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1.
REME rev. min. enferm ; 21: [1-7], 2017. tab
Article in English, Portuguese | LILACS (Americas), BDENF | ID: biblio-907933

ABSTRACT

Objetivo: analisar a taxa das peritonites no Serviço de Diálise Peritoneal de um Hospital-Escola e conhecer o perfil dos pacientes do programa de diálise peritoneal. Metodologia: estudo observacional, descritivo, retrospectivo, de natureza quantitativa, realizado no serviço de diálise no interior de São Paulo de janeiro a dezembro de 2015. RESULTADOS: dos 39 pacientes em diálise peritoneal, 51,3% eram do sexo masculino, 64,1% não idosos, 51,3% procediam de outros municípios, 69,2% aposentados, 66,7% estavam em diálise peritoneal ambulatorial contínua, 43,6% estavam em tratamento de um a dois anos e 79,5% não estavam na lista de transplante, sendo 41% em virtude de início recente na terapia. Dos 20 pacientes que apresentaram peritonite, 50% tiveram dois episódios no ano, 20% causados por Staphylococcus aureus. Em 90% o antibiótico foi administrado por via endovenosa, 95% tiveram associação de antibióticos, sendo os mais comuns ceftazidima, vancomicina e cefalotina. Dos 90% dos pacientes que saíram da terapia, 65% eram do sexo feminino, 55% moravam no município da instituição de tratamento, 70% eram aposentados e 65% estavam em diálise peritoneal ambulatorial contínua, com média de idade de 56 anos (DP=14,6 anos) e média de 1,7 ano de tratamento. A taxa de peritonite em diálise peritoneal ambulatorial contínua e diálise peritoneal automatizada foi de 2,79% e em diálise peritoneal intermitente 13,33%. CONCLUSÃO: a maioria dos pacientes que teve peritonite eram mulheres. A média de peritonites foi maior entre as pessoas com menos idade e menos tempo de tratamento e 90% dos pacientes saíram da terapia.


Objective: analyze peritonitis rates in the Peritoneal Dialysis Service of a university hospital and identify the profile of patients attending the peritoneal dialysis program. Methods: This observational, retrospective, and descriptive study with a quantitative approach was conducted at adialysis service in the interior of São Paulo, Brazil, from January to December 2015. Results: Of the 39 patients on peritoneal dialysis, 51.3% were men;64.1% were non-elderly patients; 51.3% were from towns other than where the service was located; 69.2% were retired; 66.7% were in continuous ambulatory peritoneal dialysis; the duration of treatment of 43.6% ranged from one to two years; 79.5% were not on the transplant waiting list;and 41% had recently started therapy. Of the 20 patients presenting peritonitis, 50% had two episodes and 20% of the episodes were causedby Staphylococcus aureus. The antibiotic was administered intravenously in 90% of the patients; antibiotics were associated with ceftazidime, vancomycin or cephalothin (the most common ones) in 95%. Among those who dropped out of therapy (90%): 65% were women, 55% lived in thesame town as the health facility; 70% were retired; 65% were undergoing continuous ambulatory peritoneal dialysis, and were aged 56 years old onaverage, while treatment duration was 1.7 years on average. The peritonitis rate among those on continuous ambulatory peritoneal dialysis andautomated peritoneal dialysis was 2.79%, while 13.33% were on intermittent peritoneal dialysis. Conclusion: Most patients with peritonitis werewomen, lived in the same town as the facility, were retired and underwent continuous ambulatory peritoneal dialysis, and treatment duration was1.7 years on average, and 90% of the patients dropped out of therapy.


Objetivo: analizar la tasa de peritonitis en el servicio de diálisis peritoneal de un hospital escuela; conocer el perfil de los pacientes del programa dediálisis peritoneal. Metodología: Estudio observacional, descriptivo, retrospectivo, cuantitativo realizado en el servicio de diálisis de un hospital delinterior del estado de São Paulo, entre enero y diciembre de 2015. Resultados: De los 39 pacientes en diálisis peritoneal, 51,3% eran varones, 64,1% noancianos, 51,3% venían de otros municipios, 69,2% jubilados, 66,7% en diálisis peritoneal continua ambulatoria, 43,6% en tratamiento entre uno y dosaños,79,5% no estaban en la lista de trasplantes y, entre ellos, 41% habían reiniciado recientemente el tratamiento. De los 20 paciente que presentaron peritonitis, 50% tuvieron dos episodios en el año, 20% causado por Staphylococcus aureus. En 90%, el antibiótico se administró vía venosa, 95%tuvieron asociación de antibióticos, siendo los más comunes ceftazidima, vancomicina y cefalotina, y 90% de los pacientes interrumpieron la terapia,65% eran mujeres, 55% vivían en el municipio de la institución de tratamiento, 70% eran jubilados y 65% estaban en CAPD con promedio de 56 añosde edad y 1,7 años de tratamiento. La tasa de peritonitis en diálisis peritoneal continua ambulatoria y diálisis peritoneal automatizada fue de 2,79%y en diálisis peritoneal intermitente 13,33%. Conclusión: Entre los pacientes con peritonitis, la mayoría eran mujeres, el promedio de peritonitis fuemayor entre las personas más jóvenes y con menos tiempo de tratamiento y 90% de los pacientes interrumpieron el tratamiento.


Subject(s)
Humans , Male , Female , Peritoneal Dialysis , Peritonitis/diagnosis , Peritonitis/epidemiology , Peritonitis/prevention & control , Renal Insufficiency, Chronic/complications , Socioeconomic Factors
2.
Rev. méd. Urug ; 32(3): 166-177, set. 2016. ilus, tab
Article in Spanish | LILACS (Americas) | ID: lil-796339

ABSTRACT

La peritonitis es una complicación grave de la diálisis peritoneal (DP), por lo que interesa conocer la incidencia y sensibilidad antibiótica de los gérmenes causantes. En Uruguay, desde el 1° de enero de 2004, se realiza un registro nacional de las peritonitis en DP, gérmenes, sensibilidad y evolución. Método: se analizaron los registros desde el 1° de enero de 2004 al 31 de diciembre de 2013. El registro fue aprobado por comités de ética institucionales. Resultados: en el período se registraron 850 peritonitis, con una incidencia que descendió de 0,49/paciente-año (2004-2005) a 0,37/paciente-año (2013). La incidencia de Staphylococcus aureus y Staphylococcus coagulasa negativo (SCoN) fue menor en 2009-2013 vs 2004-2005 (0,2 vs 0,12 peritonitis/paciente-año, test Poisson p<0,05). En 2009-2013: 14/54 S. aureus y 26/71 SCoN fueron meticilinorresistente, similar al período previo. El 98% de los gérmenes gramnegativos fueron sensibles a amikacina. En 145/467 (31%) episodios no se identificó germen. Se logró cura primaria en 71% de las peritonitis por grampositivos y en 45% por gramnegativos (chi2 p<0,05). En 2013 se observó mayor incidencia de peritonitis en los centros en los que no se controló el estado de portador nasal. Comentarios y conclusiones: se justifica implementar el control de portador de Staphylococcus aureus. La incidencia de peritonitis por S. aureus y SCoN meticilinorresistentes, la incidencia sostenida de gérmenes gramnegativos (con peor evolución), y el elevado porcentaje de cultivos sin desarrollo justifica mantener el protocolo antibiótico empírico inicial con vancomicina y amikacina. El descenso de la incidencia de S. aureus + SCoN podría ser atribuido a una mejor educación de los pacientes en DP.


