Prevention of Infections in Peritoneal Dialysis: Survey Among Young Tunisian Nephrologists
DOI:
https://doi.org/10.25796/bdd.v7i4.84623Keywords:
peritoneal dialysis, peritonitis, infection prevention, Practice evaluation, antibiotic prophylaxisAbstract
Peritonitis is a severe complication in peritoneal dialysis (PD) patients, contributing to technique failure and patient mortality. Tunisia lacks a national dialysis registry, making the incidence of peritonitis unclear. The International Society for Peritoneal Dialysis (ISPD) published guidelines from 2016 to 2022, outlining effective strategies for preventing infections in PD patients. This study was conducted between June and July 2022 to assess Tunisian nephrologists’ knowledge and practices for preventing infections. Using an online questionnaire, 44 participants (67.69% response rate) provided insights. Findings revealed an average score of 4.45 out of 7, indicating significant confusion among respondents. Many incorrectly believe that protecting the catheter under the skin until renal replacement therapy is initiated reduces infections. Questions also addressed nasal Staphylococcus aureus screening, antibiotic prophylaxis, surgical techniques, timing of dressing changes, and local antibiotic use. Responses varied, with 59.1% supporting systematic nasal screening but differing concerning eradication strategies. The study highlights discrepancies between current practices and ISPD guidelines among young Tunisian nephrologists. Recommendations include establishing a national dialysis registry to enhance surveillance and developing tailored national guidelines. A working group from the Tunisian Society of Nephrology, Dialysis, and Transplantation is already developing protocols to address identified gaps and improve PD patient outcomes.
References
Li, Philip Kam-tao; Chow, Kai Ming; Van De Luijtgaarden, Moniek Wm; Johnson, David W; Jager, Kitty J; Mehrotra, Rajnish; Naicker, Sarala; Pecoits-filho, Roberto; Yu, Xue Qing; Lameire, Norbert. Changes in the worldwide epidemiology of peritoneal dialysis
Lasfar LB, Guedri Y, Zellama D, et al. Long-term clinical outcomes of peritoneal dialysis patients : 10-year experience of a single unit from Tunisia. Saudi J Kidney Dis Transpl 2019;30:451-61.doi : 10.4103/1319-2442.256852.
Verger C, Veniez G, Dratwa M. Variabilité du taux de péritonites sans germe identifié dans le RDPLF. Bull Dial Domic [Internet]. 13 juin 2018 [cité 21 sept. 2024];1(1):9-13. Disponible sur : https://bdd.rdplf.org/index.php/bdd/article/view/18063
Philip Kam-Tao Li, Cheuk Chun Szeto, Beth Piraino, Javier de Arteaga, Stanley Fan, Ana E. Figueiredo, et al. ISPD Peritonitis Recommendations : 2016 Update on Prevention and Treatment. Perit Dial Int septembre-octobre 2016;36(5) 481-508
doi : 10.3747/pdi.2016.00078 :
Philip Kam-Tao Li, Kai Ming Chow, Yeoungjee ChoStanley Fan, Ana E Figueiredo, Tess Harris , et al. ISPD peritonitis guideline recommendations : 2022 update on prevention and treatment. Perit Dial Int 2022 Mar;42(2):110-153. doi : 10.1177/08968608221080586.
Gadallah MF, Ramdeen G, Mignone J, Patel D, Mitchell L, Tatro S. Role of preoperative antibiotic prophylaxis in preventing postoperative peritonitis in newly placed peritoneal dialysis catheters. Am J Kidney Dis. 2000;36:1014-9. doi : 10.1053/ajkd.2000.19104.
Tarun k Jeloka. Continuous Ambulatory Peritoneal Dialysis Peritonitis Guidelines - Consensus Statement of Peritoneal Dialysis Society of India - 2020 (Directives pour la dialyse péritonéale ambulatoire continue - Déclaration de consensus de la société indienne de dialyse péritonéale). Indian J Nephrol. Sep-Oct 2021;31(5):425-434. doi : 10.4103/ijn.IJN_73_19. Epub 2021 Sep 21.
Strippoli GF, Tong A, Johnson D, Schena FP, Craig JC. Antimicrobial agents to prevent peritonitis in peritoneal dialysis : a systematic review of randomized controlled trials. Am J Kidney Dis. 2004;44((4)):591–603. https://pubmed.ncbi.nlm.nih.gov/15384009/
Scalamogna A, Castelnovo C, De Vecchi A, Ponticelli C. Exit-site and tunnel infections in continuous ambulatory peritoneal dialysis patients. Am J Kidney Dis. 1991;18((6)):674-7. doi: 10.1016/s0272-6386(12)80608-1.
Nessim SJ, Komenda P, Rigatto C, Verrelli M, Sood MM. Fréquence et microbiologie de la péritonite et de l’infection du site de sortie chez les patients obèses en dialyse péritonéale. Perit Dial Int. 2013;33((2)):167-74. doi : 10.3747/pdi.2011.00244
Hildebrand A, Komenda P, Miller L, Rigatto C, Verrelli M, Sood AR, et al. Peritonitis and exit site infections in First Nations patients on peritoneal dialysis. Clin J Am Soc Nephrol. 2010;5((11)):1988–95. doi : 10.2215/CJN.04170510.
