RESUMO
OBJECTIVE: Despite many improvements in connectology, peritonitis continues to be a major burden in peritoneal dialysis. Because of the high variety in causative organisms and of the differences in their sensitivity patterns, surveillance of the epidemiology of peritonitis and the appropriate adaptation of the therapy are necessary. This study was performed to evaluate the influence of the nature of causative bacteria on the effectiveness of empirical treatment protocols. Based on this information, a new empiric treatment protocol was proposed. SETTING: Peritoneal dialysis program of a university hospital. DESIGN: All episodes of peritonitis at the University Hospital Gent between 1 January 1994 and 31 December 1996 were analyzed retrospectively. Results of microbiological cultures, microscopic evaluation of dialysate, and clinical course were noted. RESULTS: During 1240 patient-months at risk, 50 episodes of peritonitis with identifiable responsible bacteria were observed. Gram-positive organisms were cultured in 34 episodes, and gram-negative organisms were found in 16 episodes. No responsible organism could be identified in 25 additional cases. Resistance to methicillin was registered in 33% of the cultures with staphylococci. There was no resistance to vancomycin. A new empirical treatment protocol was proposed, using a single dose of vancomycin and gentamicin intraperitoneally the first day, followed by oral treatment with ciprofloxacin. With this protocol, a 96% coverage rate is obtained, as opposed to a 78% coverage by using the Ad Hoc Advisory Committee protocol (p < 0.01). CONCLUSION: Individual centers should continue to monitor the epidemiology of peritoneal dialysis-related peritonitis and the epidemiology of the causative organisms and their sensitivity patterns in order to adapt general guidelines into a center-tailored empirical treatment protocol.
Assuntos
Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Diálise Peritoneal/efeitos adversos , Peritonite/tratamento farmacológico , Antibacterianos/uso terapêutico , Anti-Infecciosos/uso terapêutico , Ciprofloxacina/uso terapêutico , Protocolos Clínicos , Quimioterapia Combinada/uso terapêutico , Gentamicinas/uso terapêutico , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/etiologia , Humanos , Testes de Sensibilidade Microbiana , Peritonite/epidemiologia , Peritonite/etiologia , Peritonite/microbiologia , Estudos Retrospectivos , Fatores de Risco , Vancomicina/uso terapêuticoRESUMO
Data on the outcomes of patients who are transferred between hemodialysis (HD) and peritoneal dialysis (PD) are scant. This study analyzes data on patients transferred from their initial modality at the University Hospital Gent between 1978 and 1996 for the reasons for, and outcomes from, the transfer. The reasons for the transfer from HD to PD (n = 35) were access problems (25%), cardiovascular (40%) and blood pressure problems (25%), and personal choice (10%). For the transfer from PD to HD (n = 32) peritonitis (50%), social problems (14%), adequacy or ultrafiltration problems (25%), and leakage (11%) were the reasons. There were no differences in survivals between patients who started on HD and who were transferred to PD, and those who remained on HD (P = 0.4). There were improved survivals for the patients who started on PD and who were transferred to HD compared to those remaining on PD (P = 0.01). It is concluded that transferring problematic HD patients to PD does not improve their survivals, whereas the survival of patients with PD-related complications is improved by transferring them to HD. This is due to the differences in the reasons for transfer, which are PD-related complications in the case of PD patients, and cardiovascular problems in the case of HD patients.
Assuntos
Diálise Peritoneal , Diálise Renal , Comorbidade , Humanos , Avaliação de Resultados em Cuidados de Saúde , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/mortalidade , Diálise Renal/efeitos adversos , Diálise Renal/mortalidade , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
The EDTNA/ERCA survey of Post Insertion Catheter Care in Peritoneal Dialysis (PICC) was a project organised through the Collaborative Research Programme (CRP) of the EDTNA/ERCA. In this survey, data were collected from 54 participating centres in 20 countries. From this survey it became clear that there is no standardised approach to immediate post-catheter insertion treatment protocols. If we want to reduce technique failure of PD related to catheter failure, a first step will be to investigate the different policies used in Europe in order to evaluate the outcome results derived from different policies in post insertion catheter care.
Assuntos
Cateteres de Demora , Diálise Peritoneal/instrumentação , Cuidados Pós-Operatórios/métodos , Higiene da Pele/métodos , Bandagens/normas , Cateteres de Demora/efeitos adversos , Cateteres de Demora/provisão & distribuição , Protocolos Clínicos/normas , Desinfecção/métodos , Desinfecção/normas , Falha de Equipamento , Europa (Continente) , Pesquisas sobre Atenção à Saúde , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Pesquisa em Avaliação de Enfermagem , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/enfermagem , Cuidados Pós-Operatórios/enfermagem , Cuidados Pós-Operatórios/normas , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/enfermagem , Cuidados Pré-Operatórios/normas , Higiene da Pele/enfermagem , Higiene da Pele/normas , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Inquéritos e Questionários , Irrigação Terapêutica/métodos , Irrigação Terapêutica/enfermagem , Irrigação Terapêutica/normas , Fatores de TempoRESUMO
In the last decade, there has been a renewed interest in peritoneal dialysis and this modality has been proposed as a possible alternative to haemodialysis in the care of patients with end-stage renal disease. Attempts have been made to compare various aspects of these two modes of dialysis (4,6). Clinical trials have been performed particularly comparing CAPD with haemodialysis in the treatment of certain subgroups of patients, such as children or patients with diabetic nephropathy (1,5).