Abstract Peritonitis is a severe complication of peritoneal dialysis (PD), so it is important to learn about the incidence and antibiotic sensitivity of the germs that cause it. In Uruguay, since January 1, 2004, a national record is kept for peritonitis in PD, germs, sensitivity and evolution. Method: the records from January 1, 2004 through December 31, 2013 were analyzed. The registry was approved by institutional ethical committes. Results: during the above mentioned period, 850 cases of peritonitis were recorded, and incidence dropped from 0.49/patient-year (2004-2005) to 0.37/patient-year (2013). Incidence of Staphylococcus aureus and coagulase-negative staphylococci (SCoN) was lower in 2009-2013 vs 2004-2005 (0.2 vs 0.12 peritonitis/patient-year, test Poisson p<0.05). In 2009-2013: 14/54 S. aureus and 26/71 SCoN were methicillin-resistant, similar to the previous period. 98% of Gram-negative were sensitive to amikacin. No germ was identified in 145/467 (31%) of episodes. Primary cure was achieved in 71% of peritonitis for Gram-positive and 45% for Gram-negative bacteria (chi2 p<0.05). In 2013 a greater incidence of peritonitis was observed in those centers where the nasal carriage was not controlled. Comments and conclusions: controlling Staphylococcus aureus nasal carriages is worth doing. The incidence of peritonitis by methicillin-resistant S. aureus y SCoN, the sustained incidence of Gram-negative germs (with a worse evolution), and the high percentage of cultures with no development justify keeping the initial empirical antibiotic protocol with vancomycin and amikacin. Reduction in the incidence of S. aureus + SCoN could be explained by a greater education in PD patients.


Resumo A peritonite é uma complicação grave da diálise peritoneal (DP), sendo, portanto, importante conhecer a incidência e a sensibilidade antibiótica dos gérmens causadores. No Uruguai, desde 1 de janeiro de 2004, realiza-se um registro nacional das peritonites em DP, com dados sobre gérmens, sensibilidade e evolução. Método: foram analisados os registros do período 1 de janeiro de 2004 - 31 de dezembro de 2013. O registro foi aprovado pelos comitês de ética das instituições envolvidas. Resultados: foram registradas 850 peritonites no período estudado; a incidência diminuiu de 0,49/paciente-ano no período 2004-2005 a 0,37/paciente-ano em 2013. A incidência de Staphylococcus aureus e Staphylococcus coagulase negativo (SCoN) foi menor no período 2009-2013 comparada com 2004-2005 (0,2 vs 0,12 peritonite/paciente-ano, teste de Poisson p<0,05). No período 2009-2013: 14/54 S. aureus e 26/71 SCoN foram resistentes à meticilina, similar ao período prévio. 98% dos gérmens gramnegativos eram sensíveis a amicacina. Não se pode identificar o gérmen em 145/467 (31%) episódios. Em 71% das peritonites por grampositivos e em 5% por gramnegativos (chi2 p<0,05) foi possível obter cura primária. Em 2013 foi observada uma maior incidência de peritonite nos centros em que não se realizava controle de portador nasal. Comentários e conclusões: justifica-se a realização de controle de portador de Staphylococcus aureus. A incidência de peritonite por S. aureus e SCoN resistentes à meticilina, a incidência constante de gérmens gramnegativos (com pior evolução), e a alta porcentagem de cultivos sem crescimento justificam manter o protocolo antibiótico empírico inicial com vancomicina e amicacina. A redução da incidência de S. aureus + SCoN poderia ser atribuída a melhor educação dos pacientes em DP.


Subject(s)
Humans , Peritoneal Dialysis/adverse effects , Peritonitis/epidemiology , Peritonitis/etiology , Uruguay/epidemiology
3.
Rev. latinoam. enferm. (Online) ; 23(5): 902-909, Sept.-Oct. 2015. tab
Article in English | LILACS (Americas), BDENF | ID: lil-763284

ABSTRACT

Objective: to analyze the complications related to peritonitis and catheter exit-site infections, in patients on peritoneal dialysis at home.Method: quantitative and cross-sectional study, carried out with 90 patients on peritoneal dialysis at home, in a municipality in the Northeast region of Brazil. For data collection, it was used two structured scripts and consultation on medical records. Descriptive analysis and comparison tests among independent groups were used, considering p<0.05 as level of statistical significance.Results: by comparing the frequency of peritonitis and the length of treatment, it was found that patients over two years of peritoneal dialysis were more likely to develop peritonitis (X²=6.39; p=0.01). The number of episodes of peritoneal catheter exit-site infection showed association with the length of treatment (U=224,000; p=0.015).Conclusion: peritonitis and catheter exit-site infection are associated with the length of treatment.


Objetivo: analisar as complicações relacionadas à peritonite e infecção de orifício de saída do cateter, em pacientes em diálise peritoneal no domicílio.Método: estudo quantitativo e transversal, realizado com 90 pacientes em diálise peritoneal no domicílio, em um município do Nordeste brasileiro. Para coleta de dados utilizaram-se dois roteiros estruturados e consulta aos prontuários de saúde. Foram utilizadas análises descritivas e testes de comparação entre grupos independentes, considerando o nível de significância estatística de p<0,05.Resultados: comparando-se a frequência de peritonite e o tempo de tratamento, constatou-se que pacientes com mais de dois anos de diálise peritoneal apresentaram maior chance de ter peritonite (X²=6,39; p=0,01). O número de episódios de infecção de orifício de saída do cateter peritoneal mostrou associação com o tempo de tratamento (U=224,000; p=0,015).Conclusão: a peritonite e infecção de orifício de saída do cateter estão associadas ao tempo de tratamento.


