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David W. Johnson - One of the best experts on this subject based on the ideXlab platform.

  • economic evaluation of neutral ph low glucose degradation product peritoneal dialysis solutions compared with standard solutions a secondary analysis of the balanz trial
    American Journal of Kidney Diseases, 2015
    Co-Authors: Kirsten Howard, Yeoungjee Cho, David W. Johnson, Margaret Clarke, Alison J Hayes, Alan Cass
    Abstract:

    Background Biocompatible solutions may lower Peritonitis rates, but are more costly than conventional solutions. The aim of the present study was to assess the additional costs and health outcomes of biocompatible over conventional solutions in incident peritoneal dialysis patients to guide practice decisions. Study Design Secondary economic evaluation of a randomized controlled trial. Setting & Population 185 participants in the balANZ trial. Model, Perspective, & Timeframe Cost-effectiveness of biocompatible compared to standard solution over the 2 years using an Australian health care funder perspective. Intervention Intervention group received biocompatible solutions and control group received standard solutions over 2 years. Outcomes Costs included dialysis charges, costs of treating Peritonitis, non−Peritonitis-related hospital stays, and medication. Peritonitis was the health outcome of interest; incremental cost-effectiveness ratios were reported in terms of the additional cost per additional patient avoiding Peritonitis at 2 years. Results Mean total per-patient costs were A$57,451 and A$53,930 for the biocompatible and standard-solution groups, respectively. The base-case analysis indicated an incremental cost of A$17,804 per additional patient avoiding Peritonitis at 2 years for biocompatible compared to standard solution. In a sensitivity analysis excluding extreme outliers for non−Peritonitis-related hospitalizations, mean per-patient costs were A$49,159 and A$52,009 for the biocompatible and standard-solution groups, respectively. Consequently, the incremental cost-effectiveness ratio also was reduced significantly: biocompatible solution became both less costly and more effective than standard solution and, in economic terms, was dominant over standard solution. Limitations Peritonitis was a secondary outcome of the balANZ trial. Health outcomes measured only in terms of patients avoiding Peritonitis over 2 years may underestimate the longer term benefits (eg, prolonged technique survival). Conclusions Biocompatible dialysis solutions may offer a cost-effective alternative to standard solutions for peritoneal dialysis patients. Reductions in Peritonitis-related hospital costs may offset the higher costs of biocompatible solution.

  • staphylococcus aureus Peritonitis in australian peritoneal dialysis patients predictors treatment and outcomes in 503 cases
    Peritoneal Dialysis International, 2010
    Co-Authors: S Govindarajulu, Carmel M Hawley, Stephen P Mcdonald, Fiona G Brown, Johan B Rosman, Kathryn J Wiggins, Kym M Bannister, David W. Johnson
    Abstract:

    Staphylococcus aureus Peritonitis is a serious complication of peritoneal dialysis (PD). Since reports of the course and treatment of S. aureus Peritonitis have generally been limited to small, single-center studies, the aim of the current investigation was to examine the frequency, predictors, treatment, and clinical outcomes of this condition in all 4675 patients receiving PD in Australia between 1 October 2003 and 31 December 2006. 3594 episodes of Peritonitis occurred in 1984 patients and 503 (14%) episodes of S. aureus Peritonitis occurred in 355 (8%) individuals. 273 (77%) patients experienced 1 episode of S. aureus Peritonitis, 52 (15%) experienced 2 episodes, 19 (5%) experienced 3 episodes, and 11 (3%) experienced 4 or more episodes. The predominant antibiotics used as initial empiric therapy were vancomycin (61%) and cephazolin (31%). Once S. aureus was isolated and identified, the prescription of vancomycin did not appreciably change for methicillin-sensitive S. aureus (MSSA) Peritonitis (59%) and increased for methicillin-resistant S. aureus (MRSA) Peritonitis (84%). S. aureus Peritonitis was associated with a higher rate of relapse than non-S. aureus Peritonitis (20% vs 13%, p < 0.001) but comparable rates of hospitalization (67% vs 70%, p = 0.2), catheter removal (23% vs 21%, p = 0.4), hemodialysis transfer (18% vs 18%, p = 0.6), and death (2.2% vs 2.3%, p = 0.9). MRSA Peritonitis was independently predictive of an increased risk of permanent hemodialysis transfer [odds ratio (OR) 2.11, 95% confidence interval (CI) 1.17 - 3.82] and tended to be associated with an increased risk of hospitalization (OR 2.00, 95% CI 0.96 - 4.19). The initial empiric antibiotic choice between vancomycin and cephazolin was not significantly associated with clinical outcomes, but serious adverse outcomes were more likely if vancomycin was not used for subsequent treatment of MRSA Peritonitis. In conclusion, S. aureus Peritonitis is a serious complication of PD, involves a small proportion of patients, and is associated with a high rate of relapse and repeat episodes. Other adverse clinical outcomes are similar to those for Peritonitis overall but are significantly worse for MRSA Peritonitis. Empiric initial therapy with either vancomycin or cephazolin results in comparable outcomes, provided vancomycin is prescribed when MRSA is isolated and identified.

  • culture negative Peritonitis in peritoneal dialysis patients in australia predictors treatment and outcomes in 435 cases
    American Journal of Kidney Diseases, 2010
    Co-Authors: Magid Fahim, Carmel M Hawley, Stephen P Mcdonald, Fiona G Brown, Johan B Rosman, Kathryn J Wiggins, Kym M Bannister, David W. Johnson
    Abstract:

    Background Reports of culture-negative peritoneal dialysis (PD)-associated Peritonitis have been sparse, conflicting, and limited to small single-center studies. The aim of this investigation is to examine the frequency, predictors, treatment, and outcomes of culture-negative PD-associated Peritonitis. Study Design Observational cohort study using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data. Setting & Participants All Australian PD patients between October 1, 2003, and December 31, 2006. Predictors Demographic, clinical, and facility variables. Outcomes & Measurements Culture-negative PD-associated Peritonitis occurrence, relapse, hospitalization, catheter removal, hemodialysis transfer, and death. Results Of 4,675 patients who received PD in Australia during the study period, 435 episodes of culture-negative Peritonitis occurred in 361 individuals. Culture-negative Peritonitis was not associated with demographic or clinical variables. A history of previous antibiotic treatment for Peritonitis was more common with culture-negative than culture-positive Peritonitis (42% vs 35%; P = 0.01). Compared with culture-positive Peritonitis, culture-negative Peritonitis was significantly more likely to be cured using antibiotics alone (77% vs 66%; P P P P P = 0.04). Relapse rates were similar between the 2 groups. Patients with relapsed culture-negative Peritonitis were more likely to have their catheters removed (29% vs 10% [ P Limitations Limited covariate adjustment. Residual confounding and coding bias could not be excluded. Conclusions Culture-negative Peritonitis is a common complication with a relatively benign outcome. A history of previous antibiotic treatment is a significant risk factor for this condition.

