Diez años del Registro Uruguayo de Peritonitis en Diálisis Peritoneal

Liliana Gadola; Teresa Gómez; Lucía Saez; Daniel Pérez; Lucía Orihuela; Virginia Ramella; Emma Bugstaller; Alejandra Canon; Carlota González-Bedat; Patricia Larre-Borges; Mariela Mautone; Anabella Rébori; Alicia Sans; Natalia Orihuela; Mario Forselledo; María Eugenia Torres Debat; Verónica Seija

Authors

Liliana Gadola Universidad de la República, Facultad de Medicina, Nefrología. Profesora Agregada
Teresa Gómez Sociedad Uruguaya de Nefrología, Grupo de Diálisis Peritoneal. Nefróloga
Lucía Saez Universidad de la República, Facultad de Medicina, Nefrología. Ex Asistente
Daniel Pérez Sociedad Uruguaya de Nefrología, Grupo de Diálisis Peritoneal. Nefrólogo
Lucía Orihuela Universidad de la República, Facultad de Medicina, Nefrología. Ex Asistente
Virginia Ramella Sociedad Uruguaya de Nefrología, Grupo de Diálisis Peritoneal. Nefróloga y Pediatra
Emma Bugstaller Sociedad Uruguaya de Nefrología, Grupo de Diálisis Peritoneal. Nefróloga
Alejandra Canon Universidad de la República, Facultad de Medicina, Centro de Nefrología. Ex Asistente
Carlota González-Bedat Sociedad Uruguaya de Nefrología, Registro Uruguayo de Diálisis, Grupo de Diálisis Peritoneal. Nefróloga
Patricia Larre-Borges Universidad de la República, Facultad de Medicina, Nefrología. Profesora Adjunta
Mariela Mautone Universidad de la República, Facultad de Medicina, Nefrología. Profesora Adjunta
Anabella Rébori ASSE, Centro Hospitalario Pereira Rossell, Servicio de Nefrología Pediátrica. Jefa
Alicia Sans Universidad de la República, Facultad de Medicina, Nefrología. Ex Asistente
Natalia Orihuela Sociedad Uruguaya de Nefrología, Grupo de Diálisis Peritoneal. Nefróloga
Mario Forselledo Sociedad Uruguaya de Nefrología, Grupo de Diálisis Peritoneal. Nefrólogo
María Eugenia Torres Debat Laboratorio de Bacteriología CASMU-IAMPP. Microbióloga. Universidad de la República, Facultad de Medicina, Bacteriología y Virología, Laboratorio Clínico. Ex Profesora Adjunta
Verónica Seija Universidad de la República, Facultad de Medicina, Laboratorio de Patología Clínica, orientación Bacteriología. Profesora Agregada. Microbióloga

Keywords:

PERITONITIS, PERITONEAL DYALISIS

Abstract

Peritonitis is a severe complication of peritoneal dialysis (PD), so it is important to learn about the incidence and antibiotic sensitivity of the germs that cause it. In Uruguay, since January 1, 2004, a national record is kept for peritonitis in PD, germs, sensitivity and evolution.
Method: the records from January 1, 2004 through December 31, 2013 were analyzed. The registry was approved by institutional ethical committes.
Results: during the above mentioned period, 850 cases of peritonitis were recorded, and incidence dropped from 0.49/patient-year (2004-2005) to 0.37/patient-year (2013). Incidence of Staphylococcus aureus and coagulase-negative staphylococci (SCoN) was lower in 2009-2013 vs 2004-2005 (0.2 vs 0.12 peritonitis/patient-year, test Poisson p<0.05). In 2009-2013: 14/54 S. aureus and 26/71 SCoN were methicillin-resistant, similar to the previous period. 98% of Gram-negative were sensitive to amikacin. No germ was identified in 145/467 (31%) of episodes. Primary cure was achieved in 71% of peritonitis for Gram-positive and 45% for Gram-negative bacteria (chi2 p<0.05). In 2013 a greater incidence of peritonitis was observed in those centers where the nasal carriage was not controlled.
Comments and conclusions: controlling Staphylococcus aureus nasal carriages is worth doing. The incidence of peritonitis by methicillin-resistant S. aureus y SCoN, the sustained incidence of Gram-negative germs (with a worse evolution), and the high percentage of cultures with no development justify keeping the initial empirical antibiotic protocol with vancomycin and amikacin. Reduction in the incidence of S. aureus + SCoN could be explained by a greater education in PD patients.