Objetivo: analizar las complicaciones relacionadas con la peritonitis e infección del orificio de salida del catéter, en pacientes en diálisis peritoneal en casa.Método: estudio cuantitativo y transversal, realizado con 90 pacientes en diálisis peritoneal, en casa en una ciudad en el Nordeste de Brasil. Para la recogida de datos se utilizaron dos guiones estructurados y consulta de los registros médicos. Se utilizaron análisis descriptivos y pruebas de comparación entre grupos independientes, teniendo en cuenta el nivel de significación estadística de p<0,05.Resultados: al comparar la frecuencia de peritonitis y el tiempo de tratamiento, se encontró que los pacientes con más de dos años de diálisis peritoneal eran más propensos a tener peritonitis (X²=6,39; p=0,01). El número de episodios de infección del orificio de salida del catéter peritoneal mostró asociación con el tiempo de tratamiento (U=224.000; p=0,015).Conclusión: la peritonitis e la infección de orificio de salida del catéter se asocian con el tiempo de tratamiento.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Peritonitis/microbiology , Peritonitis/epidemiology , Peritoneal Dialysis/adverse effects , Catheter-Related Infections/etiology , Catheter-Related Infections/epidemiology , Cross-Sectional Studies , Retrospective Studies , Hemodialysis, Home/adverse effects
4.
J. bras. nefrol ; 35(3): 214-219, jul.-set. 2013. tab
Article in Portuguese | LILACS (Americas) | ID: lil-687823

ABSTRACT

INTRODUÇÃO: A peritonite continua sendo a maior complicação para os pacientes em diálise peritoneal (DP). OBJETIVO: Este estudo teve como objetivo determinar as taxas de peritonite por episódio/ano (ep./ ano), ep./ano por microrganismo causador e pela mediana do número de peritonites nos pacientes em diálise peritoneal do Serviço de Nefrologia do Hospital São Lucas da PUCRS. MÉTODOS: Estudo retrospectivo e descritivo, no qual a amostra foi composta de pacientes que fizeram diálise peritoneal no Serviço de Nefrologia do HSL no período de 1984 a agosto de 2012; foram considerados somente os que possuíam dados completos. RESULTADOS: Dos 427 pacientes analisados, 53,2% eram do sexo feminino, com idade média de 48,0 ± 19,9 anos, 13% (56) de diabéticos e 71,5% (303) dos pacientes realizavam seu próprio tratamento. Ocorreram 503 episódios de peritonite e 255 pacientes tiveram pelo menos uma peritonite. Staphylococcus coagulase negativo foi o microrganismo mais prevalente. As causas de saída de tratamento foram óbito, transplante renal e peritonite, com 34,4, 25,8 e 19,2%, respectivamente. A taxa de peritonite foi de 0,63 ep./ano e ep./ ano por microrganismo foi de 0,18 ep./ ano para Staphylococcus coagulase negativo, e de 0,12 ep./ano para Staphilococcus aureus e Gram negativos. A mediana da unidade foi de 0,41. CONCLUSÃO: A taxa de peritonite ep./ano, e a mediana dos pacientes estudados encontram-se dentro do mínimo preconizado, mas abaixo das metas sugeridas, assim como a caracterização de ep./ano por microrganismo.


INTRODUCTION: Peritonitis remains the major complication in patients on peritoneal dialysis (PD), peritonitis rates vary in the literature, reflecting differences between countries, study design and populations. OBJECTIVE: This study aimed to determine the rates of peritonitis episodes per year at risk (ep./yr), ep./yr by causative microorganism and median of peritonitis in patients on peritoneal dialysis at Hospital São Lucas. METHODS: Retrospective descriptive study, with a study sample composed of patients treated with peritoneal dialysis at the Renal Unit of São Lucas Hospital between the periods from 1984 to August 2012. Only patients with complete data were considered. RESULTS: Of the 427 patients analyzed, 53.2% (227) were females, mean age was 48.0 ± 19.9 years, 13% (56) were diabetics and 71.5% (303) of the patients performed their own treatment. There were 503 episodes of peritonitis and 255 patients had at least one episode. Coagulase-negative Staphylococcus was the most prevalent organism. The main causes of dropout from treatment were death, renal transplantation and peritonitis with 34.4, 25.8 and 19.2%, respectively. The rate of peritonitis was 0.63 ep./yr, rates by microorganism were 0.18 ep./yr for coagulase-negative Staphylococcus, 0.12 ep./yr for Staphylococcus aureus and Gram negative. The median of peritonitis in the unit was 0.41 ep./yr. CONCLUSION: The rate of peritonitis ep./yr and median of patients studied is within the recommended minimum, but below the suggested targets proposed by the position statement of ISPD.


Subject(s)
Female , Humans , Male , Middle Aged , Peritoneal Dialysis/adverse effects , Peritonitis/epidemiology , Brazil , International Agencies , Retrospective Studies
5.
Rev. cuba. med ; 51(2): 117-123, abr.-jun. 2012.
Article in Spanish | LILACS (Americas) | ID: lil-642051

ABSTRACT

Introducción: en Cuba se introdujo la diálisis peritoneal a finales de los años 60, la peritonitis es la complicación más temida. Objetivo: determinar la frecuencia y la tasa de peritonitis en un programa de diálisis peritoneal domiciliaria. Métodos: se realizó un estudio observacional, descriptivo y prospectivo desde diciembre de 2007 hasta mayo de 2011. El universo estuvo constituido por 30 pacientes. Se analizaron las variables demográficas y la presencia de peritonitis. Se utilizó el análisis de distribución de frecuencias, además el Kaplan Meier para el tiempo de supervivencia libre de peritonitis. Resultados: del total de pacientes, 17 presentaron 1 episodio de peritonitis, 6 tuvieron un segundo episodio, mientras solo 1, sufrió un tercer evento para un total de 24 episodios de peritonitis; equivalente a un episodio cada 32 meses/paciente, estos se presentaron en 12 enfermos masculinos y 5 femeninos; la edad promedio fue de 46,2 años. Conclusiones: aunque la incidencia de peritonitis ha venido descendiendo en los últimos años, continúa siendo la principal complicación de este proceder terapéutico...


Introduction: in Cuba the peritoneal dialysis was introduced at the end of the 60s; the peritonitis the was the more fearsome complication. Objective: to determine the incidence rate of peritonitis in a program of peritoneal dialysis at home. Methods: a prospective, descriptive and observational study was conducted in a universe including 30 patients from December, 2007 to May, 2011. Authors analyzed the demographic variables and the peritonitis presence. The distribution of frequency analysis was used as well as the Kaplan Meier for the time of the peritonitis-free survival. Results: from the total of patients, 17 had one episode of peritonitis, 6 had a second episode whereas only one had a third event for a total of 24 episodes of peritonitis; similar to an episode each 32 months/patient, these events occurred in 12 male patients and in 5 female patients; mean age was of 46,2 years. Conclusions: although the incidence of peritonitis became decreasing in past years, it remains as the leading complication of this therapeutical procedure...


