Antibiotic availability for outpatient treatment of acute peritonitis in chronic peritoneal dialysis patients: A case series
Peritoneal dialysis (PD) is a commonly used form of renal replacement therapy for patients that have reached end-stage renal disease. Acute bacterial peritonitis (ABP) in chronic PD patients results in pain, increased costs, injury to the peritoneal membrane, and PD modality failure. Optimal antibio...
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| Veröffentlicht in: | The American journal of the medical sciences 2023-03, Vol.365 (3), p.263-269 |
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| creator | Makhyoun, Camilia N. Ullian, Michael E. |
| description | Peritoneal dialysis (PD) is a commonly used form of renal replacement therapy for patients that have reached end-stage renal disease. Acute bacterial peritonitis (ABP) in chronic PD patients results in pain, increased costs, injury to the peritoneal membrane, and PD modality failure. Optimal antibiotic treatment of acute bacterial peritonitis (ABP) in chronic PD patients should be intraperitoneal, outpatient-based, appropriate, prompt, and uninterrupted. We investigated the frequency of and predisposition to suboptimal antibiotic courses for ABP in our chronic PD patients.
Twenty-four charts of patients with ABP were reviewed, to test the null hypothesis that all ABP patients received antibiotics optimally.
After 12 patient exclusions (hospitalization), 9 suboptimal antibiotic events were detected in 6 of the remaining 12 patients, disproving the null hypothesis (p |
| doi_str_mv | 10.1016/j.amjms.2022.12.002 |
| format | Article |
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Twenty-four charts of patients with ABP were reviewed, to test the null hypothesis that all ABP patients received antibiotics optimally.
After 12 patient exclusions (hospitalization), 9 suboptimal antibiotic events were detected in 6 of the remaining 12 patients, disproving the null hypothesis (p < 0.02). Most suboptimal antibiotics courses (7 of 9) resulted from delays and/or gaps in therapy or antibiotics prescribed outside of community standard. Suboptimal antibiotic events occurred on nights and weekends rather than during the workweek (p < 0.02) and in the emergency room rather than the PD clinic (p < 0.02).
Suboptimal ABP antibiotic therapy occurs commonly and is influenced by time and location of presentation and lack of knowledge by patients and physicians. Prevention of suboptimal antibiotic courses in the treatment of ABP in chronic PD patients includes education of patients and providers and allowing emergency rooms and PD clinics to dispense antibiotics for home use.</description><identifier>ISSN: 0002-9629</identifier><identifier>EISSN: 1538-2990</identifier><identifier>DOI: 10.1016/j.amjms.2022.12.002</identifier><identifier>PMID: 36521531</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute bacterial peritonitis ; Ambulatory Care ; Anti-Bacterial Agents - therapeutic use ; Antibiotic therapy ; Humans ; Kidney Failure, Chronic - drug therapy ; Kidney Failure, Chronic - therapy ; Outpatients ; Peritoneal dialysis ; Peritoneal Dialysis - adverse effects ; Peritonitis - etiology ; Peritonitis - microbiology</subject><ispartof>The American journal of the medical sciences, 2023-03, Vol.365 (3), p.263-269</ispartof><rights>2022 Southern Society for Clinical Investigation</rights><rights>Copyright © 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c309t-c3dbb08957a7ec5e36f442d043c04b1728315a9a99b42d71710eab356e6fee833</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36521531$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Makhyoun, Camilia N.</creatorcontrib><creatorcontrib>Ullian, Michael E.</creatorcontrib><title>Antibiotic availability for outpatient treatment of acute peritonitis in chronic peritoneal dialysis patients: A case series</title><title>The American journal of the medical sciences</title><addtitle>Am J Med Sci</addtitle><description>Peritoneal dialysis (PD) is a commonly used form of renal replacement therapy for patients that have reached end-stage renal disease. Acute bacterial peritonitis (ABP) in chronic PD patients results in pain, increased costs, injury to the peritoneal membrane, and PD modality failure. Optimal antibiotic treatment of acute bacterial peritonitis (ABP) in chronic PD patients should be intraperitoneal, outpatient-based, appropriate, prompt, and uninterrupted. We investigated the frequency of and predisposition to suboptimal antibiotic courses for ABP in our chronic PD patients.
Twenty-four charts of patients with ABP were reviewed, to test the null hypothesis that all ABP patients received antibiotics optimally.
After 12 patient exclusions (hospitalization), 9 suboptimal antibiotic events were detected in 6 of the remaining 12 patients, disproving the null hypothesis (p < 0.02). Most suboptimal antibiotics courses (7 of 9) resulted from delays and/or gaps in therapy or antibiotics prescribed outside of community standard. Suboptimal antibiotic events occurred on nights and weekends rather than during the workweek (p < 0.02) and in the emergency room rather than the PD clinic (p < 0.02).