  • enterococcal Peritonitis in australian peritoneal dialysis patients predictors treatment and outcomes in 116 cases
    Nephrology Dialysis Transplantation, 2010
    Co-Authors: Matthew Edey, Carmel M Hawley, Stephen P Mcdonald, Fiona G Brown, Johan B Rosman, Kathryn J Wiggins, Kym M Bannister, David W. Johnson
    Abstract:

    Background. Enterococcal Peritonitis is a serious complication of peritoneal dialysis (PD), although reports of this condition in the literature are exceedingly limited.Methods. The frequency, predictors, treatment and clinical outcomes of enterococcal Peritonitis were investigated in all 4675 patients receiving PD in Australia between 1 October 2003 and 31 December 2006.Results. One hundred and sixteen episodes of enterococcal Peritonitis occurred in 103 individuals. Enterococcal Peritonitis tended to be associated with older age, Maori and Pacific Islander racial origin, renovascular disease and coronary artery disease. Polymicrobial Peritonitis, defined as recovery of two or more organisms from dialysate effluent, was significantly more common when an Enterococcus species was isolated than when it was not (45% vs 5%, respectively, P < 0.001, odds ratio 13.4, 95% CI 9.45-19.0). Although international guidelines recommend intraperitoneal ampicillin therapy, only 8% of patients with pure enterococcal Peritonitis were treated with this agent, whilst the majority (78%) received vancomycin monotherapy. Overall, 59 (51%) patients with enterococcal Peritonitis were successfully treated with antibiotics without experiencing relapse, catheter removal or death. The sole independent predictor of adverse clinical outcomes was recovery of additional (non-Enterococcus) organisms. Polymicrobial enterococcal Peritonitis was associated with very high rates of hospitalization (83%), catheter removal (52%), permanent haemodialysis transfer (50%) and death (5.8%). In contrast, clinical outcomes were broadly comparable for pure enterococcal and non-enterococcal Peritonitis (hospitalization 75% vs 69%, respectively; catheter removal 25% vs 21%; permanent haemodialysis transfer 17% vs 17%; death 1.6% vs 2.2%) although worse than non-enterococcal Gram-positive Peritonitis (63%, 12%, 3% and 0.6%, respectively). Removal of the PD catheter within 1 week of enterococcal Peritonitis onset was associated with a lower probability of permanent haemodialysis transfer than later removal (74% vs 100%, P = 0.03).Conclusions. Enterococcal Peritonitis is associated with an increased risk of catheter removal, permanent haemodialysis transfer and death, particularly when other organisms are isolated in the same episode.

  • polymicrobial Peritonitis in peritoneal dialysis patients in australia predictors treatment and outcomes
    American Journal of Kidney Diseases, 2010
    Co-Authors: Katherine A Barraclough, Carmel M Hawley, Stephen P Mcdonald, Fiona G Brown, Johan B Rosman, Kathryn J Wiggins, Kym M Bannister, David W. Johnson
    Abstract:

    Background The study aim was to examine the frequency, predictors, treatment, and clinical outcomes of peritoneal dialysis–associated polymicrobial Peritonitis. Study Design Observational cohort study using ANZDATA (The Australia and New Zealand Dialysis and Transplant Registry) data. Setting & Participants All Australian peritoneal dialysis patients between October 2003 and December 2006. Predictors Age, sex, race, body mass index, baseline renal function, late referral, kidney disease, smoking status, comorbidity, peritoneal permeability, center, state, organisms, and antibiotic regimen. Outcomes & Measurements Polymicrobial Peritonitis occurrence, relapse, hospitalization, catheter removal, hemodialysis transfer, and death. Results 359 episodes of polymicrobial Peritonitis occurred in 324 individuals, representing 10% of all Peritonitis episodes during 6,002 patient-years. The organisms isolated included mixed Gram-positive and Gram-negative organisms (41%), pure Gram-negative organisms (22%), pure Gram-positive organisms (25%), and mixed bacteria and fungi (13%). There were no significant independent predictors of polymicrobial Peritonitis except for the presence of chronic lung disease. Compared with single-organism infections, polymicrobial Peritonitis was associated with higher rates of hospitalization (83% vs 68%; P P P P = 0.03). Isolation of fungus or Gram-negative bacteria was the primary predictor of adverse clinical outcomes. Pure Gram-positive Peritonitis had the best clinical outcomes. Patients who had their catheters removed >1 week after polymicrobial Peritonitis onset were significantly more likely to be permanently transferred to hemodialysis therapy than those who had earlier catheter removal (92% vs 81%; P = 0.05). Limitations Limited covariate adjustment. Residual confounding and coding bias could not be excluded. Conclusions Polymicrobial Peritonitis can be treated successfully using antibiotics alone without catheter removal in most cases, particularly when only Gram-positive organisms are isolated. Isolation of Gram-negative bacteria (with or without Gram-positive bacteria) or fungi carries a worse prognosis and generally should be treated with early catheter removal and appropriate antimicrobial therapy.

Carmel M Hawley - One of the best experts on this subject based on the ideXlab platform.

  • center effects and peritoneal dialysis Peritonitis outcomes analysis of a national registry
    American Journal of Kidney Diseases, 2017
    Co-Authors: Htay Htay, Yeoungjee Cho, Carmel M Hawley, Elaine M Pascoe, Darsy Darssan, Annie Claire Nadeaufredette, Philip A Clayton, Monique Borlace, Sunil V Badve, Kamal Sud
    Abstract:

    Background Peritonitis is a common cause of technique failure in peritoneal dialysis (PD). Dialysis center−level characteristics may influence PD Peritonitis outcomes independent of patient-level characteristics. Study Design Retrospective cohort study. Setting & Participants Using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data, all incident Australian PD patients who had Peritonitis from 2004 through 2014 were included. Predictors Patient- (including demographic data, causal organisms, and comorbid conditions) and center- (including center size, proportion of patients treated with PD, and summary measures related to type, cause, and outcome of Peritonitis episodes) level predictors. Outcomes & Measurement The primary outcome was cure of Peritonitis with antibiotics. Secondary outcomes were Peritonitis-related catheter removal, hemodialysis therapy transfer, Peritonitis relapse/recurrence, hospitalization, and mortality. Outcomes were analyzed using multilevel mixed logistic regression. Results The study included 9,100 episodes of Peritonitis among 4,428 patients across 51 centers. Cure with antibiotics was achieved in 6,285 (69%) Peritonitis episodes and varied between 38% and 86% across centers. Centers with higher proportions of dialysis patients treated with PD (>29%) had significantly higher odds of Peritonitis cure (adjusted OR, 1.21; 95% CI, 1.04-1.40) and lower odds of catheter removal (OR, 0.78; 95% CI, 0.62-0.97), hemodialysis therapy transfer (OR, 0.78; 95% CI, 0.62-0.97), and Peritonitis relapse/recurrence (OR, 0.68; 95% CI, 0.48-0.98). Centers with higher proportions of Peritonitis episodes receiving empirical antibiotics covering both Gram-positive and Gram-negative organisms had higher odds of cure with antibiotics (OR, 1.22; 95% CI, 1.06-1.42). Patient-level characteristics associated with higher odds of cure were younger age and less virulent causative organisms (coagulase-negative staphylococci, streptococci, and culture negative). The variation in odds of cure across centers was 9% higher after adjustment for patient-level characteristics, but 66% lower after adjustment for center-level characteristics. Limitations Retrospective study design using registry data. Conclusions These results suggest that center effects contribute substantially to the appreciable variation in PD Peritonitis outcomes that exist across PD centers within Australia.