Subject(s)
Humans , Male , Female , Hemodialysis, Home/adverse effects , Peritonitis/epidemiology , Peritonitis/etiology , Epidemiology, Descriptive , Prospective Studies
6.
Tunisie Medicale [La]. 2012; 90 (3): 263-264
in French | IMEMR (Eastern Mediterranean) | ID: emr-146099
7.
Rev. Soc. Bras. Clín. Méd ; 9(5)set.-out. 2011.
Article in Portuguese | LILACS (Americas) | ID: lil-601354

ABSTRACT

JUSTIFICATIVA E OBJETIVOS: Avaliar a incidência de peritonites em pacientes submeti dos à diálise peritoneal ambulatorial contínua (CAPD) em uma unidade de diálise. MÉTODO: Estudo epidemiológico retrospectivo que analisou 111 pacientes submetidos à diálise peritoneal no período de setembro de 2000 a fevereiro de 2010. Foram coletados os seguintes dados: idade, sexo, raça, data do início e término do tratamento, situação atual dos pacientes, complicações observadas, número de episódios de peritonites, germes causadores, tratamentos realizados e evolução dos pacientes. As variáveis foram comparadas utilizando-se os testes Qui-quadrado e t de Student. O valor de p < 0,05 foi considerando estatisticamente significativo. RESULTADOS: Foram elegíveis para o estudo 111 pacientes submetidos à CAPD, sendo diagnosticados 57 casos de peritonites. Dentre os pacientes com peritonite a idade média foi de 61,8 ± 12,8 anos. O sexo masculino e a raça branca predominaram em 57,6% e 87,4% pacientes, respectivamente. A incidência de peritonites foi de 0,6 episódios por paciente/ano. A evolução foi satisfatória em 90% e a retirada do cateter foi realizada em 10% dos casos. CONCLUSÃO: A incidência de peritonite neste estudo foi baixa. Melhor observação do número de casos de peritonite em pacientes submetidos à CAPD, abordagem diagnóstica e terapêuticasão chaves fundamentais para desenvolver estratégias para reduzir a incidência de infecção entre estes pacientes.


BACKGROUND AND OBJECTIVES: Evaluate the incidenceof peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) in a dialysis Unit. METHOD: We made a retrospective study on 111 patients undergoing peritoneal dialysis in the period from September, 2000 to February, 2010. Age, gender, race, date of commencement and completion of treatment, current status of the patients, complications,number of episodes of peritonitis, germs and antibiotic susceptibility, treatment and outcome were collected. Incidence of peritonitis was calculated. To compare the variables were used the Chi-square and Student's t tests. A p value < 0.05 was considered statistically significant. RESULTS: In the period 111 patients were treated by CAPD and were diagnosed 57 cases of peritonitis. Among patients with peritonitis the average age was 61.8 ± 12.8 years. The male and the white race predominated in 57.6% and 87.4%, respectively. Incidence of peritonitis was 0.6 episodes per patient per year. The outcome was satisfactory in 90%; catheter removal was performed in 10%. CONCLUSION: The incidence of peritonitis in this study was low. A closer observation of the number of cases of peritonitis in patients undergoing CAPD, diagnosis and treatment are fundamental keys to developing strategies to reduce the incidence of infection among these patients.


Subject(s)
Humans , Male , Female , Peritoneal Dialysis, Continuous Ambulatory , Peritonitis/epidemiology
9.
Tunisie Medicale [La]. 2011; 89 (2): 198-201
in French | IMEMR (Eastern Mediterranean) | ID: emr-146502

ABSTRACT

An uncommon event in the natural course of Crohn's disease is the spontaneous perforation. It's the most serious intestinal complication. To report the incidence of this complication and to discuss the mechanism of the perforation. We report, retrospectively, 4 cases [3 men and one woman; median age: 30 years] of peritonitis complicating Crohn's disease and study their clinical characteristics intra operatively findings and course evolution. Steroid therapy was administrated to all patients before the perforation. The perforation sites are on the ileum in three cases and on the jejunum in one case. The treatment consists in a resection of the perforated intestine with stoma in all cases. Perforation in Crohn's disease is a rare event. The exact mechanism of the perforation is still unknown and many hypotheses are presented


Subject(s)
Humans , Male , Female , Peritonitis/epidemiology , Peritonitis/physiopathology , Acute Disease , Retrospective Studies , Intestinal Perforation
10.
Salud pública Méx ; 52(6): 511-516, Nov.-Dec. 2010. graf, tab
Article in English | LILACS (Americas) | ID: lil-572711

ABSTRACT

OBJECTIVE. To compare the nosocomial infection (NI) rate obtained from a retrospective review of clinical charts with that from the routine nosocomial infection surveillance system in a community hospital. MATERIAL AND METHODS. Retrospective review of a randomized sample of clinical charts.Results were compared to standard surveillance using crude and adjusted analyses. RESULTS. A total of 440 discharges were reviewed, there were 27 episodes of NIs among 22 patients. Cumulated incidence was 6.13 NI per 100 discharges. Diarrhea, pneumonia and peritonitis were the most common infections. Predictors of NI by Cox regression analysis included pleural catheter (HR 16.38), entry through the emergency ward, hospitalization in the intensive care unit (HR 7.19), and placement of orotracheal tube (HR 5.54). CONCLUSIONS. Frequency of NIs in this community hospital was high and underestimated. We identified urgent needs in the areas of training and monitoring.


OBJETIVO. Comparar la tasa de infecciones nosocomiales (IN) resultante de la revisión retrospectiva de expedientes clínicos con los resultados del sistema rutinario de vigilancia de IN de un hospital general. MATERIAL Y MÉTODOS. Revisión retrospectiva de una muestra seleccionada aleatoriamente de expedientes clínicos. Comparación con los resultados obtenidos por el sistema rutinario de vigilancia de IN. Análisis bivariado y multivariado de datos retrospectivos. RESULTADOS. De 440 egresos hubo 27 episodios de IN en 22 pacientes. La incidencia acumulada fue de 6.13 IN por 100 egresos. Las infecciones más frecuentes fueron diarrea, neumonía y peritonitis. Los predictores de IN fueron catéter pleural (HR 16.38), ingreso por urgencias y estancia en cuidados intensivos (HR 7.19), y colocación de tubo orotraqueal (HR 5.54). CONCLUSIONES. La frecuencia de IN fue elevada y subestimada por el sistema rutinario. Identificamos necesidades urgentes de monitoreo y entrenamiento en áreas específicas.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Cross Infection/epidemiology , Hospitals, Community/statistics & numerical data , Hospitals, Urban/statistics & numerical data , Population Surveillance , Diarrhea/epidemiology , Hospital Records/statistics & numerical data , Hospitals, Community/organization & administration , Hospitals, Urban/organization & administration , Incidence , Kaplan-Meier Estimate , Mexico/epidemiology , Predictive Value of Tests , Program Evaluation , Proportional Hazards Models , Patient Discharge/statistics & numerical data , Peritonitis/epidemiology , Pneumonia/epidemiology , Retrospective Studies , Sampling Studies , Sensitivity and Specificity
12.
J. bras. nefrol ; 32(2): 156-164, abr.-jun. 2010. tab
Article in English, Portuguese | LILACS (Americas) | ID: lil-551678

