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Kidney Week

Abstract: PO1277

Repeat Peritonitis: A New Reality After Staphylococcus aureus Carriage Surveillance Implementation

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Reis, Marina, Centro Hospitalar Vila Nova De Gaia/Espinho, Vila Nova de Gaia, Portugal
  • Gomes, Ana Marta, Centro Hospitalar Vila Nova De Gaia/Espinho, Vila Nova de Gaia, Portugal
  • Lopes, Daniela, Centro Hospitalar Vila Nova De Gaia/Espinho, Vila Nova de Gaia, Portugal
  • Santos, Clara, Centro Hospitalar Vila Nova De Gaia/Espinho, Vila Nova de Gaia, Portugal
  • Fernandes, João Carlos, Centro Hospitalar Vila Nova De Gaia/Espinho, Vila Nova de Gaia, Portugal
Background

Peritonitis is one of the major peritoneal dialysis complications and an important cause of technique failure. Notably, repeat peritonitis (RP) have substantial risk of developing further infection episodes that perpetuate peritoneal membrane damage. As Staphylococcus aureus (SA) is a major causative of RP, strategies such as staphylococcus aureus carriage surveillance (SACS) were implemented to decolonization of carriers in order to decrease SA PD infections. This study aims to describe repeat peritonitis clinical behavior and SACS influence on repeat peritonitis.

Methods

We developed one center retrospective study from 1998 to 2019 that compared RP episodes with a control group in terms of causative microorganisms, cure rate, catheter removal and permanent and temporary transfer to hemodialysis. We also compared the same data in RP episodes before and after SACS.

Results

Overall, RP were caused by gram positive microorganisms and had a significantly higher cure rate (97,1% versus 67,3%, p<0.001) and lower rate of hospitalization (11,4% versus 30,8% ) than control group. After SACS, global peritonitis rate decreased (0,54 versus 0,35 episodes per patient-year), and RP rate increased (37,5% versus 7,4% p<0,001) as Streptococci became more frequent (56,7% versus 0,0% p 0,007) and SA less frequent (3,3% versus 60,0% p=0,001). Also, RP cure rate increased (100 % versus 80,0%, p 0,013) and permanent transfer to hemodialysis decreased (6,7%, versus 40,0%, p=0,03).

Conclusion

RP Group have more favorable results than control group that presented higher gram-negative peritonitis rate. After SACS, Streptococci became more frequent than SA in repeat group, peritonitis outcomes became more favorable but repeat peritonitis rate increased. We believe that as measures to prevent SA infections are implemented more programs will face this reality.

Repeat Peritonitis Causative Micoorganisms
 Before SACS (n=5)After SACS (n=30)Univariate Analysis
p value
Streptococci spp017, 56,7%0,007
Coagulase-negative Staphylococcus 2, 40,0%7, 23,3%0,48
Staphylococcus aureus3, 60,0%1, 3,3%0,001
Gram negative01, 3,3%0,55