  • recent Peritonitis associates with mortality among patients treated with peritoneal dialysis
    Journal of The American Society of Nephrology, 2012
    Co-Authors: Neil Boudville, Carmel M Hawley, Stephen P Mcdonald, Kathryn J Wiggins, Kym M Bannister, Philip A Clayton, Sunil V Badve, Anna Kemp, Wai H Lim, Fiona G Brown
    Abstract:

    Peritonitis is a major complication of peritoneal dialysis, but the relationship between Peritonitis and mortality among these patients is not well understood. In this case-crossover study, we included the 1316 patients who received peritoneal dialysis in Australia and New Zealand from May 2004 through December 2009 and either died on peritoneal dialysis or within 30 days of transfer to hemodialysis. Each patient served as his or her own control. The mean age was 70 years, and the mean time receiving peritoneal dialysis was 3 years. In total, there were 1446 reported episodes of Peritonitis with 27% of patients having ≥2 episodes. Compared with the rest of the year, there were significantly increased odds of Peritonitis during the 120 days before death, although the magnitude of this association was much greater during the 30 days before death. Compared with a 30-day window 6 months before death, the odds for Peritonitis was six-fold higher during the 30 days immediately before death (odds ratio, 6.2; 95% confidence interval, 4.4–8.7). In conclusion, Peritonitis significantly associates with mortality in peritoneal dialysis patients. The increased odds extend up to 120 days after an episode of Peritonitis but the magnitude is greater during the initial 30 days.

  • coagulase negative staphylococcal Peritonitis in australian peritoneal dialysis patients predictors treatment and outcomes in 936 cases
    Nephrology Dialysis Transplantation, 2010
    Co-Authors: Magid Fahim, Carmel M Hawley, Stephen P Mcdonald, Fiona G Brown, Johan B Rosman, Kathryn J Wiggins, Kym M Bannister, D Johnson
    Abstract:

    Background. Coagulase-negative staphylococcal (CNS) Peritonitis is the most common cause of peritoneal dialysis (PD)-associated Peritonitis. Previous reports of this important condition have been sparse and generally limited to single-centre studies. Methods. The frequency, predictors, treatment and clinical outcomes of CNS Peritonitis were examined by multivariate logistic regression and multilevel Poisson regression in all adult PD patients in Australia between 2003 and 2006. Results. A total of 936 episodes of CNS Peritonitis (constituting 26% of all Peritonitis episodes) occurred in 620 individuals. The observed rate of CNS Peritonitis was 0.16 episodes per patient-year. Lower rates of CNS Peritonitis were independently predicted by Asian racial origin (adjusted odds ratio [OR], 0.52; 95% CI, 0.35–0.79), renovascular nephrosclerosis (OR, 0.40; 95% CI, 0.18–0.86), early referral to a renal unit prior to dialysis commencement (OR, 0.38; 95% CI, 0.19–0.79) and treatment with automated PD at any time during the PD career (OR, 0.79; 95% CI, 0.66–0.96). The majority of CNS Peritonitis episodes were initially treated with intraperitoneal vancomycin or cephazolin in combination with gentamicin. This regimen was changed in 533 (57%) individuals after a median period of 3 days, most commonly to vancomycin monotherapy. The median total antibiotic course duration was 14 days. Compared with other forms of Peritonitis, CNS episodes were significantly more likely to be cured by antibiotics alone (76 vs 64%, P 2 months). Conclusions. CNS Peritonitis is a common complication with a relatively benign outcome compared with other forms of PD-associated Peritonitis. Relapsed and repeat Peritonitis are relatively common and are associated with worse outcomes.

  • staphylococcus aureus Peritonitis in australian peritoneal dialysis patients predictors treatment and outcomes in 503 cases
    Peritoneal Dialysis International, 2010
    Co-Authors: S Govindarajulu, Carmel M Hawley, Stephen P Mcdonald, Fiona G Brown, Johan B Rosman, Kathryn J Wiggins, Kym M Bannister, David W. Johnson
    Abstract:

    Staphylococcus aureus Peritonitis is a serious complication of peritoneal dialysis (PD). Since reports of the course and treatment of S. aureus Peritonitis have generally been limited to small, single-center studies, the aim of the current investigation was to examine the frequency, predictors, treatment, and clinical outcomes of this condition in all 4675 patients receiving PD in Australia between 1 October 2003 and 31 December 2006. 3594 episodes of Peritonitis occurred in 1984 patients and 503 (14%) episodes of S. aureus Peritonitis occurred in 355 (8%) individuals. 273 (77%) patients experienced 1 episode of S. aureus Peritonitis, 52 (15%) experienced 2 episodes, 19 (5%) experienced 3 episodes, and 11 (3%) experienced 4 or more episodes. The predominant antibiotics used as initial empiric therapy were vancomycin (61%) and cephazolin (31%). Once S. aureus was isolated and identified, the prescription of vancomycin did not appreciably change for methicillin-sensitive S. aureus (MSSA) Peritonitis (59%) and increased for methicillin-resistant S. aureus (MRSA) Peritonitis (84%). S. aureus Peritonitis was associated with a higher rate of relapse than non-S. aureus Peritonitis (20% vs 13%, p < 0.001) but comparable rates of hospitalization (67% vs 70%, p = 0.2), catheter removal (23% vs 21%, p = 0.4), hemodialysis transfer (18% vs 18%, p = 0.6), and death (2.2% vs 2.3%, p = 0.9). MRSA Peritonitis was independently predictive of an increased risk of permanent hemodialysis transfer [odds ratio (OR) 2.11, 95% confidence interval (CI) 1.17 - 3.82] and tended to be associated with an increased risk of hospitalization (OR 2.00, 95% CI 0.96 - 4.19). The initial empiric antibiotic choice between vancomycin and cephazolin was not significantly associated with clinical outcomes, but serious adverse outcomes were more likely if vancomycin was not used for subsequent treatment of MRSA Peritonitis. In conclusion, S. aureus Peritonitis is a serious complication of PD, involves a small proportion of patients, and is associated with a high rate of relapse and repeat episodes. Other adverse clinical outcomes are similar to those for Peritonitis overall but are significantly worse for MRSA Peritonitis. Empiric initial therapy with either vancomycin or cephazolin results in comparable outcomes, provided vancomycin is prescribed when MRSA is isolated and identified.