ABSTRACT

INTRODUÇÃO: Peritonite é a principal complicação relacionada com a diálise peritoneal (DP). OBJETIVO: Avaliar possíveis preditores para o seu desenvolvimento em pacientes em programa crônico na modalidade. MÉTODO: Realizou-se estudo de coorte retrospectivo em 330 pacientes (média de idade 53 ± 19 anos) em programa de DP na Clínica de Nefrologia de Sergipe (Clinese), em Aracaju/ SE, Brasil, entre 1.º de janeiro de 2003 e 31 de dezembro de 2007. Variáveis sociodemográficas e clínicas foram avaliadas comparativamente entre pacientes que apresentaram (141 por cento - 42,7 por cento) ou não (189 por cento - 57,3 por cento) peritonite. Na análise estatística, utilizaramse teste t de Student, qui-quadrado e modelo de regressão com múltiplas variáveis. RESULTADOS : Ocorreu um episódio de peritoniteacada28,4pacientes/mês(0,42episódio/ paciente/ano). O Staphylococcus aureus foi o agente etiológico mais frequente (27,8 por cento). Não se utilizava antibioticoterapia profilática e 136 pacientes (41,2 por cento) haviam apresentado previamente infecção de sítio de saída do cateter peritoneal (ISSCP). Identificou-se maior risco de peritonite nos pacientes com albuminemia < 3,0 g/dL no início do tratamento [risco relativo (RR) = 2,0; intervalo de confiança (IC) de 95 por cento = 1,21 - 3,43; p < 0,01], escolaridade < 4 anos (RR = 2,15; IC = 1,09 - 4,24; p = 0,03) e com histórico de ISSCP (RR = 2,63; IC = 1,57 - 4,41; p < 0,01). Não houve diferença significante entre os grupos no tocante a gênero, idade, renda familiar, procedência, presença ou não de diabetes, forma de início do tratamento (se eletiva ou emergencial), tipo de cateter e tipo de implante. CONCLUSÕES: Hipoalbuminemia, menor escolaridade e ISSCP mostraram-se como fatores preditores independentes de peritonite. Embora os índices de peritonite observados sigam os padrões internacionais, recomendam-se estratégias profiláticas para ISSCP.


INTRODUCTION: Peritonitis remains a major complication of peritoneal dialysis (PD). OBJECTIVE: Evaluate peritonitis incidence, etiology and outcome in cronic PD patients. METHODS: A retrospective cohort study was carried out on 330 patients (mean age of 53 ± 19 years) who had been treated by PD in a dialysis center in Aracaju/SE, Brazil between January 1st, 2003 and December 31th, 2007. Data of patients with and without peritonitis were compared using Student's ttest, chi-squared statistic and multiple logistic regression. RESULTS: There were 213 peritonitis among 141 patients (1.51 episode/patient) resulting in a rate of 28.44 patient/episode/ month (0.42 patient/episode/year). Staphylococcus aureus was the most frequent micro-organism isolated (27.8 percent), followed by Escherichia coli (13.4 percent) and 32.5 percent were culture-negative peritonitis. A greater risk of peritonitis was identified at the patients with hypoalbuminemia [relative risk (RR) = 2.0; 95 percent confidence interval (CI) = 1.21 - 3.43; p < 0,01], < 4 school years (RR = 2.15; CI = 1.09 - 4.24; p = 0.03) and catheter's exit site infection (RR = 2.63; IC = 1.57 - 4.41; p < 0.01). There were no significant difference among gender, age, family income, diabetes mellitus, type of dialysis treatment, type of catheter and its surgical implant. CONCLUSIONS: Hypoalbuminemia, low schooling and catheter's exit site infection were associated with greater risk to peritonitis. Although peritonitis rate follow international pattern, prophylactic strategies are recommended.


Subject(s)
Aged , Humans , Middle Aged , Peritoneal Dialysis , Peritonitis , Cohort Studies , Peritonitis/epidemiology , Peritonitis/etiology , Retrospective Studies
13.
J. bras. nefrol ; 32(1): 100-106, jan.-mar. 2010. tab, graf
Article in Portuguese | LILACS (Americas) | ID: lil-548401

ABSTRACT

Introdução: Investigou-se um universo de 30 crianças e adolescentes portadores de doença renal crônica em tratamento dialítico, assistidos pelo Hospital das Clínicas da UFMg, a fim de determinar fatores de risco para a frequência de peritonites e de internações. Método: Estudo descritivo em que para a obtenção dos resultados utilizou-se o software SPSS (Statistical Package for Social Science) versão 13.0. Testaram-se as variáveis: baixa escolaridade, baixa renda familiar, nível de informação inadequado, inadequação da antissepsia das mãos para a realização da diálise, ausência de pia no quarto da diálise como fator de risco para maior frequência de peritonites e internações. Resultados: Os valores de Odds ratio estiveram dentro dos limites dos intervalos de confiança (95%) e em alguns casos foram <1, indicando a possibilidade de associação negativa entre algumas variáveis independentes e as variáveis pesquisadas, embora sem diferença estatística significativa. Conclusão: Não foi detectada significância estatística para as variáveis testadas, embora haja uma tendência para a sua ocorrência.


Introduction: We investigated a population of 30 children and adolescents with chronic kidney disease on dialysis, assisted by the Hospital das Clínicas, to determine risk factors for the frequency of peritonitis and hospitalization. Method: Descriptive study in which to obtain the results we used the software SPSS (Statistical Package for Social Science) version 13.0. They tested the following variables: low education, low family income, level of inadequate information, inadequate antisepsis of hands to perform the dialysis, no sink in the room of dialysis as a risk factor for increased frequency of peritonitis and hospitalization. Results: Odds ratio values were within the confidence interval (95%) and in some cases were <1, indicating the possibility of a negative association between some independent variables and the variables studied, although not statistically significant. Conclusion: There was no statistical significance for the variables tested, although there is a tendency for its occurrence.


Subject(s)
Humans , Male , Female , Child , Adolescent , Peritoneal Dialysis/adverse effects , Peritonitis/epidemiology , Peritonitis/etiology , Risk Factors , Hospitalization
14.
Benha Medical Journal. 2009; 26 (2): 287-306
in English | IMEMR (Eastern Mediterranean) | ID: emr-112063

