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Abstract: TH-PO394

A Peritonitis Surveillance System Developed by a Large Dialysis Organization to Improve the Accuracy and Consistency of Peritonitis Rate Reporting in the United States

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Schreiber, Martin J., DaVita, Inc, Denver, Colorado, United States
  • Njord, Levi, DaVita, Inc, Denver, Colorado, United States
  • Zywno, Meredith L., DaVita, Inc, Denver, Colorado, 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
  • Tetley, James Richard, DaVita, Inc, Denver, Colorado, United States
Background

Peritonitis (PTN) remains a major reason for hospitalization of peritoneal dialysis (PD) patients and may result in transfer to in-center hemodialysis. In August 2015, a standardized approach to PTN surveillance was introduced by a large dialysis organization (LDO) to improve the consistency and accuracy of PTN event identification across affiliated programs in the US. The goal of this analysis was to examine the impact of this new surveillance system on the reporting of PTN events since 2015.

Methods

Under the surveillance system, patients with PTN are identified following 6 hierarchical business rules that include the 4 standard diagnostic rules for PTN (based on positive culture, positive cell count, abdominal pain) as well as hospitalization for infection and receipt of intraperitoneal (IP) antibiotics (>8 days, >2 vancomycin doses within 8 days, or >5 doses of non-vancomycin within 8 days). An exemption process exists for PTN events based on the IP antibiotic dosing rule alone. Episodes occurring within 28 days of identification of a prior episode with the same causal organism were considered relapse episodes and were not included in calculations of PTN rates.

Results

During the period August 2015 to December 2017, 10,814 cases of PTN were identified under the surveillance system. Of these, 6280 (58.1%) were identified by standard diagnostic rules, an additional 2793 (25.8%) were identified based on hospitalization, and a further 1741 (16.1%) were identified based on receipt of IP antibiotics. Exemption filings have remained relatively constant over time. The average time to first PTN event was 19.4 months, with 8.6% of events occurring in the first 90 days on PD. Among PD patients overall, 88% experienced no episodes of PTN, 10% developed 1 episode/year, and 2% were observed to have 2 or more PTN events/year.

Conclusion

A consistent approach to identifying PTN events combining standard criteria with infection-related hospitalizations and IP antibiotic dosing is necessary to compare rates between practices in the US and across LDOs and different countries.

Funding

  • Commercial Support