POS-692 THE CASE SERIES OF PERITONEAL DIALYSIS-ASSOCIATED PERITONITIS AND NEUTROPHIL-TO-LYMPHOCYTE RATIO DURING PANDEMIC ERA

ABSTRACT

Introduction: Peritonitis is a major complication of Peritoneal Dialysis (PD), inadequate response to treatment, and the inflammatory state inherent in PD patients may result in hospitalization time and mortality. This Study aims to observe prognosis patients who Peritoneal Dialysis-Associated Peritonitis (PDAP) by Neutrophil-to-Lymphocyte Ratio (NLR). Methods: We have performed observation the incidences of peritonitis, causative organisms, clinical outcomes and mortality between patients undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD) during pandemic era from January 2020-September 2021 in Central General Hospital Dr. Sardjito. Outcomes and clinical course of treatment in the selected patients were reviewed. Results: The Latest case, Male, 22 years old,the Peritoneal Equilibration Test (PET) results are Low. Since the end of August 2021 felt pain in the abdomen accompanied by cloudy dialysis fluid and sometimes there is fibrin. From routine blood examination, the results NLR is 2. The patient received Ceftriaxone and Gentamicin with the results of dialysate fluid culture obtained Klebsiella Pneumonia. The symptoms of peritonitis improved but on the 14th day the symptoms started to reappear, the antibiotics were continued and a re-culture was performed on the 15th day, Burkholderia Cepacia bacteria were sensitive to Meropenem, Trimethoprim/Sulfamethoxazole, and Ceftazidime. Next case, male, 71 years old, since 2014 using CAPD with the last evaluation of PET was High Average. Complaints were felt in early October 2020 with same symptoms. The NLR is 21 and the results of culture Staphylococcus Capitis. Patients receiving therapy with Vancomycin and evaluation of culture results negative. But in December 2020 the signs and symptoms appeared again with NLR 25. Because of the weakness condition, the patient was hospitalized with the culture results Pseudomonas Aeruginosa, sensitive to Ciprofloxacin, because of improvement, the patient was allowed outpatient. The results of the culture evaluation showed the bacteria were the same as sensitive to the same antibiotic group as well, but was replaced with Ceftazidim and Fluconazole. After 14 days of administration antibiotics, the complaints improved and the culture results were negative. In March 2021 the patient came back with the same complaints again related to recurrent peritonitis, with culture results showing Pseudomonas Aeruginosa infection and only sensitive to Ciprofloxacin and Gentamicin. The patient received both antibiotic therapy in an outpatient condition but in the course of his illness the patient died because COVID-19 in other hospital. For last case, the patient was 51 years old with PET Low Average results and NLR 6. The patient presented with persistent symptoms peritonitis 3 times continously after the evaluation but the culture results were always negative. In the treatment of the first infection, the patient had received therapy Ceftazidime and Gentamicin, but because the symptoms did not improve, the patient's antibiotics were then replaced with Ciprofloxacin, and the third evaluation was given Vancomycin even though the bacteria did not grow. Due to the condition of recurrent peritonitis infection in this patient, access to CAPD was then withdrawn and back to HD. Conclusions: According to our findings, the incidence of symptomatic PDAP maybe related with NLR, it can be a prognostic factor but still unclear. No conflict of interest