ABSTRACT

Spontaneous bacterial peritonitis [SBP] is a frequent severe and potentially life-threatening complication of cirrhotic patients with ascites. The clinical presentation of SBP depends on the stage at which the infection is diagnosed. In early stages, most patients are asymptomatic or present with insidious, non specific symptoms. As the disease progresses, patients show signs and symptoms of peritoneal infection. To determine the prevalent pathogens responsible for SBP in our locality and their sensitivity pattern, to test the efficiency of different culture techniques in microbial isolation, and to study the diagnostic predictors of such cases. Two hundred fifteen adults with cirrhotic ascites consecutively admitted to Tropical Medicine Unit Mansoura University Hospital were screened for SBP. One hundred eight SBP episodes from 92 adult patients were compared to 88 cirrhotic ascites patients cross-matched with age and sex without SBP. Diagnosis of cirrhosis was based on clinical biochemical radiological and/or histo-pathological data. Ascitic fluid was subjected to cytological biochemical examination and culture on both conventional and blood culture bottles at the bedside for bacterial identification and antimicrobial susceptibility testing. Diagnosis of SBP and its variants were made depending on ascitic fluid poly-morphnuclear count >/= 250 cell/ mm[3] and/or monomicrobial growth in ascitic fluid culture without evidence of an infra-abdominal surgically treatable source of infection, and no recent use of antibiotics. A total of 432 diagnostic paracentesis were performed in 215 cirrhotic patients with ascites. The prevalence of SBP was 25.02%. History of previous episode of SBP or history of paracentesis were significantly more frequent in SBP patients [P=0.000 and P=0.001] respectively also, Abdominal wall edema and redness [cellulitis], presence of ascetic fluid with numerous fine internal hyper-echoic particulates by ultrasonography and the aspiration of slightly turbid ascites were significantly more frequent in SBP patients [P= 0.01, P=0.031 and P=0.035] respectively. Ascitic fluid protein levels and serum albumin levels were significantly lower and serum creatinine levels were significantly higher in SBP patients. [P=0.009, P=0.03, and P= 0.003] respectively. Applying the model of logistic regression analysis between SBP and Non SBP clinical and laboratory data revealed that; previous SBP episode, low ascitic fluid protein levels, high serum creatinine and low serum albumin levels were significant predictors of SBP [P-0.000]. Fourty-nine [45.37%] episodes of SBP were detected by the conventional culture compared to 79 [73.15%] by modified technique with a significant P value <0.001. Gram-negative bacteria were the cause of SBP in 46 [58.23%] culture positive episodes while Gram-positive bacteria were the isolated organisms in 33 cases [41.77%]. Escherichia coli and Staphylococcus aureus were the most commonly detected organisms in 40 [50.63%] and 26 [32.91%] cases respectively. In this study, 31.65% of cultures were highly sensitive to Levofloxacin, 29.11% were sensitive to Cefotaxime, 20.25% were sensitive to Amoxicillin-Clavulanic acid, 18.99% were sensitive to Meropenem, 17.72% were sensitive to Ciprofloxacin and 15.19% were sensitive to Ceftazidime. On the other hand, antibiotic resistant rates to Ciprofloxacin were 25.32%, 24.05% to Ceftazidime and 21.52% to Cefotaxime. Previous SBP episode, low ascetic fluid protein levels, high serum creatinine, and low serum albumin levels, all had a significant prediction of SBP. Beside cytological and biochemical examination, culture of ascitic fluid in blood culture bottles at bedside increases the sensitivity of SBP detection and must be a routine in every hospitalized patient with cirrhotic ascites. Gram-negative organisms still, the prevalent microorganisms causing SBP but there is a significant recent increase in Gram-posittue pathogen with emergence of maltidrug resistance especially for Ciprofloxacin, Ceftazidime and Cefotaxime. These recent changes may have an impact on guidelines for management and treatment of SBP in oar locality


Subject(s)
Humans , Male , Female , Liver Cirrhosis , Ascitic Fluid , Culture Techniques , Microbial Sensitivity Tests , Peritonitis/epidemiology , Abdomen/diagnostic imaging
15.
Gac. méd. Méx ; 144(4): 297-302, jul.-ago. 2008. tab, ilus
Article in Spanish | LILACS (Americas) | ID: lil-568055

ABSTRACT

Objetivo: Determinar el riesgo de los pacientes pediátricos con insuficiencia renal crónica terminal en programa de diálisis peritoneal continua ambulatoria (DPCA), portadores de Staphylococcus aureus (SA) en nariz, manos o sitio de salida del catéter, para desarrollar episodio de peritonitis causado por una cepa idéntica. Métodos: Estudio longitudinal en un centro de DPCA perteneciente a un hospital pediátrico de tercer nivel. Al ingresar al estudio se tomaron cultivos de las narinas, sitio de salida del catéter y manos, de 29 pacientes vigilados por un periodo promedio de 369 ± 80 días (de 224 a 516 días), y de las narinas y manos de sus madres. Las cepas de SA aisladas se conservaron en glicerol BHI a –20°C para análisis posterior. Los episodios de peritonitis se monitorearon y registraron. Cuando se aisló una cepa de SA del líquido de diálisis efluente se comparó con la previa identificada por electroforesis en gel de campos pulsados. Resultados: Se presentaron siete episodios de peritonitis causados por SA en seis pacientes, uno de los cuales era portador previo de la misma cepa en la nariz y dos en el sitio de salida del catéter. El riesgo relativo de desarrollar un episodio de peritonitis causado por una cepa preexistente localizada en el sitio de salida del catéter fue de 0.948, y de 0.525 por una cepa preexistente localizada en la nariz. Conclusiones: Los portadores de SA no parecen tener riesgo más alto de desarrollar peritonitis causada por una cepa de SA relacionada que los no portadores. No se sustenta la recomendación de monitorear el estado de portador nasal o en el sitio de salida del catéter en los pacientes tratados con DPCA. La conveniencia de erradicar el SA de la nariz o el sitio de salida del catéter también es cuestionable.


OBJECTIVE: To determine the risk of pediatric end stage renal disease patients undergoing continuous ambulatory peritoneal dialysis to develop a subsecuent peritonitis episode caused by an identical Staphylococcus aureus (SA) strain. METHODS: Longitudinal survey carried out in a CAPD center at the nephrology department of a tertiary care (reference) pediatric hospital. At recruitment, swabs were collected from the nares, exit site, and hands, respectively from 29 patients who were followed-up for a mean period of 369 +/- 80 days (range 224-516 days), and from the nares and hands of their mothers. Isolated SA strains were kept in BHI glycerol at -20 degrees C for subsequent analysis. Peritonitis episodes were monitored and registered. When a SA strain was isolated from the dialysate effluent it was compared with the preexisting strain by PFGE. RESULTS: We report 7 SA-mediated peritonitis episodes among 6 patients. Only one of these patients was a previous nasal carrier, and 2 were previous exit site carriers of the same SA strain. The relative risk of developing a peritonitis episode caused by a preexistent SA strain colonizing the exit site was 0.948. The relative risk of developing a peritonitis episode caused by a preexistent SA strain colonizing the nares was 0.525. CONCLUSIONS: SA carriers do not appear to be at higher risk of developing peritonitis by an SA related strain than non-carriers. Our results do not lend support to the recommendation of monitoring nasal or exit site carrier status in CAPD patients. The need of attempting to eradicate SA from nose or exit site is also questioned.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Kidney Failure, Chronic/therapy , Peritoneal Dialysis, Continuous Ambulatory , Peritonitis/epidemiology , Peritonitis/microbiology , Staphylococcus aureus/isolation & purification , Carrier State , Longitudinal Studies , Nose/microbiology , Risk Assessment , Risk Factors , Nails/microbiology
16.
Rev. argent. microbiol ; 40(1): 17-23, ene.-mar. 2008. graf, tab
Article in English | LILACS (Americas) | ID: lil-634570

