Abstract: TH-OR090

Randomized Trial on Adjunctive Lavage for Severe Peritonitis

Session Information

  • Peritoneal Dialysis
    November 02, 2017 | Location: Room 290, Morial Convention Center
    Abstract Time: 04:54 PM - 05:06 PM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Wong, Steve Siu-Man, Alice Ho Miu Ling Nethersole Hospital, N.T., Hong Kong
  • Cheng, Yuk Lun, Alice Ho Miu Ling Nethersole Hospital, N.T., Hong Kong
  • Yu, Alex W., Hong Kong Baptist Hospital, Kowloon, Hong Kong
Background

No adjunctive therapy has been shown to improve the antibiotic response in peritoneal dialysis (PD)-related peritonitis. This study was conducted to assess if adjunctive lavage is useful for severe cases, as it may enhance the removal of bacteria and inflammatory cells from the peritoneal cavity.

Methods

Intraperitoneal (IP) cefazolin/ ceftazidime were the empirical treatment for PD peritonitis. Severe cases were defined as persistent symptoms with PD effluent (PDE) leukocyte count >1090/mm3 on day 3. We excluded patients with concurrent exit site infection (ESI), or known fungal/ mycobacterial growth from the PDE.

Recruited patients with severe peritonitis were randomized into the lavage or control group. While both groups involved empirical antibiotics escalation (vancomycin/ gentamicin) before the microbiology report became available, continuous lavage by a cycler PD machine was applied in the lavage group for 2-3 days, during which the antibiotics were given intravenously. Usual PD regimen and IP administration of antibiotics were resumed after lavage completed.

Primary endpoint was the treatment outcome: success (cleared PDE) or failure (catheter removed).

Results

Between March 2014 and May 2017, there were 399 peritonitis episodes in our center. A total of 39 episodes, involving 36 patients, were recruited. The other 360 episodes were not recruited mostly because of their mild severity or treatment initiated in other units.

Among the recruited patients, 5 were excluded due to later development of ESI (n=1), fungal (n=3) or mycobacterial growth (n=1) from the PDE. The peritonitis details and outcome are shown in the Table.

Conclusion

Adjunctive lavage did not bring additional merit. Yet, the high treatment success rates in both groups indicated that an early antibiotic escalation could be beneficial in severe PD peritonitis with poor clinical response.

Patients' characteristics & peritonitis details
 Lavage group (n=17)Control group (n=17)P values
Age, years64.1 ± 9.258.8 ± 10.20.12
Male gender, n (%)12 (70.6)5 (29.4)0.04
Peritoneal dialysis vintage, years4.2 ± 2.74.7 ± 3.60.57
Dialysate leukocyte count on day 3, /mm36804 ± 51645297 ± 38760.34
Gram-positive peritonitis, n (%)6 (35.3)10 (58.8)0.30
Gram-negative peritonitis, n (%)8 (47.1)4 (23.5)0.28
Mixed gram-positive & gram-negative peritonitis, n (%)3 (17.6)2 (11.8)1.00
Culture-negative peritonitis, n (%)0 (0.0)1 (5.9)1.00
Treatment success, n (%)12 (70.6)14 (82.4)0.69