  • culture negative Peritonitis in peritoneal dialysis patients in australia predictors treatment and outcomes in 435 cases
    American Journal of Kidney Diseases, 2010
    Co-Authors: Magid Fahim, Carmel M Hawley, Stephen P Mcdonald, Fiona G Brown, Johan B Rosman, Kathryn J Wiggins, Kym M Bannister, David W. Johnson
    Abstract:

    Background Reports of culture-negative peritoneal dialysis (PD)-associated Peritonitis have been sparse, conflicting, and limited to small single-center studies. The aim of this investigation is to examine the frequency, predictors, treatment, and outcomes of culture-negative PD-associated Peritonitis. Study Design Observational cohort study using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data. Setting & Participants All Australian PD patients between October 1, 2003, and December 31, 2006. Predictors Demographic, clinical, and facility variables. Outcomes & Measurements Culture-negative PD-associated Peritonitis occurrence, relapse, hospitalization, catheter removal, hemodialysis transfer, and death. Results Of 4,675 patients who received PD in Australia during the study period, 435 episodes of culture-negative Peritonitis occurred in 361 individuals. Culture-negative Peritonitis was not associated with demographic or clinical variables. A history of previous antibiotic treatment for Peritonitis was more common with culture-negative than culture-positive Peritonitis (42% vs 35%; P = 0.01). Compared with culture-positive Peritonitis, culture-negative Peritonitis was significantly more likely to be cured using antibiotics alone (77% vs 66%; P P P P P = 0.04). Relapse rates were similar between the 2 groups. Patients with relapsed culture-negative Peritonitis were more likely to have their catheters removed (29% vs 10% [ P Limitations Limited covariate adjustment. Residual confounding and coding bias could not be excluded. Conclusions Culture-negative Peritonitis is a common complication with a relatively benign outcome. A history of previous antibiotic treatment is a significant risk factor for this condition.

Fiona G Brown - One of the best experts on this subject based on the ideXlab platform.

  • recent Peritonitis associates with mortality among patients treated with peritoneal dialysis
    Journal of The American Society of Nephrology, 2012
    Co-Authors: Neil Boudville, Carmel M Hawley, Stephen P Mcdonald, Kathryn J Wiggins, Kym M Bannister, Philip A Clayton, Sunil V Badve, Anna Kemp, Wai H Lim, Fiona G Brown
    Abstract:

    Peritonitis is a major complication of peritoneal dialysis, but the relationship between Peritonitis and mortality among these patients is not well understood. In this case-crossover study, we included the 1316 patients who received peritoneal dialysis in Australia and New Zealand from May 2004 through December 2009 and either died on peritoneal dialysis or within 30 days of transfer to hemodialysis. Each patient served as his or her own control. The mean age was 70 years, and the mean time receiving peritoneal dialysis was 3 years. In total, there were 1446 reported episodes of Peritonitis with 27% of patients having ≥2 episodes. Compared with the rest of the year, there were significantly increased odds of Peritonitis during the 120 days before death, although the magnitude of this association was much greater during the 30 days before death. Compared with a 30-day window 6 months before death, the odds for Peritonitis was six-fold higher during the 30 days immediately before death (odds ratio, 6.2; 95% confidence interval, 4.4–8.7). In conclusion, Peritonitis significantly associates with mortality in peritoneal dialysis patients. The increased odds extend up to 120 days after an episode of Peritonitis but the magnitude is greater during the initial 30 days.

  • coagulase negative staphylococcal Peritonitis in australian peritoneal dialysis patients predictors treatment and outcomes in 936 cases
    Nephrology Dialysis Transplantation, 2010
    Co-Authors: Magid Fahim, Carmel M Hawley, Stephen P Mcdonald, Fiona G Brown, Johan B Rosman, Kathryn J Wiggins, Kym M Bannister, D Johnson
    Abstract:

    Background. Coagulase-negative staphylococcal (CNS) Peritonitis is the most common cause of peritoneal dialysis (PD)-associated Peritonitis. Previous reports of this important condition have been sparse and generally limited to single-centre studies. Methods. The frequency, predictors, treatment and clinical outcomes of CNS Peritonitis were examined by multivariate logistic regression and multilevel Poisson regression in all adult PD patients in Australia between 2003 and 2006. Results. A total of 936 episodes of CNS Peritonitis (constituting 26% of all Peritonitis episodes) occurred in 620 individuals. The observed rate of CNS Peritonitis was 0.16 episodes per patient-year. Lower rates of CNS Peritonitis were independently predicted by Asian racial origin (adjusted odds ratio [OR], 0.52; 95% CI, 0.35–0.79), renovascular nephrosclerosis (OR, 0.40; 95% CI, 0.18–0.86), early referral to a renal unit prior to dialysis commencement (OR, 0.38; 95% CI, 0.19–0.79) and treatment with automated PD at any time during the PD career (OR, 0.79; 95% CI, 0.66–0.96). The majority of CNS Peritonitis episodes were initially treated with intraperitoneal vancomycin or cephazolin in combination with gentamicin. This regimen was changed in 533 (57%) individuals after a median period of 3 days, most commonly to vancomycin monotherapy. The median total antibiotic course duration was 14 days. Compared with other forms of Peritonitis, CNS episodes were significantly more likely to be cured by antibiotics alone (76 vs 64%, P 2 months). Conclusions. CNS Peritonitis is a common complication with a relatively benign outcome compared with other forms of PD-associated Peritonitis. Relapsed and repeat Peritonitis are relatively common and are associated with worse outcomes.

  • staphylococcus aureus Peritonitis in australian peritoneal dialysis patients predictors treatment and outcomes in 503 cases
    Peritoneal Dialysis International, 2010
    Co-Authors: S Govindarajulu, Carmel M Hawley, Stephen P Mcdonald, Fiona G Brown, Johan B Rosman, Kathryn J Wiggins, Kym M Bannister, David W. Johnson
    Abstract:

