Peritonitis-Free Survival in Peritoneal Dialysis According to Staphylococcus spp. Nasal Carriage
- Home Dialysis - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
- Alvarez Zapata, Naomi Alejandra, Secretaria de Salud de Mexico, Mérida, Yucatán, Mexico
- Tapia Silva, Leticia Mirell, Secretaria de Salud de Mexico, Mérida, Yucatán, Mexico
Mexico ranks second with the highest prevalence of peritoneal dialysis (PD) in Latin America. Yucatan in Mexico has the highest prevalence of obesity, diabetes, and kidney stones, the main risk factors for progression to kidney failure (KF). The Agustín O'Horan General Hospital receives patients with chronic kidney disease without affiliation to any health service in which PD is the first line treatment for KF. In our center, PD associated peritonitis continues to be a major cause of hospitalization, PD failure, transition to hemodialysis, and even death. Previous reports suggested that nasal carriage of Staphylococcus spp (SS) conferred an increased risk of PD related peritonitis, however this notion has been challenged by new evidence.
We conducted a prospective study from March 1st 2022 to March 31st 2023. We included all incident PD patients who underwent nasal swabbing prior to PD catheter placement. Patients were followed up for at least 30 days after the PD catheter placement and the time of first peritonitis was recorded. We compared the peritonitis free survival between SS nasal carriers and PD patients with nasal culture negative (CN).
172 patients started PD during the study period. Fifty one patients were excluded due to contamination or the absence of a nasal swab sample prior to PD catheter placement. 121 patients were included in the study, 54.54% were women, the mean age was 51.6 years, and 61% of the population had type 2 diabetes. Thirty four patients had a positive nasal culture for SS and all of them were treated with intranasal mupirocin. Patients were followed for at least 30 days after PD catheter placement with a mean follow up of 138.9 days. Data were censored for patients who had mechanical complications, did not develop peritonitis or were lost to follow up. 46 cases of peritonitis occurred during the follow up. The etiology of PD related peritonitis included 17 SS, 14 non SS, 8 polymicrobial and 7 CN peritonitis cases. Peritonitis free survival in nasal carriers of SS was 76.2 days compared to 69.3 days in patients with CN. There was no significant difference in peritonitis free survival between the two groups.
Nasal carriage of SS does not appear to have an impact on peritonitis free survival. The benefit of performing a nasal culture prior to PD catheter placement remains to be elucidated.