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Abstract: TH-PO395

Analysis of After-Hours Oral Antibiotic Protocol for the Treatment of Suspected Peritonitis in Peritoneal Dialysis Patients

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Schreiber, Martin J., DaVita, Inc, Denver, Colorado, United States
  • Pegues, David A., Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Van hout, Bram, DaVita, Inc, Denver, Colorado, United States
  • Rodriguez, Julie A., DaVita, Inc, Denver, Colorado, United States
  • Cassin, Michelle, DaVita, Inc, Denver, Colorado, United States
  • Huwe, Aaron, DaVita, Inc, Denver, Colorado, United States
  • Njord, Levi, DaVita, Inc, Denver, Colorado, United States
  • Aronoff, George R., DaVita, Inc, Denver, Colorado, United States
Background

Delays in initiating antibacterial therapy for the treatment of peritonitis may lead to increased risk of peritoneal dialysis (PD) failure. Because intraperitoneal (IP) antibiotic treatment is not available after business hours at most dialysis centers, it is important to have a protocol in place for oral “bridge” therapy until a patient can receive IP treatment. The current analysis was conducted, following FDA fluoroquinolone alert notifications, to evaluate the probability of activity of selected oral antibiotic agents against observed PD infections.

Methods

Causative organisms and oral antibiotic susceptibility were analyzed for all peritonitis cases identified during 2016 among PD patients treated by an LDO. Based on these findings, we determined the probability of activity of selected oral antibiotic agents (cefazolin, cefdinir, ciprofloxacin, trimethoprim/sulfamethoxazole [TMP/SMX]) against infections overall, gram-positive infections, and gram-negative infections.

Results

A total of 4534 cases of peritonitis were analyzed. Causative organisms were: coagulase-negative Staphylococcus (41.4%), gram-negative rods (21.2%), Staphylococcus aureus (8.1%), Streptococcus (9.9%), Enterococcus (5.5%), fungal (3.9%), other (12.5%). Assuming this distribution of pathogens for PD infections overall, TMP/SMX was predicted to be the most active agent (57.2% of episodes susceptible), followed by cefdinir (50.6%), ciprofloxacin (42%), and cefazolin (39.4%). Among gram-positive infections alone, 74.3% would be expected to be susceptible to TMP/SMX, and 62.7% to cefdinir. Among gram-negative infections, ciprofloxacin was predicted to be the most active agent (84.3% of episodes susceptible).

Conclusion

Early initiation of treatment for peritonitis is critical to avoid PD failure. Designing a strategy for early therapy administered at home, until a patient can receive IP treatment, can potentially improve outcomes. Based on the current analyses, TMP/SMX and cefdinir are predicted to be the most active oral agents for the treatment of suspected gram-positive infections. Ciprofloxacin should be used only in the case of suspected high-risk, gram-negative infections.

Funding

  • Commercial Support