Moncrief JW, Popovich RP, Broadrick LJ, He ZZ, Simmons EE, Tate RA. The Moncrief-Popovich catheter. Une nouvelle technique d’accès péritonéal pour les patients en dialyse péritonéale. ASAIO J. 1993 Jan-Mar;39(1):62-5. https://pubmed.ncbi.nlm.nih.gov/8439683/
Dasgupta MK. Moncrief-Popovich catheter and implantation technique : the AV fistula of peritoneal dialysis (cathéter Moncrief-Popovich et technique d’implantation : la fistule AV de la dialyse péritonéale). Adv Ren Replace Ther. 2002 Apr;9(2):116-24. doi : 10.1053/jarr.2002.33518.
Osako K, Sakurada T, Koitabashi K, Sueki S, Shibagaki Y. Early Postoperative Complications of Peritoneal Dialysis Catheter Surgery Conducted by Nephrologists : A Single-Center Experience Over an Eight-Year Period. Adv Perit Dial. 2017 Jan;33(2017):26-30. https://pubmed.ncbi.nlm.nih.gov/29668427/
Li PK, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE, et al. ISPD Peritonitis Recommendations : 2016 Update on Prevention and Treatment. Perit Dial Int. 2016 Sep 10;36(5):481-508. doi : 10.3747/pdi.2016.00078.
Ranganathan D, John GT, Yeoh E, Williams N, O’Loughlin B, Han T, et al. A randomized controlled trial to determine the appropriate time to initiate peritoneal dialysis after insertion of catheter (Timely PD Study) Perit Dial Int. 2017;37((4)):420-8. doi : 10.3747/pdi.2016.00066.
Leon Hsueh, Susie L. Hu, Ankur D. Shah. Periprocedural Peritonitis Prophylaxis : A Summary of the Microbiology and the Role of Systemic Antimicrobials. Kidney Dis 2021;7:90-99. doi : 10.1159/000513773
Leblanc M, Ouimet D, Pichette V. Dialysate leaks in peritoneal dialysis. Semin Dial. 2001;14((1)):50-4. doi : 10.1046/j.1525-139x.2001.00014.x.
C Szeto, PK Li, DW. Johnson, J Dong, AE Figueiredo. Recommandations de l’ISPD sur les infections liées aux cathéters : 2017 UPDATE. Peritoneal Dialysis International, Vol. 37, pp. 141-154. doi : 10.3747/pdi.2016.00120.
Amato D, de Jesús Ventura M, G Miranda, B Leaños, G Alcántara, M E Hurtado, R Paniagua. Staphylococcal peritonitis in continuous ambulatory peritoneal dialysis : colonization with identical strains at exit site, nose, and hands. Am J Kidney Dis. 2001 Jan;37(1):43-48. doi : 10.1053/ajkd.2001.20576.
Zimmerman SW, Ahrens E, Johnson CA, Craig W, Leggett J, O’Brien M, et al. Randomized controlled trial of prophylactic rifampin for peritoneal dialysisrelated infections. Am J Kidney Dis. 18:225-231. doi : 10.1016/s0272-6386(12)80883-3.
Xu G, Tu W, Xu C. Mupirocin for preventing exit-site infection and perito-nitis in patients undergoing peritoneal dialysis. Nephrol Dial Transplant. 2010;25:587-92. doi : 10.1093/ndt/gfp411.
Judith Bernardini BSN Beth Piraino MD Jean Holley MD James R.Johnston MD Ronald Lutes DO. Am J Kidney Dis. Vol 27, No 5 (mai), 1996 : pp 695-700. https://doi.org/10.1016/S0272-6386(96)90105-5
Lobbedeez T, Gardam M, Dedier H, Burdzy D, Chu M, Izatt S, et al. Routine use of mupirocin at the peritoneal catheter exit site and mupirocin resis-tance : Still low after 7 years. Nephrol Dial Transplant. 2004;19:3140-3. doi : 10.1093/ndt/gfh494
Al-Hwiesh AK, Abdul-Rahman IS, Al-Muhanna FA, Al-Sulaiman MH, Al-Jondebi MS, Divino-Filho JC. Prévention des infections des cathéters de dialyse péritonéale chez les patients saoudiens en dialyse péritonéale : The emergence of high-level mupirocin resistance. Int J Artif Organs. 2013;36:473-83. doi : 10.5301/ijao.5000207.
Piraino B, Bernardini J, Florio T, Fried L. Staphylococcus aureus prophylaxis and trends in gram negative infections in peritoneal dialysis patients. Perit Dial Int. 2003;23:456-9. https://pubmed.ncbi.nlm.nih.gov/14604197/
Bernardini J, Bender F, Florio T, Sloand J, Palmmontalbano L, Fried L, et al. J Am Soc Nephrol. 2005 Feb;16(2):539-45. doi : 10.1681/ASN.2004090773.
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