    Staphylococcus aureus Peritonitis is a serious complication of peritoneal dialysis (PD). Since reports of the course and treatment of S. aureus Peritonitis have generally been limited to small, single-center studies, the aim of the current investigation was to examine the frequency, predictors, treatment, and clinical outcomes of this condition in all 4675 patients receiving PD in Australia between 1 October 2003 and 31 December 2006. 3594 episodes of Peritonitis occurred in 1984 patients and 503 (14%) episodes of S. aureus Peritonitis occurred in 355 (8%) individuals. 273 (77%) patients experienced 1 episode of S. aureus Peritonitis, 52 (15%) experienced 2 episodes, 19 (5%) experienced 3 episodes, and 11 (3%) experienced 4 or more episodes. The predominant antibiotics used as initial empiric therapy were vancomycin (61%) and cephazolin (31%). Once S. aureus was isolated and identified, the prescription of vancomycin did not appreciably change for methicillin-sensitive S. aureus (MSSA) Peritonitis (59%) and increased for methicillin-resistant S. aureus (MRSA) Peritonitis (84%). S. aureus Peritonitis was associated with a higher rate of relapse than non-S. aureus Peritonitis (20% vs 13%, p < 0.001) but comparable rates of hospitalization (67% vs 70%, p = 0.2), catheter removal (23% vs 21%, p = 0.4), hemodialysis transfer (18% vs 18%, p = 0.6), and death (2.2% vs 2.3%, p = 0.9). MRSA Peritonitis was independently predictive of an increased risk of permanent hemodialysis transfer [odds ratio (OR) 2.11, 95% confidence interval (CI) 1.17 - 3.82] and tended to be associated with an increased risk of hospitalization (OR 2.00, 95% CI 0.96 - 4.19). The initial empiric antibiotic choice between vancomycin and cephazolin was not significantly associated with clinical outcomes, but serious adverse outcomes were more likely if vancomycin was not used for subsequent treatment of MRSA Peritonitis. In conclusion, S. aureus Peritonitis is a serious complication of PD, involves a small proportion of patients, and is associated with a high rate of relapse and repeat episodes. Other adverse clinical outcomes are similar to those for Peritonitis overall but are significantly worse for MRSA Peritonitis. Empiric initial therapy with either vancomycin or cephazolin results in comparable outcomes, provided vancomycin is prescribed when MRSA is isolated and identified.

  • culture negative Peritonitis in peritoneal dialysis patients in australia predictors treatment and outcomes in 435 cases
    American Journal of Kidney Diseases, 2010
    Co-Authors: Magid Fahim, Carmel M Hawley, Stephen P Mcdonald, Fiona G Brown, Johan B Rosman, Kathryn J Wiggins, Kym M Bannister, David W. Johnson
    Abstract:

    Background Reports of culture-negative peritoneal dialysis (PD)-associated Peritonitis have been sparse, conflicting, and limited to small single-center studies. The aim of this investigation is to examine the frequency, predictors, treatment, and outcomes of culture-negative PD-associated Peritonitis. Study Design Observational cohort study using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data. Setting & Participants All Australian PD patients between October 1, 2003, and December 31, 2006. Predictors Demographic, clinical, and facility variables. Outcomes & Measurements Culture-negative PD-associated Peritonitis occurrence, relapse, hospitalization, catheter removal, hemodialysis transfer, and death. Results Of 4,675 patients who received PD in Australia during the study period, 435 episodes of culture-negative Peritonitis occurred in 361 individuals. Culture-negative Peritonitis was not associated with demographic or clinical variables. A history of previous antibiotic treatment for Peritonitis was more common with culture-negative than culture-positive Peritonitis (42% vs 35%; P = 0.01). Compared with culture-positive Peritonitis, culture-negative Peritonitis was significantly more likely to be cured using antibiotics alone (77% vs 66%; P P P P P = 0.04). Relapse rates were similar between the 2 groups. Patients with relapsed culture-negative Peritonitis were more likely to have their catheters removed (29% vs 10% [ P Limitations Limited covariate adjustment. Residual confounding and coding bias could not be excluded. Conclusions Culture-negative Peritonitis is a common complication with a relatively benign outcome. A history of previous antibiotic treatment is a significant risk factor for this condition.

  • enterococcal Peritonitis in australian peritoneal dialysis patients predictors treatment and outcomes in 116 cases
    Nephrology Dialysis Transplantation, 2010
    Co-Authors: Matthew Edey, Carmel M Hawley, Stephen P Mcdonald, Fiona G Brown, Johan B Rosman, Kathryn J Wiggins, Kym M Bannister, David W. Johnson
    Abstract:

    Background. Enterococcal Peritonitis is a serious complication of peritoneal dialysis (PD), although reports of this condition in the literature are exceedingly limited.Methods. The frequency, predictors, treatment and clinical outcomes of enterococcal Peritonitis were investigated in all 4675 patients receiving PD in Australia between 1 October 2003 and 31 December 2006.Results. One hundred and sixteen episodes of enterococcal Peritonitis occurred in 103 individuals. Enterococcal Peritonitis tended to be associated with older age, Maori and Pacific Islander racial origin, renovascular disease and coronary artery disease. Polymicrobial Peritonitis, defined as recovery of two or more organisms from dialysate effluent, was significantly more common when an Enterococcus species was isolated than when it was not (45% vs 5%, respectively, P < 0.001, odds ratio 13.4, 95% CI 9.45-19.0). Although international guidelines recommend intraperitoneal ampicillin therapy, only 8% of patients with pure enterococcal Peritonitis were treated with this agent, whilst the majority (78%) received vancomycin monotherapy. Overall, 59 (51%) patients with enterococcal Peritonitis were successfully treated with antibiotics without experiencing relapse, catheter removal or death. The sole independent predictor of adverse clinical outcomes was recovery of additional (non-Enterococcus) organisms. Polymicrobial enterococcal Peritonitis was associated with very high rates of hospitalization (83%), catheter removal (52%), permanent haemodialysis transfer (50%) and death (5.8%). In contrast, clinical outcomes were broadly comparable for pure enterococcal and non-enterococcal Peritonitis (hospitalization 75% vs 69%, respectively; catheter removal 25% vs 21%; permanent haemodialysis transfer 17% vs 17%; death 1.6% vs 2.2%) although worse than non-enterococcal Gram-positive Peritonitis (63%, 12%, 3% and 0.6%, respectively). Removal of the PD catheter within 1 week of enterococcal Peritonitis onset was associated with a lower probability of permanent haemodialysis transfer than later removal (74% vs 100%, P = 0.03).Conclusions. Enterococcal Peritonitis is associated with an increased risk of catheter removal, permanent haemodialysis transfer and death, particularly when other organisms are isolated in the same episode.

Kym M Bannister - One of the best experts on this subject based on the ideXlab platform.

  • recent Peritonitis associates with mortality among patients treated with peritoneal dialysis
    Journal of The American Society of Nephrology, 2012
    Co-Authors: Neil Boudville, Carmel M Hawley, Stephen P Mcdonald, Kathryn J Wiggins, Kym M Bannister, Philip A Clayton, Sunil V Badve, Anna Kemp, Wai H Lim, Fiona G Brown
    Abstract:

    Peritonitis is a major complication of peritoneal dialysis, but the relationship between Peritonitis and mortality among these patients is not well understood. In this case-crossover study, we included the 1316 patients who received peritoneal dialysis in Australia and New Zealand from May 2004 through December 2009 and either died on peritoneal dialysis or within 30 days of transfer to hemodialysis. Each patient served as his or her own control. The mean age was 70 years, and the mean time receiving peritoneal dialysis was 3 years. In total, there were 1446 reported episodes of Peritonitis with 27% of patients having ≥2 episodes. Compared with the rest of the year, there were significantly increased odds of Peritonitis during the 120 days before death, although the magnitude of this association was much greater during the 30 days before death. Compared with a 30-day window 6 months before death, the odds for Peritonitis was six-fold higher during the 30 days immediately before death (odds ratio, 6.2; 95% confidence interval, 4.4–8.7). In conclusion, Peritonitis significantly associates with mortality in peritoneal dialysis patients. The increased odds extend up to 120 days after an episode of Peritonitis but the magnitude is greater during the initial 30 days.

