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Peritoneal Dialysis-Associated Peritonitis (PDAP) is a common and severe complication in patients with chronic kidney disease (CKD) undergoing renal replacement therapy (RRT), with an incidence reported at 30% in some literature. Despite being aware of this complication for 35 years and the adoption of several preventive measures, such as adequate training of medical staff in catheter handling, prophylactic antibiotic therapy, application of topical antibiotics, and early management of infections at catheter insertion site, we still encounter episodes of PDAP.
A retrospective, observational, single-center study was conducted, involving 167 patients with end-stage kidney disease (ESKD) requiring urgent dialysis between February 1, 2021, and October 28, 2023. From our studied population, 137 catheters were placed by the interventional nephrology service, while 30 catheters were placed by the general surgery service. Our objective is to describe the percentage of PDAP events during hospitalization in both groups, the most frequently isolated microorganisms, and the number of patients requiring catheter removal in each group.
For the purpose of this paper, we defined early PD catheter insertion-related peritonitis as the one occurring within 30 days of PD catheter insertion. Among 167 patients who underwent peritoneal dialysis for the first time, 12.57% experienced PDAP. A higher frequency of peritonitis (p=0.015) was observed in catheters placed by the general surgery service (26.6%) compared to those placed by the nephrology service (9.4%). Culture-negative peritonitis was significantly more common in the interventional nephrology group (38.4%) compared to the general surgery group (25%). Catheter removal was necessary in 75% of the general surgery group, compared to 61% in the interventional nephrology group, with no significant difference associated with the technique (p = 0.183).
It is important to point out the importance of being aware of early peritoneal dialysis-associated peritonitis (EPDAP), as it can be attributed to enteric peritonitis (involving an inflammatory reaction in the peritoneal membrane) or to recent antibiotic exposure as a treatment for any other infection. Along with gram-positive bacteria, these are the most frequently encountered findings in cultures. In our study, it was observed that the most common finding is negative cultures, and it is more frequently associated with placement by general surgery.