Abstract: FR-PO477
Variation in the Approach to Antibiotic Administration for the Treatment of Peritoneal Dialysis-Associated Peritonitis: Results From a Survey of US Medical Directors Participating in the OPPUS Study
Session Information
- Peritoneal Dialysis: Current Topics
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Al sahlawi, Muthana, King Faisal University, Al-Hasa, Eastern, Saudi Arabia
- Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Khan, Sana F., University of Virginia, Charlottesville, Virginia, United States
- El Shamy, Osama, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Piraino, Beth M., University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
- Schreiber, Martin J., DaVita Inc, Denver, Colorado, United States
- Teitelbaum, Isaac, University of Colorado Denver School of Medicine, Aurora, Colorado, United States
- Garcia, Leslie, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Perl, Jeffrey, St. Michael's Hospital, Toronto, Ontario, Canada
Background
Peritoneal dialysis (PD)-associated peritonitis carries significant morbidity and is the leading cause of technique failure and transition to hemodialysis. This study aimed to explore the variation in antibiotic dosing and administration for the treatment of PD-associated peritonitis among a diverse group of PD facilities participating in the Optimizing Prevention of PD-associated Peritonitis in US (OPPUS) study.
Methods
As part of the OPPUS study, an online peritonitis-focused survey was administered in quarter 1 of 2022 to medical directors at 40 PD study sites, representing independent, small, medium, and large sized dialysis organizations. Surveys to date were completed by 38 of these study sites.
Results
Most centers (78%) provide patients with antibiotics for self-administration at home whenever peritonitis is suspected but to be taken during clinic off-hours. Clinics differ considerably regarding the types and numbers of intraperitoneal vs oral antibiotics prescribed for such self-administration. Antibiotics are routinely administered in one exchange/day in 95% of facilities; only 47% of facilities adjust dose for residual kidney function. Moreover, most centers (82%) indicated having no access to effluent cell count before initiation of antibiotics, with typically >12-hour turnaround time before effluent cell count results are available at 74% of PD units. Large inter-facility variability was seen as to when repeat PD effluent cell count(s) and culture(s) should be taken. In addition, only 62% of facilities routinely check vancomycin trough levels when intra-peritoneal vancomycin is prescribed.
Conclusion
Prompt administration of antibiotics has been consistently shown to be associated with better outcomes of peritonitis treatment. Significant variations exist in antibiotic dosing and administration for PD-associated peritonitis across PD facilities in the US. It is notable that less than 20% of PD units routinely have access to PD effluent cell count results before treatment is initiated. Identifying optimal antibiotic dosing and administration practices that maximize the likelihood of cure is an important step to improve peritonitis outcomes and decrease related adverse events.
Funding
- Other NIH Support