  • coagulase negative staphylococcal Peritonitis in australian peritoneal dialysis patients predictors treatment and outcomes in 936 cases
    Nephrology Dialysis Transplantation, 2010
    Co-Authors: Magid Fahim, Carmel M Hawley, Stephen P Mcdonald, Fiona G Brown, Johan B Rosman, Kathryn J Wiggins, Kym M Bannister, D Johnson
    Abstract:

    Background. Coagulase-negative staphylococcal (CNS) Peritonitis is the most common cause of peritoneal dialysis (PD)-associated Peritonitis. Previous reports of this important condition have been sparse and generally limited to single-centre studies. Methods. The frequency, predictors, treatment and clinical outcomes of CNS Peritonitis were examined by multivariate logistic regression and multilevel Poisson regression in all adult PD patients in Australia between 2003 and 2006. Results. A total of 936 episodes of CNS Peritonitis (constituting 26% of all Peritonitis episodes) occurred in 620 individuals. The observed rate of CNS Peritonitis was 0.16 episodes per patient-year. Lower rates of CNS Peritonitis were independently predicted by Asian racial origin (adjusted odds ratio [OR], 0.52; 95% CI, 0.35–0.79), renovascular nephrosclerosis (OR, 0.40; 95% CI, 0.18–0.86), early referral to a renal unit prior to dialysis commencement (OR, 0.38; 95% CI, 0.19–0.79) and treatment with automated PD at any time during the PD career (OR, 0.79; 95% CI, 0.66–0.96). The majority of CNS Peritonitis episodes were initially treated with intraperitoneal vancomycin or cephazolin in combination with gentamicin. This regimen was changed in 533 (57%) individuals after a median period of 3 days, most commonly to vancomycin monotherapy. The median total antibiotic course duration was 14 days. Compared with other forms of Peritonitis, CNS episodes were significantly more likely to be cured by antibiotics alone (76 vs 64%, P 2 months). Conclusions. CNS Peritonitis is a common complication with a relatively benign outcome compared with other forms of PD-associated Peritonitis. Relapsed and repeat Peritonitis are relatively common and are associated with worse outcomes.

  • staphylococcus aureus Peritonitis in australian peritoneal dialysis patients predictors treatment and outcomes in 503 cases
    Peritoneal Dialysis International, 2010
    Co-Authors: S Govindarajulu, Carmel M Hawley, Stephen P Mcdonald, Fiona G Brown, Johan B Rosman, Kathryn J Wiggins, Kym M Bannister, David W. Johnson
    Abstract:

    Staphylococcus aureus Peritonitis is a serious complication of peritoneal dialysis (PD). Since reports of the course and treatment of S. aureus Peritonitis have generally been limited to small, single-center studies, the aim of the current investigation was to examine the frequency, predictors, treatment, and clinical outcomes of this condition in all 4675 patients receiving PD in Australia between 1 October 2003 and 31 December 2006. 3594 episodes of Peritonitis occurred in 1984 patients and 503 (14%) episodes of S. aureus Peritonitis occurred in 355 (8%) individuals. 273 (77%) patients experienced 1 episode of S. aureus Peritonitis, 52 (15%) experienced 2 episodes, 19 (5%) experienced 3 episodes, and 11 (3%) experienced 4 or more episodes. The predominant antibiotics used as initial empiric therapy were vancomycin (61%) and cephazolin (31%). Once S. aureus was isolated and identified, the prescription of vancomycin did not appreciably change for methicillin-sensitive S. aureus (MSSA) Peritonitis (59%) and increased for methicillin-resistant S. aureus (MRSA) Peritonitis (84%). S. aureus Peritonitis was associated with a higher rate of relapse than non-S. aureus Peritonitis (20% vs 13%, p < 0.001) but comparable rates of hospitalization (67% vs 70%, p = 0.2), catheter removal (23% vs 21%, p = 0.4), hemodialysis transfer (18% vs 18%, p = 0.6), and death (2.2% vs 2.3%, p = 0.9). MRSA Peritonitis was independently predictive of an increased risk of permanent hemodialysis transfer [odds ratio (OR) 2.11, 95% confidence interval (CI) 1.17 - 3.82] and tended to be associated with an increased risk of hospitalization (OR 2.00, 95% CI 0.96 - 4.19). The initial empiric antibiotic choice between vancomycin and cephazolin was not significantly associated with clinical outcomes, but serious adverse outcomes were more likely if vancomycin was not used for subsequent treatment of MRSA Peritonitis. In conclusion, S. aureus Peritonitis is a serious complication of PD, involves a small proportion of patients, and is associated with a high rate of relapse and repeat episodes. Other adverse clinical outcomes are similar to those for Peritonitis overall but are significantly worse for MRSA Peritonitis. Empiric initial therapy with either vancomycin or cephazolin results in comparable outcomes, provided vancomycin is prescribed when MRSA is isolated and identified.

  • culture negative Peritonitis in peritoneal dialysis patients in australia predictors treatment and outcomes in 435 cases
    American Journal of Kidney Diseases, 2010
    Co-Authors: Magid Fahim, Carmel M Hawley, Stephen P Mcdonald, Fiona G Brown, Johan B Rosman, Kathryn J Wiggins, Kym M Bannister, David W. Johnson
    Abstract:

    Background Reports of culture-negative peritoneal dialysis (PD)-associated Peritonitis have been sparse, conflicting, and limited to small single-center studies. The aim of this investigation is to examine the frequency, predictors, treatment, and outcomes of culture-negative PD-associated Peritonitis. Study Design Observational cohort study using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data. Setting & Participants All Australian PD patients between October 1, 2003, and December 31, 2006. Predictors Demographic, clinical, and facility variables. Outcomes & Measurements Culture-negative PD-associated Peritonitis occurrence, relapse, hospitalization, catheter removal, hemodialysis transfer, and death. Results Of 4,675 patients who received PD in Australia during the study period, 435 episodes of culture-negative Peritonitis occurred in 361 individuals. Culture-negative Peritonitis was not associated with demographic or clinical variables. A history of previous antibiotic treatment for Peritonitis was more common with culture-negative than culture-positive Peritonitis (42% vs 35%; P = 0.01). Compared with culture-positive Peritonitis, culture-negative Peritonitis was significantly more likely to be cured using antibiotics alone (77% vs 66%; P P P P P = 0.04). Relapse rates were similar between the 2 groups. Patients with relapsed culture-negative Peritonitis were more likely to have their catheters removed (29% vs 10% [ P Limitations Limited covariate adjustment. Residual confounding and coding bias could not be excluded. Conclusions Culture-negative Peritonitis is a common complication with a relatively benign outcome. A history of previous antibiotic treatment is a significant risk factor for this condition.