Suboptimal ABP antibiotic therapy occurs commonly and is influenced by time and location of presentation and lack of knowledge by patients and physicians. Prevention of suboptimal antibiotic courses in the treatment of ABP in chronic PD patients includes education of patients and providers and allowing emergency rooms and PD clinics to dispense antibiotics for home use.</description><subject>Acute bacterial peritonitis</subject><subject>Ambulatory Care</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotic therapy</subject><subject>Humans</subject><subject>Kidney Failure, Chronic - drug therapy</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Outpatients</subject><subject>Peritoneal dialysis</subject><subject>Peritoneal Dialysis - adverse effects</subject><subject>Peritonitis - etiology</subject><subject>Peritonitis - microbiology</subject><issn>0002-9629</issn><issn>1538-2990</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1v1DAQhi0EokvhFyAhH7ls8EecxEgcVhUtSJV6gbM1cSZiVkm82E6llfrj8bJbjlz88fqZGflh7L0UlRSy-bSvYN7PqVJCqUqqSgj1gm2k0d1WWSteso0o0dY2yl6xNynthZCqk_o1u9KNUQWUG_a0WzL1FDJ5Do9AE_Q0UT7yMUQe1nyATLhkniNCnk-nMHLwa0Z-wEg5LJQpcVq4_xXLxT_HCBMfCKZjKs-XLukz33EPCXkqEKa37NUIU8J3l_2a_bz9-uPm2_b-4e77ze5-67WwuaxD34vOmhZa9AZ1M9a1GkStvah72apOSwMWrO1L3MpWCoRemwabEbHT-pp9PPc9xPB7xZTdTMnjNMGCYU1OtcaYVje1Kqg-oz6GlCKO7hBphnh0UriTdrd3f7W7k3YnlSuOS9WHy4C1n3H4V_PsuQBfzgCWbz4SRpd8MeJxoIg-uyHQfwf8AQrqlxg</recordid><startdate>202303</startdate><enddate>202303</enddate><creator>Makhyoun, Camilia N.</creator><creator>Ullian, Michael E.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202303</creationdate><title>Antibiotic availability for outpatient treatment of acute peritonitis in chronic peritoneal dialysis patients: A case series</title><author>Makhyoun, Camilia N. ; Ullian, Michael E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c309t-c3dbb08957a7ec5e36f442d043c04b1728315a9a99b42d71710eab356e6fee833</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Acute bacterial peritonitis</topic><topic>Ambulatory Care</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotic therapy</topic><topic>Humans</topic><topic>Kidney Failure, Chronic - drug therapy</topic><topic>Kidney Failure, Chronic - therapy</topic><topic>Outpatients</topic><topic>Peritoneal dialysis</topic><topic>Peritoneal Dialysis - adverse effects</topic><topic>Peritonitis - etiology</topic><topic>Peritonitis - microbiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Makhyoun, Camilia N.</creatorcontrib><creatorcontrib>Ullian, Michael E.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of the medical sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Makhyoun, Camilia N.</au><au>Ullian, Michael E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antibiotic availability for outpatient treatment of acute peritonitis in chronic peritoneal dialysis patients: A case series</atitle><jtitle>The American journal of the medical sciences</jtitle><addtitle>Am J Med Sci</addtitle><date>2023-03</date><risdate>2023</risdate><volume>365</volume><issue>3</issue><spage>263</spage><epage>269</epage><pages>263-269</pages><issn>0002-9629</issn><eissn>1538-2990</eissn><abstract>Peritoneal dialysis (PD) is a commonly used form of renal replacement therapy for patients that have reached end-stage renal disease. Acute bacterial peritonitis (ABP) in chronic PD patients results in pain, increased costs, injury to the peritoneal membrane, and PD modality failure. Optimal antibiotic treatment of acute bacterial peritonitis (ABP) in chronic PD patients should be intraperitoneal, outpatient-based, appropriate, prompt, and uninterrupted. We investigated the frequency of and predisposition to suboptimal antibiotic courses for ABP in our chronic PD patients.
Twenty-four charts of patients with ABP were reviewed, to test the null hypothesis that all ABP patients received antibiotics optimally.
After 12 patient exclusions (hospitalization), 9 suboptimal antibiotic events were detected in 6 of the remaining 12 patients, disproving the null hypothesis (p < 0.02). Most suboptimal antibiotics courses (7 of 9) resulted from delays and/or gaps in therapy or antibiotics prescribed outside of community standard. Suboptimal antibiotic events occurred on nights and weekends rather than during the workweek (p < 0.02) and in the emergency room rather than the PD clinic (p < 0.02).
Suboptimal ABP antibiotic therapy occurs commonly and is influenced by time and location of presentation and lack of knowledge by patients and physicians. Prevention of suboptimal antibiotic courses in the treatment of ABP in chronic PD patients includes education of patients and providers and allowing emergency rooms and PD clinics to dispense antibiotics for home use.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>36521531</pmid><doi>10.1016/j.amjms.2022.12.002</doi><tpages>7</tpages></addata></record> |
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| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Acute bacterial peritonitis Ambulatory Care Anti-Bacterial Agents - therapeutic use Antibiotic therapy Humans Kidney Failure, Chronic - drug therapy Kidney Failure, Chronic - therapy Outpatients Peritoneal dialysis Peritoneal Dialysis - adverse effects Peritonitis - etiology Peritonitis - microbiology |
| title | Antibiotic availability for outpatient treatment of acute peritonitis in chronic peritoneal dialysis patients: A case series |
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