Characteristics and outcomes of hospital-acquired and community-acquired peritonitis in patients on peritoneal dialysis: a retrospective cohort study

Background Peritonitis remains a significant complication of peritoneal dialysis. However, there is limited information on the clinical characteristics and outcomes of hospital-acquired peritonitis compared to community-acquired peritonitis in patients undergoing peritoneal dialysis. Furthermore, th...

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Veröffentlicht in:Journal of nephrology 2023-09, Vol.36 (7), p.1877-1888
Hauptverfasser: Ling, Chau Wei, Sud, Kamal, Peterson, Gregory, Fethney, Judith, Van, Connie, Patel, Rahul, Zaidi, Syed Tabish Razi, Castelino, Ronald
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container_end_page 1888
container_issue 7
container_start_page 1877
container_title Journal of nephrology
container_volume 36
creator Ling, Chau Wei
Sud, Kamal
Peterson, Gregory
Fethney, Judith
Van, Connie
Patel, Rahul
Zaidi, Syed Tabish Razi
Castelino, Ronald
description Background Peritonitis remains a significant complication of peritoneal dialysis. However, there is limited information on the clinical characteristics and outcomes of hospital-acquired peritonitis compared to community-acquired peritonitis in patients undergoing peritoneal dialysis. Furthermore, the microbiology and outcomes of community-acquired peritonitis may vary from hospital-acquired peritonitis. Therefore, the aim was to gather and analyse data to address this gap. Methods Retrospective review of the medical records of all adult patients on peritoneal dialysis within the peritoneal dialysis units in four university teaching hospitals in Sydney, Australia, who developed peritonitis between January 2010 and November 2020. We compared the clinical characteristics, microbiology and outcomes of community-acquired peritonitis and hospital-acquired peritonitis. Community acquired peritonitis was defined as the development of peritonitis in the outpatient setting. Hospital-acquired peritonitis was defined as: (1) developed peritonitis anytime during hospitalisation for any medical condition other than peritonitis, (2) diagnosed with peritonitis within 7 days of hospital discharge and developed symptoms of peritonitis within 3 days of the hospital discharge. Results Overall, 904 episodes of peritoneal dialysis-associated peritonitis were identified in 472 patients, of which 84 (9.3%) episodes were hospital-acquired. Patients with hospital-acquired peritonitis had lower mean serum albumin levels compared to those with community-acquired peritonitis(22.95 g/L vs. 25.76 g/L, p  = 0.002). At the time of diagnosis, lower median peritoneal effluent leucocyte and polymorph counts were observed with hospital-acquired peritonitis compared to community-acquired peritonitis (1236.00/mm 3 vs. 3183.50/mm 3 , p  
doi_str_mv 10.1007/s40620-023-01597-w
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However, there is limited information on the clinical characteristics and outcomes of hospital-acquired peritonitis compared to community-acquired peritonitis in patients undergoing peritoneal dialysis. Furthermore, the microbiology and outcomes of community-acquired peritonitis may vary from hospital-acquired peritonitis. Therefore, the aim was to gather and analyse data to address this gap. Methods Retrospective review of the medical records of all adult patients on peritoneal dialysis within the peritoneal dialysis units in four university teaching hospitals in Sydney, Australia, who developed peritonitis between January 2010 and November 2020. We compared the clinical characteristics, microbiology and outcomes of community-acquired peritonitis and hospital-acquired peritonitis. Community acquired peritonitis was defined as the development of peritonitis in the outpatient setting. Hospital-acquired peritonitis was defined as: (1) developed peritonitis anytime during hospitalisation for any medical condition other than peritonitis, (2) diagnosed with peritonitis within 7 days of hospital discharge and developed symptoms of peritonitis within 3 days of the hospital discharge. Results Overall, 904 episodes of peritoneal dialysis-associated peritonitis were identified in 472 patients, of which 84 (9.3%) episodes were hospital-acquired. Patients with hospital-acquired peritonitis had lower mean serum albumin levels compared to those with community-acquired peritonitis(22.95 g/L vs. 25.76 g/L, p  = 0.002). At the time of diagnosis, lower median peritoneal effluent leucocyte and polymorph counts were observed with hospital-acquired peritonitis compared to community-acquired peritonitis (1236.00/mm 3 vs. 3183.50/mm 3 , p  &lt; 0.01 and 1037.00/mm 3 vs. 2800.00/mm 3 , p  &lt; 0.01, respectively). Higher proportions of peritonitis due to Pseudomonas spp. (9.5% vs. 3.7%, p  = 0.020) and vancomycin-resistant Enterococcus (2.4% vs. 0.0%, p  = 0.009), lower rates of complete cure (39.3% vs. 61.7%, p  &lt; 0.001), higher rates of refractory peritonitis (39.3% vs. 16.4%, p  &lt; 0.001) and higher all-cause mortality within 30 days of peritonitis diagnosis (28.6% vs. 3.3%, p  &lt; 0.001) were observed in the hospital-acquired peritonitis group compared to the community-acquired peritonitis group, respectively. Conclusions Despite having lower peritoneal dialysis effluent leucocyte counts at the time of diagnosis, patients with hospital-acquired peritonitis had poorer outcomes, including lower rates of complete cure, higher rates of refractory peritonitis and higher rates of all-cause mortality within 30 days of diagnosis, compared to those with community-acquired peritonitis. 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The Author(s).</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c398t-846da9be3d1d9a94f42fbd176a0f31edcd79c4bad052333aa66cb0a76c96b2af3</cites><orcidid>0000-0002-6445-4314</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40620-023-01597-w$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40620-023-01597-w$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,315,781,785,886,27929,27930,41493,42562,51324</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36913080$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ling, Chau Wei</creatorcontrib><creatorcontrib>Sud, Kamal</creatorcontrib><creatorcontrib>Peterson, Gregory</creatorcontrib><creatorcontrib>Fethney, Judith</creatorcontrib><creatorcontrib>Van, Connie</creatorcontrib><creatorcontrib>Patel, Rahul</creatorcontrib><creatorcontrib>Zaidi, Syed Tabish Razi</creatorcontrib><creatorcontrib>Castelino, Ronald</creatorcontrib><title>Characteristics and outcomes of hospital-acquired and community-acquired peritonitis in patients on peritoneal dialysis: a retrospective cohort study</title><title>Journal of nephrology</title><addtitle>J Nephrol</addtitle><addtitle>J Nephrol</addtitle><description>Background Peritonitis remains a significant complication of peritoneal dialysis. However, there is limited information on the clinical characteristics and outcomes of hospital-acquired peritonitis compared to community-acquired peritonitis in patients undergoing peritoneal dialysis. Furthermore, the microbiology and outcomes of community-acquired peritonitis may vary from hospital-acquired peritonitis. Therefore, the aim was to gather and analyse data to address this gap. Methods Retrospective review of the medical records of all adult patients on peritoneal dialysis within the peritoneal dialysis units in four university teaching hospitals in Sydney, Australia, who developed peritonitis between January 2010 and November 2020. We compared the clinical characteristics, microbiology and outcomes of community-acquired peritonitis and hospital-acquired peritonitis. Community acquired peritonitis was defined as the development of peritonitis in the outpatient setting. Hospital-acquired peritonitis was defined as: (1) developed peritonitis anytime during hospitalisation for any medical condition other than peritonitis, (2) diagnosed with peritonitis within 7 days of hospital discharge and developed symptoms of peritonitis within 3 days of the hospital discharge. Results Overall, 904 episodes of peritoneal dialysis-associated peritonitis were identified in 472 patients, of which 84 (9.3%) episodes were hospital-acquired. Patients with hospital-acquired peritonitis had lower mean serum albumin levels compared to those with community-acquired peritonitis(22.95 g/L vs. 25.76 g/L, p  = 0.002). At the time of diagnosis, lower median peritoneal effluent leucocyte