  • enterococcal Peritonitis in australian peritoneal dialysis patients predictors treatment and outcomes in 116 cases
    Nephrology Dialysis Transplantation, 2010
    Co-Authors: Matthew Edey, Carmel M Hawley, Stephen P Mcdonald, Fiona G Brown, Johan B Rosman, Kathryn J Wiggins, Kym M Bannister, David W. Johnson
    Abstract:

    Background. Enterococcal Peritonitis is a serious complication of peritoneal dialysis (PD), although reports of this condition in the literature are exceedingly limited.Methods. The frequency, predictors, treatment and clinical outcomes of enterococcal Peritonitis were investigated in all 4675 patients receiving PD in Australia between 1 October 2003 and 31 December 2006.Results. One hundred and sixteen episodes of enterococcal Peritonitis occurred in 103 individuals. Enterococcal Peritonitis tended to be associated with older age, Maori and Pacific Islander racial origin, renovascular disease and coronary artery disease. Polymicrobial Peritonitis, defined as recovery of two or more organisms from dialysate effluent, was significantly more common when an Enterococcus species was isolated than when it was not (45% vs 5%, respectively, P < 0.001, odds ratio 13.4, 95% CI 9.45-19.0). Although international guidelines recommend intraperitoneal ampicillin therapy, only 8% of patients with pure enterococcal Peritonitis were treated with this agent, whilst the majority (78%) received vancomycin monotherapy. Overall, 59 (51%) patients with enterococcal Peritonitis were successfully treated with antibiotics without experiencing relapse, catheter removal or death. The sole independent predictor of adverse clinical outcomes was recovery of additional (non-Enterococcus) organisms. Polymicrobial enterococcal Peritonitis was associated with very high rates of hospitalization (83%), catheter removal (52%), permanent haemodialysis transfer (50%) and death (5.8%). In contrast, clinical outcomes were broadly comparable for pure enterococcal and non-enterococcal Peritonitis (hospitalization 75% vs 69%, respectively; catheter removal 25% vs 21%; permanent haemodialysis transfer 17% vs 17%; death 1.6% vs 2.2%) although worse than non-enterococcal Gram-positive Peritonitis (63%, 12%, 3% and 0.6%, respectively). Removal of the PD catheter within 1 week of enterococcal Peritonitis onset was associated with a lower probability of permanent haemodialysis transfer than later removal (74% vs 100%, P = 0.03).Conclusions. Enterococcal Peritonitis is associated with an increased risk of catheter removal, permanent haemodialysis transfer and death, particularly when other organisms are isolated in the same episode.

Kathryn J Wiggins - One of the best experts on this subject based on the ideXlab platform.

  • recent Peritonitis associates with mortality among patients treated with peritoneal dialysis
    Journal of The American Society of Nephrology, 2012
    Co-Authors: Neil Boudville, Carmel M Hawley, Stephen P Mcdonald, Kathryn J Wiggins, Kym M Bannister, Philip A Clayton, Sunil V Badve, Anna Kemp, Wai H Lim, Fiona G Brown
    Abstract:

    Peritonitis is a major complication of peritoneal dialysis, but the relationship between Peritonitis and mortality among these patients is not well understood. In this case-crossover study, we included the 1316 patients who received peritoneal dialysis in Australia and New Zealand from May 2004 through December 2009 and either died on peritoneal dialysis or within 30 days of transfer to hemodialysis. Each patient served as his or her own control. The mean age was 70 years, and the mean time receiving peritoneal dialysis was 3 years. In total, there were 1446 reported episodes of Peritonitis with 27% of patients having ≥2 episodes. Compared with the rest of the year, there were significantly increased odds of Peritonitis during the 120 days before death, although the magnitude of this association was much greater during the 30 days before death. Compared with a 30-day window 6 months before death, the odds for Peritonitis was six-fold higher during the 30 days immediately before death (odds ratio, 6.2; 95% confidence interval, 4.4–8.7). In conclusion, Peritonitis significantly associates with mortality in peritoneal dialysis patients. The increased odds extend up to 120 days after an episode of Peritonitis but the magnitude is greater during the initial 30 days.

  • coagulase negative staphylococcal Peritonitis in australian peritoneal dialysis patients predictors treatment and outcomes in 936 cases
    Nephrology Dialysis Transplantation, 2010
    Co-Authors: Magid Fahim, Carmel M Hawley, Stephen P Mcdonald, Fiona G Brown, Johan B Rosman, Kathryn J Wiggins, Kym M Bannister, D Johnson
    Abstract:

    Background. Coagulase-negative staphylococcal (CNS) Peritonitis is the most common cause of peritoneal dialysis (PD)-associated Peritonitis. Previous reports of this important condition have been sparse and generally limited to single-centre studies. Methods. The frequency, predictors, treatment and clinical outcomes of CNS Peritonitis were examined by multivariate logistic regression and multilevel Poisson regression in all adult PD patients in Australia between 2003 and 2006. Results. A total of 936 episodes of CNS Peritonitis (constituting 26% of all Peritonitis episodes) occurred in 620 individuals. The observed rate of CNS Peritonitis was 0.16 episodes per patient-year. Lower rates of CNS Peritonitis were independently predicted by Asian racial origin (adjusted odds ratio [OR], 0.52; 95% CI, 0.35–0.79), renovascular nephrosclerosis (OR, 0.40; 95% CI, 0.18–0.86), early referral to a renal unit prior to dialysis commencement (OR, 0.38; 95% CI, 0.19–0.79) and treatment with automated PD at any time during the PD career (OR, 0.79; 95% CI, 0.66–0.96). The majority of CNS Peritonitis episodes were initially treated with intraperitoneal vancomycin or cephazolin in combination with gentamicin. This regimen was changed in 533 (57%) individuals after a median period of 3 days, most commonly to vancomycin monotherapy. The median total antibiotic course duration was 14 days. Compared with other forms of Peritonitis, CNS episodes were significantly more likely to be cured by antibiotics alone (76 vs 64%, P 2 months). Conclusions. CNS Peritonitis is a common complication with a relatively benign outcome compared with other forms of PD-associated Peritonitis. Relapsed and repeat Peritonitis are relatively common and are associated with worse outcomes.