ABSTRACT

This study reports the infectious peritonitis rates in 44 patients on peritoneal dialysis in three different systems over the last 15 years, covering clinical outcomes, exit-site infections, tunnel infections, causative microorganisms, and the history of susceptibility of organisms causing peritonitis, in order to establish our center-specific selection of empiric therapy. Two microbiological procedures were herein used: method A, where 100 ml of dialysate were centrifuged and cultured in standard media and into blood-culture bottles; and method B, where 10 ml were directly injected into blood-culture bottles. Swabs from the exit-site or tunnel were taken when purulent drainage was observed. There were 96 episodes of peritonitis during 110.43 patient-years (0.87 episodes/patient-year). Sensitivity of method A was 96.88% (93/96 episodes) versus 81.25% (78/96) of method B (p= 0.001). Gram stain sensitivity was 36.46%. The etiologic agents were 64 (56.64%) gram-positive cocci, 22 (19.47%) gram-negative fermentative rods, 20 (17.7%) gram-negative non fermentative rods, 5 (4.43%) yeasts, 1 (0.88%) micelial fungus, and 1 (0.88%) anaerobic rod. Fifty-five exit-site infections were documented (0.5 episodes/patient-year). Ceftazidime and imipenem showed excellent activity on gram-negative rods. There were 92.3% of methicillin-susceptible Staphylococcus aureus but only 33.3% of methicillin-susceptible coagulase- negative staphylococci; vancomycin was active against 100% of the gram-positive cocci. The clinical outcomes of peritonitis were 73 initial cure, 19 catheter removal and four related deaths. The empiric therapy in our center should be vancomycin plus ceftazidime or imipenem. Once the etiological agent and its susceptibility pattern are known, the deescalating therapy must be applied to avoid the emergence and spread of vancomycin-resistant microorganisms.


Se comunican las tasas de peritonitis infecciosa de 44 pacientes en tres sistemas diferentes de diálisis peritoneal durante los últimos 15 años. Se evaluaron evolución clínica, infecciones del sitio de salida y del túnel, y los microorganismos causales y su sensibilidad, a fin de seleccionar la mejor terapia empírica para nuestro centro. Se realizaron dos procedimientos microbiológicos, método A: 100 ml del dializado fueron centrifugados y cultivados por métodos convencionales y en frascos para hemocultivo; método B: 10 ml fueron directamente inoculados en frascos para hemocultivo. Los hisopados del sitio de salida y del túnel fueron realizados cuando se observó supuración. Se registraron 96 episodios de peritonitis en 110,43 paciente-años (0,87 episodios/paciente-año). La sensibilidad del método A fue 96,88% versus 81,25% del método B (p = 0,001). La sensibilidad de la coloración de Gram fue 36,46%. La distribución de los agentes etiológicos fue la siguiente: 64 (56,64%) cocos gram-positivos, 22 (19,47%) bacilos gram-negativos fermentadores, 20 (17,7%) bacilos gram-negativos no fermentadores, 5 (4,43%) levaduras, 1 (0,88%) hongo micelial, 1 (0,88%) bacilo anaerobio. Fueron documentadas 55 infecciones del sitio de salida (0,5 episodios/paciente-año). La ceftazidima y el imipenem mostraron una excelente actividad sobre los bacilos gram-negativos. La sensibilidad a meticilina fue de 92,3% para Staphylococcus aureus y 33,3% para estafilococos coagulasa negativos; la vancomicina fue activa frente al 100% de los cocos gram-positivos. La evolución clínica de las peritonitis fue: 73 curas, 19 remociones de catéter y cuatro muertes relacionadas. La terapia empírica en nuestro centro debería ser vancomicina más ceftazidima o imipenem. Una vez conocidos el agente etiológico y su sensibilidad, se debería aplicar la terapia de desescalonamiento para evitar la emergencia y diseminación de microorganismos resistentes a la vancomicina.


Subject(s)
Female , Humans , Male , Middle Aged , Peritonitis/epidemiology , Peritonitis/microbiology , Renal Dialysis , Argentina , Hospitals, Teaching , Kidney Failure, Chronic/therapy , Retrospective Studies , Time Factors
17.
Rev. argent. microbiol ; 39(4): 213-217, oct.-dic. 2007. tab
Article in English | LILACS (Americas) | ID: lil-634559

ABSTRACT

Fungal peritonitis is a rare but serious complication of peritoneal dialysis. The aim of this study was to analyze peritonitis rates, associated factors, clinical course, microbiological aspects, therapeutic regimens, and outcome of patients with fungal peritonitis in the dialysis center of a teaching hospital over the last 25 years. A hundred and eighty three episodes of peritonitis were detected and microbiologically documented in 57 patients. Fungi were identified in eight episodes (4.37%) occurring in seven female patients. The fungal peritonitis rate was 0.06 episodes/patient-year. Gram and Giemsa stains were positive in five out of eight dialysate fluids. The causative microorganisms were: Candida albicans in five episodes, and Candida parapsilosis, Candida glabrata, and Neosartorya hiratsukae in the remaining three. Antibiotics were administered to all but one patient, within 3 months before fungal peritonitis was detected. All patients required hospitalization, and antifungal therapy was administered in all episodes. The Tenckhoff catheter was removed in seven out of eight fungal peritonitis. All patients recovered from the fungal episodes. In the group of patients studied, it is concluded that recent exposure to antibiotics and female sex, were strongly associated with the development of fungal peritonitis by yeasts. The peritonitis caused by the environmental filamentous fungus did not require antibiotic pressure. Direct microscopy of the dialysate pellet was extremely useful for the prompt management of the fungal episode. Fungal peritonitis preceded by multiple episodes of bacterial peritonitis always determined the definitive dropout of the patient from the peritoneal dialysis program. Patients with de novo yeastrelated peritonitis could continue on the program.


La peritonitis fúngica es una complicación infrecuente pero grave de la diálisis peritoneal. Los objetivos de este trabajo fueron el análisis de las tasas de peritonitis, factores asociados, aspectos clínicos y microbiológicos, esquemas terapéuticos y evolución de los pacientes afectados. Se detectaron y documentaron microbiológicamente 183 episodios de peritonitis en 57 pacientes. Se identificaron hongos en ocho episodios (4,37%) en siete pacientes, todos ellos de sexo femenino. La tasa de peritonitis fúngica fue 0,06 episodios/paciente-año. Las coloraciones de Gram y Giemsa revelaron la presencia de microorganismos en cinco de los ocho líquidos de diálisis evaluados. Los microorganismos causales fueron Candida albicans en cinco episodios y Candida parapsilosis, Candida glabrata y Neosartorya hiratsukae en los otros tres. Todos estos pacientes, excepto uno, habían recibido antibióticos en los tres meses previos al episodio de peritonitis fúngica. El catéter de Tenckhoff fue extraído en siete de los ocho episodios. Todos los pacientes evolucionaron favorablemente. Concluimos que en la población estudiada el sexo femenino y la administración reciente de antibióticos estuvieron estrechamente relacionados con el desarrollo de peritonitis fúngicas por levaduras. Sin embargo, la peritonitis causada por el hongo filamentoso ambiental no requirió de la presión antibiótica. La microscopía del sedimento del líquido de diálisis fue útil en el manejo precoz del episodio. La peritonitis fúngica precedida por múltiples episodios de peritonitis bacteriana determinó siempre la exclusión definitiva del paciente del programa de diálisis peritoneal. Los pacientes con peritonitis de novo por levaduras, en cambio, pudieron continuar en él.


Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Candidiasis/epidemiology , Catheters, Indwelling/adverse effects , Cross Infection/epidemiology , Peritoneal Dialysis/adverse effects , Peritonitis/epidemiology , Ascomycota , Anti-Bacterial Agents/adverse effects , Argentina/epidemiology , Bacterial Infections/complications , Bacterial Infections/drug therapy , Candidiasis/etiology , Cross Infection/etiology , Cross Infection/microbiology , Equipment Contamination , Hospitals, Teaching/statistics & numerical data , Mycoses/epidemiology , Mycoses/etiology , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Peritoneal Dialysis, Continuous Ambulatory/instrumentation , Peritoneal Dialysis/instrumentation , Peritonitis/etiology , Peritonitis/microbiology , Retrospective Studies , Superinfection/epidemiology , Superinfection/etiology , Superinfection/microbiology
18.
Yonsei Medical Journal ; : 104-111, 2005.
Article in English | WPRIM (Western Pacific) | ID: wprim-35926

ABSTRACT

Sclerosing encapsulating peritonitis (SEP) is a rare but serious complication in patients with continuous ambulatory peritoneal dialysis (CAPD), and is characterized by a progressive, intra-abdominal, inflammatory process resulting in the formation of sheets of new fibrous tissue, which cover, bind, and constrict the viscera, thereby compromising the motility of the bowel. No satisfactory estimate is available on the comparative incidence of dialysis related SEP and the pathogenesis of SEP still remains uncertain. Although recent therapeutic approaches have reported varying degrees of success, an efficient measure to detect, at an early stage, patients at risk for SEP would be beneficial and a standardized treatment regimen to prevent the illness is urgently needed. This study aimed to evaluate the clinical features of SEP and to identify the possible risk factors for the development of SEP in CAPD patients. We retrospectively reviewed by questionnaire SEP cases among CAPD patients from 7 university hospital dialysis centers in Korea, including Yonsei University, Ajou University, Catholic University, Inha University, Kyungpook University, Seoul National University and Soonchunhyang University, from January 1981 to December 2002. Out of a total of 4, 290 CAPD patients in these centers, 34 cases developed SEP with an overall prevalence of 0.79%. The male to female ratio was 17: 17. The median age of these patients was 44.5 years (range 19 - 66). The median duration of CAPD before SEP was 64 months (9 - 144) and 68% of patients (23/34) had been on CAPD for more than 4 years. Peritonitis (including two fungal cases) was the main cause of catheter removal in SEP (27 cases, 79%). Seventy-five percent of the cases (15/ 20) were administered beta-blocker for a mean duration of 85 months (26 - 130). Among 10 cases with available peritoneal equilibration test (PET) data, 8 showed high transporter characteristics, and the remaining 2 were high average. Eighteen cases were diagnosed by clinical and radiologic methods, and 16 were surgically diagnosed. Eleven cases were surgically treated and the others were treated conservatively with intermittent total parenteral nutrition (TPN). The overall mortality rate was 24%. SEP is a serious, life threatening complication of CAPD. Most cases had a PD duration of more than 4 years, a history of severe peritonitis, and high transporter characteristics in PET. Therefore, to reduce the incidence of SEP, careful monitoring and treatment, including early catheter removal in patients with severe peritonitis, should be considered for long-term CAPD patients with the above characteristics.


Subject(s)
Adult , Aged , Female , Humans , Incidence , Korea/epidemiology , Male , Middle Aged , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Peritonitis/epidemiology , Prevalence , Sclerosis
19.
Med. intensiva ; 21(2): 19-23, 2004. tab
Article in Spanish | LILACS (Americas) | ID: lil-542264

ABSTRACT

Introducción: En la evolución de las peritonitis generalizadas influyen factores propios del paciente, ligados a la enfermedad, a los gérmenes y ralacionados con la operación. Objetivo: evaluar los factores que se asociaron al pronóstico de pacientes con peritonitis generalizada. Material y métodos: Se realizó un estudio de cohorte en enfermos atendidos en la Unidad de cuidados intensivos UCI del Hospital Universitario "Carlos Manuel de Céspedes" de Bayamo, Granma, Cuba, Entre el 1º de enero de 1999 hasta el 31 de mayo de 2001. Se incluyeron 134 enfermos por cumplir los criterios diagnósticos de la enfermedad. El pronóstico se consideró de acuerdo con el estado al egreso de la UCI, vivo o fallecido. Se calculó el riesgo relativo de fallecer (RR) para cada factor, con un intervalo de confianza del 95% (IC95%). Resultados: La presencia de DMO (RR 10,38 IC95% 5,73-18,84), el estado físico III-V según la Clasificación de la ASA (RR 4,16 IC95% 2,04-8,48), las peritonitis causadas por necrosis intestinal (RR 3,91 IC95% 2,93-5,23), las postoperatorias (RR 2,85 IC95% 1,70-4,74) y las provocadas por perforación de víscera intraabdominal (RR 1,64 IC95% 0,93-2,87) se asociaron significativamente a la muerte. La edad mayor de 60 años (RR 3,38 IC95% 1,94-5,74), el antecedente de enfermedad previa (RR3, IC95% 1,75-5,44), un tiempo de evolución mayor de veinticuatro horas (RR 3,05 IC95% 1,44-6,49) y la desnutrición (RR 2,24 IC95% 1,29-3,90) tambien influyeron negativamente en el pronóstico. Conclusiones: Ciertos factores propios del paciente y ligados a la enfermedad se asocian al riesgo de fallecer. Con cada uno de ellos, por separado, podrán hacerse predicciones acerca del pronóstico.


Subject(s)
Humans , Male , Female , Prognosis , Peritonitis/surgery , Critical Care , Peritonitis/epidemiology , Peritonitis/mortality
20.
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-31132

ABSTRACT

A prospective observational study examing the incidence, predisposing factors and microbiological aspects of peritonitis complicating acute intermittent peritoneal dialysis (IPD) was performed in Hospital Universiti Sains Malaysia, a referral hospital situated in Northeast Malaysia. Over a 7- month period, a total of 126 acute IPD treatments were included involving 69 patients. The majority of patients suffered from chronic or end stage renal failure (92.7%) and nearly half (47.8%) have underlying diabetes mellitus. Peritonitis occured in 25 treatment sessions giving a frequency of 19.8% of procedures performed. The mean interval between starting dialysis and the first sign of peritonitis was 3.5 days, with 12% of peritonitis occuring before day 3 of treatment. Frequent catheter manipulation and/or leakages were identified as significant predisposing factors for peritonitis and the risk of peritonitis was increased with longer duration of IPD. Gram-negative infections were seen twice more commonly than gram-positive infections. We recommend the use of cloxacillin in combination with either an aminoglycoside or a cephalosporin as empirical antibiotic coverage until culture reports are available.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Demography , Female , Gram-Negative Bacterial Infections/complications , Gram-Positive Bacterial Infections/complications , Humans , Incidence , Malaysia/epidemiology , Male , Middle Aged , Peritoneal Dialysis/adverse effects , Peritonitis/epidemiology , Prospective Studies
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