and polymorph counts were observed with hospital-acquired peritonitis compared to community-acquired peritonitis (1236.00/mm 3 vs. 3183.50/mm 3 , p  &lt; 0.01 and 1037.00/mm 3 vs. 2800.00/mm 3 , p  &lt; 0.01, respectively). Higher proportions of peritonitis due to Pseudomonas spp. (9.5% vs. 3.7%, p  = 0.020) and vancomycin-resistant Enterococcus (2.4% vs. 0.0%, p  = 0.009), lower rates of complete cure (39.3% vs. 61.7%, p  &lt; 0.001), higher rates of refractory peritonitis (39.3% vs. 16.4%, p  &lt; 0.001) and higher all-cause mortality within 30 days of peritonitis diagnosis (28.6% vs. 3.3%, p  &lt; 0.001) were observed in the hospital-acquired peritonitis group compared to the community-acquired peritonitis group, respectively. Conclusions Despite having lower peritoneal dialysis effluent leucocyte counts at the time of diagnosis, patients with hospital-acquired peritonitis had poorer outcomes, including lower rates of complete cure, higher rates of refractory peritonitis and higher rates of all-cause mortality within 30 days of diagnosis, compared to those with community-acquired peritonitis. Graphic abstract</description><subject>Adult</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine &amp; Public Health</subject><subject>Nephrology</subject><subject>original</subject><subject>original Article</subject><subject>Peritoneal Dialysis - adverse effects</subject><subject>Peritoneum</subject><subject>Peritonitis - diagnosis</subject><subject>Peritonitis - epidemiology</subject><subject>Peritonitis - etiology</subject><subject>Retrospective Studies</subject><subject>Urology</subject><issn>1724-6059</issn><issn>1121-8428</issn><issn>1724-6059</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><recordid>eNp9kc1u3SAQhVHVqElv-wJdVCy7ccuPDaabqrrqnxQpm2SNxoBziWxwACe6D5L3Lc1N0nTTFWjOmW8GDkLvKPlICZGfcksEIw1hvCG0U7K5fYFOqGRtI0inXj67H6PXOV8RwrqOta_QMReKctKTE3S33UECU1zyuXiTMQSL41pMnF3GccS7mBdfYGrAXK8-OXvvqPK8Bl_2f8tLRZRYaz5jH_ACxbtQKiM8Sg4mbD1M--zzZww4uZIq3Znib1xF7mIqOJfV7t-goxGm7N4-nBt08f3b-fZnc3r249f262ljuOpL07fCghoct9QqUO3YsnGwVAogI6fOGiuVaQewpGOccwAhzEBACqPEwGDkG_TlwF3WYa7-unCCSS_Jz5D2OoLX_yrB7_RlvNGUdC2XRFbChwdCitery0XPPhs3TRBcXLNmshcd7Wkdv0HsYDX11Tm58WkOJfpPoPoQqK6B6vtA9W1tev98w6eWxwSrgR8MuUrh0iV9FdcU6q_9D_sbV8WzfQ</recordid><startdate>20230901</startdate><enddate>20230901</enddate><creator>Ling, Chau Wei</creator><creator>Sud, Kamal</creator><creator>Peterson, Gregory</creator><creator>Fethney, Judith</creator><creator>Van, Connie</creator><creator>Patel, Rahul</creator><creator>Zaidi, Syed Tabish Razi</creator><creator>Castelino, Ronald</creator><general>Springer International Publishing</general><scope>C6C</scope><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><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6445-4314</orcidid></search><sort><creationdate>20230901</creationdate><title>Characteristics and outcomes of hospital-acquired and community-acquired peritonitis in patients on peritoneal dialysis: a retrospective cohort study</title><author>Ling, Chau Wei ; Sud, Kamal ; Peterson, Gregory ; Fethney, Judith ; Van, Connie ; Patel, Rahul ; Zaidi, Syed Tabish Razi ; Castelino, Ronald</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c398t-846da9be3d1d9a94f42fbd176a0f31edcd79c4bad052333aa66cb0a76c96b2af3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine &amp; Public Health</topic><topic>Nephrology</topic><topic>original</topic><topic>original Article</topic><topic>Peritoneal Dialysis - adverse effects</topic><topic>Peritoneum</topic><topic>Peritonitis - diagnosis</topic><topic>Peritonitis - epidemiology</topic><topic>Peritonitis - etiology</topic><topic>Retrospective Studies</topic><topic>Urology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ling, Chau Wei</creatorcontrib><creatorcontrib>Sud, Kamal</creatorcontrib><creatorcontrib>Peterson, Gregory</creatorcontrib><creatorcontrib>Fethney, Judith</creatorcontrib><creatorcontrib>Van, Connie</creatorcontrib><creatorcontrib>Patel, Rahul</creatorcontrib><creatorcontrib>Zaidi, Syed Tabish Razi</creatorcontrib><creatorcontrib>Castelino, Ronald</creatorcontrib><collection>Springer Nature OA/Free Journals</collection><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><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ling, Chau