Practice variations in antibiotic administration for the management of peritonitis in patients on automated peritoneal dialysis in Australia and New Zealand

Abstract

In the absence of guidelines on the management of peritoneal dialysis (PD)-associated peritonitis in patients on automated peritoneal dialysis (APD), variations in clinical practice potentially exist between PD units that could affect clinical outcomes. This study aimed to document the current practices of treating PD-associated peritonitis in patients on APD across Australia and New Zealand and the reasons for practice variations using a cross-sectional online survey. Of the 62 PD units, 34 medical leads (55%) responded to the survey. When treating APD-associated peritonitis, 21 units (62%) continued patients on APD and administered intraperitoneal (IP) antibiotics in manual daytime exchanges; of these, 17 (81%) considered allowing at least 6 h dwell time for adequate absorption of the IP antibiotics as an important reason for adding manual daytime exchange. Nine units (26%) temporarily switched patients from APD to continuous ambulatory peritoneal dialysis (CAPD); of these, five (55%) reported a lack of pharmacokinetic (PK) data for IP antibiotics in APD, four (44%) reported a shortage of APD-trained nursing staff to perform APD exchanges during hospitalisation and three (33%) reported inadequate time for absorption of IP antibiotics on APD as important reasons for their practice. Four units (12%) continued patients on APD and administered IP antibiotics during APD exchanges; of these, three (75%) believed that PK data available in CAPD could be extrapolated to APD. This study demonstrates wide variations in the management of APD-associated peritonitis in Australia and New Zealand; it points towards the lack of PK on antibiotics used to treat peritonitis as an important reason underpinning practice variations.

Keywords

Antibiotics automated peritoneal dialysis intraperitoneal peritonitis practice variation

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References

Szeto

Piraino

, et al. ISPD Peritonitis recommendations: 2016 update on prevention and treatment. Perit Dial Int 2016; 36(5): 481–508.

Szeto

PKT

. Peritoneal dialysis-associated peritonitis. Clin J Am Soc Nephrol 2019; 14(7): 1100–1105.

Mancini

Piraino

. Review of antibiotic dosing with peritonitis in APD. Perit Dial Int 2019; 39(4): 299–305.

Ling

Sud

Van

, et al. Pharmacokinetics of culture-directed antibiotics for the treatment of peritonitis in automated peritoneal dialysis: a systematic narrative review. Perit Dial Int 2021; 41(3): 261–272.

Htay

Cho

Pascoe

, et al. Center effects and peritoneal dialysis peritonitis outcomes: analysis of a national registry. Am J Kidney Dis 2018; 71(6): 814–821.

Al Sahlawi

Zhao

McCullough

, et al. Variation in peritoneal dialysis–related peritonitis outcomes in the peritoneal dialysis outcomes and practice patterns study (PDOPPS). Am J Kidney Dis 2021; 79(1): S0272–S6386.

Perl

Davies

Lambie

, et al. The peritoneal dialysis outcomes and practice patterns study (PDOPPS): unifying efforts to inform practice and improve global outcomes in peritoneal dialysis. Perit Dial Int 2016; 36(3): 297–307.

Robinson

Bieber

Pisoni

, et al. Dialysis outcomes and practice patterns study (DOPPS): its strengths, limitations, and role in informing practices and policies. Clin J Am Soc Nephrol 2012; 7(11): 1897–1905.

De Vecchi

Scalamogna

Finazzi

, et al. Preliminary evaluation of incremental peritoneal dialysis in 25 patients. Perit Dial Int 2000; 20(4): 412–417.

10.

Rüger

van Ittersum

Comazzetto

, et al. Similar peritonitis outcome in CAPD and APD patients with dialysis modality continuation during peritonitis. Perit Dial Int 2011; 31(1): 39–47.

11.

Al Sahlawi

Bargman

Perl

. Peritoneal dialysis–associated peritonitis: suggestions for management and mistakes to avoid. Kidney Med 2020; 2(4): 467–775.

12.

Gilmore

Kim

LaSalvia

, et al. Treatment of enterococcal peritonitis with intraperitoneal daptomycin in a vancomycin-allergic patient and a review of the literature. Perit Dial Int 2013; 33(4): 353–357.

13.

Huen

Hall

Topal

, et al. Successful use of intraperitoneal daptomycin in the treatment of vancomycin-resistant enterococcus peritonitis. Am J Kidney Dis 2009; 54(3): 538–541.

14.

de Moraes

Olandoski

Caramori

JCT

, et al. Novel predictors of peritonitis-related outcomes in the BRAZPD cohort. Perit Dial Int 2014; 34(2): 179–187.

15.

Manley

Bailie

. Automated peritoneal dialysis symposium: treatment of peritonitis in APD: pharmacokinetic principles. Semin Dial 2002; 15(6): 418–421.

16.

Manley

Bailie

Asher

, et al. Pharmacokinetics of intermittent intraperitoneal cefazolin in continuous ambulatory peritoneal dialysis patients. Perit Dial Int 1999; 19(1): 65–70.

17.

Manley

Bridwell

Elwell

, et al. Influence of peritoneal dialysate flow rate on the pharmacokinetics of cefazolin. Perit Dial Int 2003; 23(5): 469–474.

18.

Stevenson

Tang

Cho

, et al. The role of monitoring vancomycin levels in patients with peritoneal dialysis-associated peritonitis. Perit Dial Int 2015; 35(2): 222–228.

19.

Tang

Cho

Hawley

, et al. The role of monitoring gentamicin levels in patients with gram-negative peritoneal dialysis-associated peritonitis. Perit Dial Int 2014; 34(2): 219–226.

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