  • staphylococcus aureus Peritonitis in australian peritoneal dialysis patients predictors treatment and outcomes in 503 cases
    Peritoneal Dialysis International, 2010
    Co-Authors: S Govindarajulu, Carmel M Hawley, Stephen P Mcdonald, Fiona G Brown, Johan B Rosman, Kathryn J Wiggins, Kym M Bannister, David W. Johnson
    Abstract:

    Staphylococcus aureus Peritonitis is a serious complication of peritoneal dialysis (PD). Since reports of the course and treatment of S. aureus Peritonitis have generally been limited to small, single-center studies, the aim of the current investigation was to examine the frequency, predictors, treatment, and clinical outcomes of this condition in all 4675 patients receiving PD in Australia between 1 October 2003 and 31 December 2006. 3594 episodes of Peritonitis occurred in 1984 patients and 503 (14%) episodes of S. aureus Peritonitis occurred in 355 (8%) individuals. 273 (77%) patients experienced 1 episode of S. aureus Peritonitis, 52 (15%) experienced 2 episodes, 19 (5%) experienced 3 episodes, and 11 (3%) experienced 4 or more episodes. The predominant antibiotics used as initial empiric therapy were vancomycin (61%) and cephazolin (31%). Once S. aureus was isolated and identified, the prescription of vancomycin did not appreciably change for methicillin-sensitive S. aureus (MSSA) Peritonitis (59%) and increased for methicillin-resistant S. aureus (MRSA) Peritonitis (84%). S. aureus Peritonitis was associated with a higher rate of relapse than non-S. aureus Peritonitis (20% vs 13%, p < 0.001) but comparable rates of hospitalization (67% vs 70%, p = 0.2), catheter removal (23% vs 21%, p = 0.4), hemodialysis transfer (18% vs 18%, p = 0.6), and death (2.2% vs 2.3%, p = 0.9). MRSA Peritonitis was independently predictive of an increased risk of permanent hemodialysis transfer [odds ratio (OR) 2.11, 95% confidence interval (CI) 1.17 - 3.82] and tended to be associated with an increased risk of hospitalization (OR 2.00, 95% CI 0.96 - 4.19). The initial empiric antibiotic choice between vancomycin and cephazolin was not significantly associated with clinical outcomes, but serious adverse outcomes were more likely if vancomycin was not used for subsequent treatment of MRSA Peritonitis. In conclusion, S. aureus Peritonitis is a serious complication of PD, involves a small proportion of patients, and is associated with a high rate of relapse and repeat episodes. Other adverse clinical outcomes are similar to those for Peritonitis overall but are significantly worse for MRSA Peritonitis. Empiric initial therapy with either vancomycin or cephazolin results in comparable outcomes, provided vancomycin is prescribed when MRSA is isolated and identified.

  • culture negative Peritonitis in peritoneal dialysis patients in australia predictors treatment and outcomes in 435 cases
    American Journal of Kidney Diseases, 2010
    Co-Authors: Magid Fahim, Carmel M Hawley, Stephen P Mcdonald, Fiona G Brown, Johan B Rosman, Kathryn J Wiggins, Kym M Bannister, David W. Johnson
    Abstract:

    Background Reports of culture-negative peritoneal dialysis (PD)-associated Peritonitis have been sparse, conflicting, and limited to small single-center studies. The aim of this investigation is to examine the frequency, predictors, treatment, and outcomes of culture-negative PD-associated Peritonitis. Study Design Observational cohort study using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data. Setting & Participants All Australian PD patients between October 1, 2003, and December 31, 2006. Predictors Demographic, clinical, and facility variables. Outcomes & Measurements Culture-negative PD-associated Peritonitis occurrence, relapse, hospitalization, catheter removal, hemodialysis transfer, and death. Results Of 4,675 patients who received PD in Australia during the study period, 435 episodes of culture-negative Peritonitis occurred in 361 individuals. Culture-negative Peritonitis was not associated with demographic or clinical variables. A history of previous antibiotic treatment for Peritonitis was more common with culture-negative than culture-positive Peritonitis (42% vs 35%; P = 0.01). Compared with culture-positive Peritonitis, culture-negative Peritonitis was significantly more likely to be cured using antibiotics alone (77% vs 66%; P P P P P = 0.04). Relapse rates were similar between the 2 groups. Patients with relapsed culture-negative Peritonitis were more likely to have their catheters removed (29% vs 10% [ P Limitations Limited covariate adjustment. Residual confounding and coding bias could not be excluded. Conclusions Culture-negative Peritonitis is a common complication with a relatively benign outcome. A history of previous antibiotic treatment is a significant risk factor for this condition.

  • enterococcal Peritonitis in australian peritoneal dialysis patients predictors treatment and outcomes in 116 cases
    Nephrology Dialysis Transplantation, 2010
    Co-Authors: Matthew Edey, Carmel M Hawley, Stephen P Mcdonald, Fiona G Brown, Johan B Rosman, Kathryn J Wiggins, Kym M Bannister, David W. Johnson
    Abstract:

    Background. Enterococcal Peritonitis is a serious complication of peritoneal dialysis (PD), although reports of this condition in the literature are exceedingly limited.Methods. The frequency, predictors, treatment and clinical outcomes of enterococcal Peritonitis were investigated in all 4675 patients receiving PD in Australia between 1 October 2003 and 31 December 2006.Results. One hundred and sixteen episodes of enterococcal Peritonitis occurred in 103 individuals. Enterococcal Peritonitis tended to be associated with older age, Maori and Pacific Islander racial origin, renovascular disease and coronary artery disease. Polymicrobial Peritonitis, defined as recovery of two or more organisms from dialysate effluent, was significantly more common when an Enterococcus species was isolated than when it was not (45% vs 5%, respectively, P < 0.001, odds ratio 13.4, 95% CI 9.45-19.0). Although international guidelines recommend intraperitoneal ampicillin therapy, only 8% of patients with pure enterococcal Peritonitis were treated with this agent, whilst the majority (78%) received vancomycin monotherapy. Overall, 59 (51%) patients with enterococcal Peritonitis were successfully treated with antibiotics without experiencing relapse, catheter removal or death. The sole independent predictor of adverse clinical outcomes was recovery of additional (non-Enterococcus) organisms. Polymicrobial enterococcal Peritonitis was associated with very high rates of hospitalization (83%), catheter removal (52%), permanent haemodialysis transfer (50%) and death (5.8%). In contrast, clinical outcomes were broadly comparable for pure enterococcal and non-enterococcal Peritonitis (hospitalization 75% vs 69%, respectively; catheter removal 25% vs 21%; permanent haemodialysis transfer 17% vs 17%; death 1.6% vs 2.2%) although worse than non-enterococcal Gram-positive Peritonitis (63%, 12%, 3% and 0.6%, respectively). Removal of the PD catheter within 1 week of enterococcal Peritonitis onset was associated with a lower probability of permanent haemodialysis transfer than later removal (74% vs 100%, P = 0.03).Conclusions. Enterococcal Peritonitis is associated with an increased risk of catheter removal, permanent haemodialysis transfer and death, particularly when other organisms are isolated in the same episode.