The Relationship Between Presentation and the Time of Initial Administration of Antibiotics With Outcomes of Peritonitis in Peritoneal Dialysis Patients: The PROMPT Study.

ABSTRACT

INTRODUCTION: The impact of time to treatment on clinical outcome is an established precept in infectious disease but is not established in peritoneal dialysis-related peritonitis (PDRP). METHODS: In a prospective multicenter study of PDRP, symptom-to-contact time (SC), contact-to-treatment time (CT), defined as the time from health care presentation to initial antibiotic, and symptom-to-treatment time (ST) were determined. RESULTS: One hundred sixteen patients had 159 episodes of PDRP. Median SC for all episodes was 5.0 hours (first to third quartile [Q1-Q3] 1.3-13.9); CT, 2.3 hours (Q1-Q3 1.2-4.0); and ST, 9.0 hours (Q1-Q3 4.7-25.3). Thirty-eight (23.9%) patient episodes (28 catheter removals and 10 deaths) met the primary composite outcome of PD failure at 30 days (PD-fail). The risk of PD-fail increased by 5.5% for each hour of delay of administration of antibiotics (odds ratio [OR] for CT 1.055; 95% confidence interval [CI] 1.005-1.109; P = 0.032). Neither SC (OR 1.00; 95% CI 0.99-1.01; P = 0.74) nor ST (OR 1.00; 95% CI 0.99-1.01; P = 0.48) was associated with PD-fail. In a multivariable analysis, only CT for presentation to a hospital-based facility compared with a community facility (OR 1.068; 95% CI 1.013-1.126; P = 0.015) and female sex (OR 2.4; 95% CI 1.1-5.4; P = 0.027) were independently associated with PD-fail. Each hour of delay in administering antibacterial therapy from the time of presentation to a hospital facility increased the risk of PD failure or death by 6.8%. DISCUSSION: Strategies targeted to expedited antibiotic treatment should be implemented to improve outcomes from PDRP.