References

(1) Bender FH, Bernardini J, Piraino B. Prevention of infectious complications in peritoneal dialysis: best demonstrated practices. Kidney Int Suppl 2006; (103):S44-54.
(2) Ballerini L, Paris V. Nosogogy: when the learner is a patient with chronic renal failure. Kidney Int Suppl 2006; (103):S122-6.
(3) Hsieh YP, Wang SC, Chang CC, Wen YK, Chiu PF, Yang Y. The negative impact of early peritonitis on continuous ambulatory peritoneal dialysis patients. Perit Dial Int 2014; 34(6):627-35.
(4) Montenegro J, Correa-Rotter R, Riella M. Tratado de diálisis peritoneal. 2 ed. Barcelona: Elsevier, 2009.
(5) Piraino B, Bailie GR, Bernardini J, Boeschoten E, Gupta A, Holmes C, et al; ISPD Ad Hoc Advisory Committee. Peritoneal dialysis-related infections recommendations: 2005 update. Perit Dial Int 2005; 25(2):107-31.
(6) Piraino B, Bernardini J, Brown E, Figueiredo A, Johnson DW, Lye WC, et al. ISPD position statement on reducing the risks of peritoneal dialysis-related infections. Perit Dial Int 2011; 31(6):614-30.
(7) Barretti P, Doles JV, Pinotti DG, El Dib R. Efficacy of antibiotic therapy for peritoneal dialysis-associated peritonitis: a proportional meta-analysis. BMC Infect Dis 2014; 14:445.
(8) Akoh JA. Peritoneal dialysis associated infections: An update on diagnosis and management. World J Nephrol 2012; 1(4):106-22.
(9) Gadola L, Orihuela L, Pérez D, Gómez T, Solá L, Chifflet L, et al. Peritonitis in peritoneal dialysis patients in Uruguay. Perit Dial Int 2008; 28(3):232-5.
(10) Li PK, Chow KM. Infectious complications in dialysis: epidemiology and outcomes. Nat Rev Nephrol 2011; 8(2):77-88.
(11) Ballinger AE, Palmer SC, Wiggins KJ, Craig JC, Johnson DW, Cross NB, et al. Treatment for peritoneal dialysis-associated peritonitis. Cochrane Database Syst Rev 2014; (4):CD005284.
(12) Cho Y, Johnson DW. Peritoneal dialysis-related peritonitis: towards improving evidence, practices, and outcomes. Am J Kidney Dis 2014; 64(2):278-89.
(13) Bajo Rubio MA, Selgas R, Remón C, Arrieta J, Álvarez-Ude F, Arenas MD, et al. Plan de calidad científico-técnica y de mejora continua de la calidad en diálisis peritoneal. Nefrología (Madr.) 2010; 30(1):28-45.
(14) Gadola L, Poggi C, Poggio M, Sáez L, Ferrari A, Romero J, et al. Using a multidisciplinary training program to reduce peritonitis in peritoneal dialysis patients. Perit Dial Int 2013; 33(1):38-45.
(15) Yip T, Tse KC, Lam MF, Cheng SW, Lui SL, Tang S, et al. Risks and outcomes of peritonitis after flexible colonoscopy in CAPD patients. Perit Dial Int 2007; 27(5):560-4.
(16) Barretti P, Pereira D, Brasil MA, de Lourdes Cunha M, Caramori J, Montelli A. Evolution of gram-negative bacilli susceptibility in peritoneal dialysis-related peritonitis in Brazil: a single center’s experience over nine years. Perit Dial Int 2009; 29(2):230-3.
(17) Gadola L, Schwedt E, Díaz A, Sola L, Falchi B, Verdaguer C, et al. Informe del Programa de Diálisis Peritoneal Continua Ambulatoria (Uruguay). En: I Congresso Latino Americano de Diálise Peritoneal. Florianópolis, 21-23 de outubro de 1988.
