Peritoneal Dialysis–Related Infection Rates and Outcomes: Results From the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS)

• DOI: 10.1053/j.ajkd.2019.09.016
• Publication Date: 2020-01-10T23:21:13Z
• Authors: Jeffrey Perl; Douglas S. Fuller; Brian A. Bieber; Neil Boudville; Talerngsak Kanjan...; Yasuhiko Ito; Sharon J. Nessim; Beth M. Piraino; Ronald L. Pisoni; Bruce M. Robinson; Douglas E. Schaubel; Martin J. Schreiber; Isaac Teitelbaum; Graham Woodrow; Junhui Zhao; David W. Johnson
• Keywords: Adult; Male; Internationality; Peritonitis; facility practices; Peritoneal dialysis (PD); Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; best practices; Humans; Prospective Studies; Practice Patterns, Physicians'; peritonitis; Aged; 2727 Nephrology; Peritoneal Dialysis and Outcomes Practice Patterns Study (PDOPPS); PD-related infection; microbiology; technique failure; bacterial infection; Middle Aged; 3. Good health; Treatment Outcome; causative organism; epidemiology; Female; international comparisons; peritonitis prevention; Peritoneal Dialysis; hospitalization

Rationale & ObjectivePeritoneal dialysis (PD)-related peritonitis carries high morbidity for PD patients. Understanding the characteristics and risk factors can guide regional development of prevention strategies. We describe rates associations selected facility practices with among countries participating in Peritoneal Dialysis Outcomes Practice Patterns Study (PDOPPS).Study DesignObservational prospective cohort study.Setting Participants7,051 adult patients 209 facilities across 7 (Australia, New Zealand, Canada, Japan, Thailand, United Kingdom, States).ExposuresFacility (census count, age, nurse to patient ratio) (use automated PD, use icodextrin or biocompatible solutions, antibiotic prophylaxis strategies, duration training).OutcomesPeritonitis rate (by country, overall variation facilities), microbiology patterns.Analytical ApproachPoisson estimation, proportional models adjusted case-mix variables.Results2,272 episodes were identified 7,051 (crude rate, 0.28 episodes/patient-year). Facility variable within each country exceeded 0.50/patient-year 10% facilities. Overall rates, per patient-year, 0.40 (95% CI, 0.36-0.46) 0.38 0.32-0.46) 0.35 0.30-0.40) Australia/New 0.29 0.26-0.32) 0.27 0.25-0.30) 0.26 0.24-0.27) States. The was similar countries, except where Gram-negative infections culture-negative more common. size positively associated Japan (rate ratio [RR] 10 patients, 1.07; 95% 1.04-1.09). Lower observed that had higher (RR percentage points greater, 0.95; 0.91-1.00), used antibiotics at catheter insertion (RR, 0.83; 0.69-0.99), training 6 (vs <6) days 0.81; 0.68-0.96). seen topical exit-site mupirocin aminoglycoside ointment, but this association did not achieve conventional levels statistical significance 0.79; 0.62-1.01).LimitationsSampling variation, selection bias estimates), residual confounding (associations).ConclusionsImportant international differences exist may result from varied potentially modifiable treatment practices. These findings inform future guidelines setting lower maximally acceptable rates. (PDOPPS). Observational study. States). training). Peritonitis patterns. Poisson variables. 2,272 0.62-1.01). Sampling (associations). Important