHODS: We conducted a retrospective review of all PD peritonitis cases and positive PD fluid cultures obtained over a 5-year period in Western Australia following the introduction of a statewide protocol for the initial management of PD peritonitis with intraperitoneal vancomycin and gentamicin. RESULTS: The incidence of PD peritonitis decreased from 1 in 16 patient months (0.75/year at risk) to 1 in 29 patient months (0.41/year at risk) over the 5 years. There were 1,319 culture-positive samples and 1,069 unique isolates identified. Gram-positive bacteria accounted for 69.9{\%} of positive cultures, with vancomycin resistance averaging 2{\%} over the study period. Gram-negative bacteria accounted for 25.4{\%} of positive cultures, with gentamicin resistance identified in an average of 8{\%} of organisms. No increase in antimicrobial resistance to vancomycin or gentamicin occurred over the 5 years and there was no change in the proportion of gram-positive (69.9{\%}), gram-negative (25.4{\%}) or fungal (4.4{\%}) organisms causing PD peritonitis. CONCLUSIONS: Over time, the peritonitis rates have dramatically improved although the profile of causative organisms remains similar. Empirical treatment of PD peritonitis with intraperitoneal vancomycin and gentamicin remains efficacious, with high levels of susceptibility and no evidence that the introduction of this statewide empirical PD peritonitis treatment protocol is driving resistance to these agents.",
keywords = "Adult, Anti-Bacterial Agents, Australia, Clinical Protocols, Drug Resistance, Bacterial, Female, Humans, Kidney Failure, Chronic, Male, Peritoneal Dialysis, Peritonitis, Retrospective Studies, Journal Article",
author = "McGuire, {Amanda L} and Christine Carson and Tim Inglis and Aron Chakera",
note = "Copyright {\circledC} 2015 International Society for Peritoneal Dialysis.",
year = "2015",
month = "12",
doi = "10.3747/pdi.2014.00117",
language = "English",
volume = "35",
pages = "722--728",
journal = "Peritoneal Dialysis International",
issn = "0896-8608",
publisher = "Multimed, Inc.",
number = "7",

}

TY - JOUR

T1 - Effects of a Statewide Protocol for the Management of Peritoneal Dialysis-Related Peritonitis on Microbial Profiles and Antimicrobial Susceptibilities

T2 - A Retrospective Five-Year Review

AU - McGuire, Amanda L

AU - Carson, Christine

AU - Inglis, Tim

AU - Chakera, Aron

N1 - Copyright © 2015 International Society for Peritoneal Dialysis.

PY - 2015/12

Y1 - 2015/12

N2 - BACKGROUND: Peritonitis is a major complication of peritoneal dialysis (PD) and is associated with significant morbidity and mortality. Early empirical antibiotic therapy is recommended, with the choice of agents guided by local resistance patterns. As routine use of specific antimicrobial agents can drive resistance, regular assessment of causative organisms and their susceptibility to empirical therapy is essential. METHODS: We conducted a retrospective review of all PD peritonitis cases and positive PD fluid cultures obtained over a 5-year period in Western Australia following the introduction of a statewide protocol for the initial management of PD peritonitis with intraperitoneal vancomycin and gentamicin. RESULTS: The incidence of PD peritonitis decreased from 1 in 16 patient months (0.75/year at risk) to 1 in 29 patient months (0.41/year at risk) over the 5 years. There were 1,319 culture-positive samples and 1,069 unique isolates identified. Gram-positive bacteria accounted for 69.9% of positive cultures, with vancomycin resistance averaging 2% over the study period. Gram-negative bacteria accounted for 25.4% of positive cultures, with gentamicin resistance identified in an average of 8% of organisms. No increase in antimicrobial resistance to vancomycin or gentamicin occurred over the 5 years and there was no change in the proportion of gram-positive (69.9%), gram-negative (25.4%) or fungal (4.4%) organisms causing PD peritonitis. CONCLUSIONS: Over time, the peritonitis rates have dramatically improved although the profile of causative organisms remains similar. Empirical treatment of PD peritonitis with intraperitoneal vancomycin and gentamicin remains efficacious, with high levels of susceptibility and no evidence that the introduction of this statewide empirical PD peritonitis treatment protocol is driving resistance to these agents.

AB - BACKGROUND: Peritonitis is a major complication of peritoneal dialysis (PD) and is associated with significant morbidity and mortality. Early empirical antibiotic therapy is recommended, with the choice of agents guided by local resistance patterns. As routine use of specific antimicrobial agents can drive resistance, regular assessment of causative organisms and their susceptibility to empirical therapy is essential. METHODS: We conducted a retrospective review of all PD peritonitis cases and positive PD fluid cultures obtained over a 5-year period in Western Australia following the introduction of a statewide protocol for the initial management of PD peritonitis with intraperitoneal vancomycin and gentamicin. RESULTS: The incidence of PD peritonitis decreased from 1 in 16 patient months (0.75/year at risk) to 1 in 29 patient months (0.41/year at risk) over the 5 years. There were 1,319 culture-positive samples and 1,069 unique isolates identified. Gram-positive bacteria accounted for 69.9% of positive cultures, with vancomycin resistance averaging 2% over the study period. Gram-negative bacteria accounted for 25.4% of positive cultures, with gentamicin resistance identified in an average of 8% of organisms. No increase in antimicrobial resistance to vancomycin or gentamicin occurred over the 5 years and there was no change in the proportion of gram-positive (69.9%), gram-negative (25.4%) or fungal (4.4%) organisms causing PD peritonitis. CONCLUSIONS: Over time, the peritonitis rates have dramatically improved although the profile of causative organisms remains similar. Empirical treatment of PD peritonitis with intraperitoneal vancomycin and gentamicin remains efficacious, with high levels of susceptibility and no evidence that the introduction of this statewide empirical PD peritonitis treatment protocol is driving resistance to these agents.

KW - Adult

KW - Anti-Bacterial Agents

KW - Australia

KW - Clinical Protocols

KW - Drug Resistance, Bacterial

KW - Female

KW - Humans

KW - Kidney Failure, Chronic

KW - Male

KW - Peritoneal Dialysis

KW - Peritonitis

KW - Retrospective Studies

KW - Journal Article

U2 - 10.3747/pdi.2014.00117

DO - 10.3747/pdi.2014.00117

M3 - Article

VL - 35

SP - 722

EP - 728

JO - Peritoneal Dialysis International

JF - Peritoneal Dialysis International

SN - 0896-8608

IS - 7

ER -