Wei</au><au>Sud, Kamal</au><au>Peterson, Gregory</au><au>Fethney, Judith</au><au>Van, Connie</au><au>Patel, Rahul</au><au>Zaidi, Syed Tabish Razi</au><au>Castelino, Ronald</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Characteristics and outcomes of hospital-acquired and community-acquired peritonitis in patients on peritoneal dialysis: a retrospective cohort study</atitle><jtitle>Journal of nephrology</jtitle><stitle>J Nephrol</stitle><addtitle>J Nephrol</addtitle><date>2023-09-01</date><risdate>2023</risdate><volume>36</volume><issue>7</issue><spage>1877</spage><epage>1888</epage><pages>1877-1888</pages><issn>1724-6059</issn><issn>1121-8428</issn><eissn>1724-6059</eissn><abstract>Background Peritonitis remains a significant complication of peritoneal dialysis. However, there is limited information on the clinical characteristics and outcomes of hospital-acquired peritonitis compared to community-acquired peritonitis in patients undergoing peritoneal dialysis. Furthermore, the microbiology and outcomes of community-acquired peritonitis may vary from hospital-acquired peritonitis. Therefore, the aim was to gather and analyse data to address this gap. Methods Retrospective review of the medical records of all adult patients on peritoneal dialysis within the peritoneal dialysis units in four university teaching hospitals in Sydney, Australia, who developed peritonitis between January 2010 and November 2020. We compared the clinical characteristics, microbiology and outcomes of community-acquired peritonitis and hospital-acquired peritonitis. Community acquired peritonitis was defined as the development of peritonitis in the outpatient setting. Hospital-acquired peritonitis was defined as: (1) developed peritonitis anytime during hospitalisation for any medical condition other than peritonitis, (2) diagnosed with peritonitis within 7 days of hospital discharge and developed symptoms of peritonitis within 3 days of the hospital discharge. Results Overall, 904 episodes of peritoneal dialysis-associated peritonitis were identified in 472 patients, of which 84 (9.3%) episodes were hospital-acquired. Patients with hospital-acquired peritonitis had lower mean serum albumin levels compared to those with community-acquired peritonitis(22.95 g/L vs. 25.76 g/L, p  = 0.002). At the time of diagnosis, lower median peritoneal effluent leucocyte and polymorph counts were observed with hospital-acquired peritonitis compared to community-acquired peritonitis (1236.00/mm 3 vs. 3183.50/mm 3 , p  &lt; 0.01 and 1037.00/mm 3 vs. 2800.00/mm 3 , p  &lt; 0.01, respectively). Higher proportions of peritonitis due to Pseudomonas spp. (9.5% vs. 3.7%, p  = 0.020) and vancomycin-resistant Enterococcus (2.4% vs. 0.0%, p  = 0.009), lower rates of complete cure (39.3% vs. 61.7%, p  &lt; 0.001), higher rates of refractory peritonitis (39.3% vs. 16.4%, p  &lt; 0.001) and higher all-cause mortality within 30 days of peritonitis diagnosis (28.6% vs. 3.3%, p  &lt; 0.001) were observed in the hospital-acquired peritonitis group compared to the community-acquired peritonitis group, respectively. Conclusions Despite having lower peritoneal dialysis effluent leucocyte counts at the time of diagnosis, patients with hospital-acquired peritonitis had poorer outcomes, including lower rates of complete cure, higher rates of refractory peritonitis and higher rates of all-cause mortality within 30 days of diagnosis, compared to those with community-acquired peritonitis. Graphic abstract</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>36913080</pmid><doi>10.1007/s40620-023-01597-w</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-6445-4314</orcidid><oa>free_for_read</oa></addata></record>
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1724-6059
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subjects Adult
Hospitals
Humans
Medicine
Medicine & Public Health
Nephrology
original
original Article
Peritoneal Dialysis - adverse effects
Peritoneum
Peritonitis - diagnosis
Peritonitis - epidemiology
Peritonitis - etiology
Retrospective Studies
Urology
title Characteristics and outcomes of hospital-acquired and community-acquired peritonitis in patients on peritoneal dialysis: a retrospective cohort study
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