(18) Rodríguez-Carmona A, Pérez-Fontán M, López-Muñiz A, Ferreiro-Hermida T, García-Falcón T. Correlation between glycemic control and the incidence of peritoneal and catheter tunnel and exit-site infections in diabetic patients undergoing peritoneal dialysis. Perit Dial Int 2014; 34(6):618-26.
(19) Szeto CC, Chow KM, Wong TY, Leung CB, Li PK. Influence of climate on the incidence of peritoneal dialysis-related peritonitis. Perit Dial Int 2003; 23(6):580-6.
(20) Stinghen AE, Barretti P, Pecoits-Filho R. Factors contributing to the differences in peritonitis rates between centers and regions. Perit Dial Int 2007; 27(Suppl 2):S281-5.
(21) Núñez-Moral M, Sánchez-Álvarez JE, González-Díaz I, Peláez-Requejo B, Quintana-Fernández A, Rodríguez-Suárez C. Seasonal variations and influence of the weather on the appearance of peritoneal infection. Nefrología 2014; 34(6):743-8.
(22) Cho Y, Badve SV, Hawley CM, McDonald SP, Brown FG, Boudville N, et al. Seasonal variation in peritoneal dialysis-associated peritonitis: a multi-centre registry study. Nephrol Dial Transplant 2012; 27(5):2028-36.
(23) van Esch S, Krediet R, Struijk DG. Prognostic factors for peritonitis outcome. En: Ronco C, Rosner MH, Crepaldi C, eds. Peritoneal dialysis: state of the art 2012. Basel: Karger 2012. v.178:264-70.
(24) Szeto CC, Chow KM. Gram-negative peritonitis—the Achilles heel of peritoneal dialysis? Perit Dial Int 2007; 27(Suppl 2):S267-71.
(25) Siva B, Hawley CM, McDonald SP, Brown FG, Rosman JB, Wiggins KJ, et al. Pseudomonas peritonitis in Australia: predictors, treatment, and outcomes in 191 cases. Clin J Am Soc Nephrol 2009; 4(5):957-64.
(26) Szeto CC, Chow VC, Chow KM, Lai RW, Chung KY, Leung CB, et al. Enterobacteriaceae peritonitis complicating peritoneal dialysis: a review of 210 consecutive cases. Kidney Int 2006; 69(7):1245-52.
(27) Muñoz de Bustillo E, Borrás F, Gómez-Roldán C, Pérez-Contreras FJ, Olivares J, García R, et al. Impacto de las peritonitis en la supervivencia a largo plazo de los pacientes en diálisis peritoneal. Nefrología (Madr.) 2011; 31(6):723-32.
(28) de Moraes TP, Olandoski M, Caramori JC, Martin LC, Fernandes N, Divino-Filho JC, et al. Novel predictors of peritonitis-related outcomes in the BRAZPD cohort. Perit Dial Int 2014; 34(2):179-87.
(29) Tsai CC, Lee JJ, Liu TP, Ko WC, Wu CJ, Pan CF, et al. Effects of age and diabetes mellitus on clinical outcomes in patients with peritoneal dialysis-related peritonitis. Surg Infect (Larchmt) 2013; 14(6):540-6.
(30) Kumar VA, Sidell MA, Yang WT, Jones JP. Predictors of peritonitis, hospital days, and technique survival for peritoneal dialysis patients in a managed care setting. Perit Dial Int 2014; 34(2):171-8.
(31) Feneberg R, Warady BA, Alexander SR, Schaefer F; International Pediatric Peritonitis Registry. The international pediatric peritonitis registry: a global Internet-based initiative in pediatric dialysis. Perit Dial Int 2005; 25(Suppl 3):S130-4.