Assuntos
Falência Renal Crônica/terapia , Diálise Peritoneal Ambulatorial Contínua/normas , Diálise Renal/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bélgica/epidemiologia , Criança , Feminino , Unidades Hospitalares de Hemodiálise/estatística & dados numéricos , Humanos , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal Ambulatorial Contínua/métodos , Diálise Peritoneal Ambulatorial Contínua/mortalidade , Diálise Renal/métodos , Diálise Renal/mortalidade , Análise de Sobrevida , Resultado do TratamentoRESUMO
Access to the peritoneal cavity is an essential factor for successful peritoneal dialysis. The technique of catheter insertion can influence technique success and patient satisfaction. As compared to conventional surgical laparotomy, a bedside blind insertion technique under local anaesthesia has logistical advantages for the patient, the hospital and the community. This study compares outcomes of both methods in a single centre. A retrograde analysis of a prospectively collected database on all catheters implanted at the University hospital Ghent between 1/1/1998 and 31/5/2002 was carried out. During this period, catheters were implanted either by conventional laparotomy (CL) or by a bedside blind insertion technique (BI) under local anaesthesia.
Assuntos
Cateterismo/métodos , Cateteres de Demora , Quartos de Pacientes , Diálise Peritoneal/instrumentação , Sistemas Automatizados de Assistência Junto ao Leito , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Local , Cateterismo/efeitos adversos , Cateterismo/instrumentação , Cateterismo/enfermagem , Cateteres de Demora/efeitos adversos , Feminino , Humanos , Laparotomia , Masculino , Pessoa de Meia-Idade , Papel do Profissional de Enfermagem , Diálise Peritoneal/efeitos adversos , Modelos de Riscos Proporcionais , Estudos Prospectivos , Análise de Sobrevida , Resultado do TratamentoAssuntos
Doenças Cardiovasculares/complicações , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Arritmias Cardíacas/etiologia , Arteriosclerose/etiologia , Doenças Cardiovasculares/terapia , Insuficiência Cardíaca/terapia , Hemodinâmica/fisiologia , Humanos , Hiperlipidemias/etiologia , Hiperlipidemias/terapia , Hipertensão Renal/terapia , Hipertrofia Ventricular Esquerda/etiologia , Falência Renal Crônica/complicações , Lipoproteínas/metabolismo , Fatores de RiscoAssuntos
Doenças Cardiovasculares/terapia , Falência Renal Crônica/terapia , Diálise Peritoneal Ambulatorial Contínua , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Causas de Morte , Terapia Combinada , Seguimentos , Humanos , Falência Renal Crônica/etiologia , Falência Renal Crônica/mortalidade , Fatores de Risco , Taxa de SobrevidaAssuntos
Injúria Renal Aguda/etiologia , Falência Renal Crônica/terapia , Transplante de Rim/imunologia , Diálise Peritoneal Ambulatorial Contínua , Complicações Pós-Operatórias/etiologia , Injúria Renal Aguda/imunologia , Adulto , Creatinina/sangue , Ciclosporina/administração & dosagem , Ciclosporina/efeitos adversos , Quimioterapia Combinada , Feminino , Seguimentos , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/imunologia , Humanos , Tolerância Imunológica/efeitos dos fármacos , Tolerância Imunológica/imunologia , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Falência Renal Crônica/imunologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/imunologia , Fatores de RiscoRESUMO
In this study, the factors in overnight dwell fluid (8 to 10 hr dwell) depressing granulocyte (GC) NAD(P)H-oxidase dependent radical species production are characterized. At present, most studies have essentially focused on fresh, unspent dialysate and on peritoneal macrophages. The response to Staphylococcus aureus (Staph A) was dose-dependently depressed for both GC CO2 production (from 91.3 +/- 8.4 to 9.0 +/- 1.5 dpm/10(3) GC, P < 0.01) and chemiluminescence (CL) (peak from 7.3 +/- 0.8 to 1.6 +/- 0.8 cps x 10(3)/GC, P < 0.01). Stimulation with formyl-methionine-leucine-phenylalanine (f-MLP), phorbol myristic acid (PMA), Staphylococcus epidermidis (Staph Epi), E. coli, latex and zymosan revealed a parallel depression, pointing to an intrinsic metabolic defect, rather than failure of particle ingestion. The addition of glucose to the normal cell medium to obtain the same concentration as in the CAPD effluent (2.9 +/- 0.3 mg/dl) depressed function but not to the same extent as the genuine PD effluent. Opsonization of Staph A and E. coli induced a partial correction. No effect of pH or osmolality was observed. HPLC fractionation of CAPD effluent on a polarity based gradient revealed an elution of depressive factors in hydrophobic fractions with a nadir in F7 and F12. Analysis of the elution pattern of various uremic solutes revealed elution in F12 of p-cresol, a solute with known inhibitory effect on GC function. These events may be related to recent peritonitis (CL in response to Staph A 0.3 +/- 0.1 in effluent of 6 patients with recent peritonitis versus 2.6 +/- 0.8 cps x 10(3)/GC in 12 patients without recent peritonitis (P < 0.01). We conclude that the GC response is depressed in the presence of CAPD effluent due to excess glucose, lack of opsonization, and uremic solutes of which p-cresol is one of the responsible compounds.