[The microbial pattern of the catheter exit-site infection in peritoneal dialysis: A non-diphtheria Corynebacteria emergence?]. / Patrón microbiológico de la infección del cateter peritoneal: aumento de Corynebacterium sp?

BACKGROUND: A prospective cohort study was undertaken to compare the rates of the infecting microorganisms of the peritoneal catheter exit-site in three periods of the prophylactic protocol of a peritoneal dialysis program. All patients treated for more than one month on Peritoneal Dialysis were included: Fourty-eight in Period 1 (P1), 48 in Period 2 (P2), and 54 in Period 3 (P3). Each period was of 3 years. METHODS: Infection prophylaxis protocol: P1: hydrogen peroxide or povidone iodine and non-occlusive dressing; P2: sterile water (boiled water) instead of antiseptic agents, semi-permeable dressing for taking showers, and nasal mupirocine prophylaxis for Staphylococcus aureus carriers; P3: equal to P2, plus local application of antibiotics in equivocal exit-site for infection and argentic nitrate in granulation tissue. MAIN OUTCOME MEASURE: The rates of catheter infection and microorganisms causing infection were analysed by means of the Poisson regression method. Chi-square and ANOVA when appropriate. RESULTS: The proportion of catheters implanted by nephrologist or surgeon (p<0.01) and modality treatment by CAPD or CCPD (p<0.0001) were significantly different in the three periods, while the Staph. Aureus carrieres was in the limit of significance (p=0.048). Throughout the three periods, a significantly decreasing rate of total (P=0.0035) and acute infections (P<0.001), Staph. aureus (P=0.003) and peritonitis (P=0.0025) were found. The Pseudomonas aer. (P=0.006) and Gram negative Bacteria (P=0.023) decreased significantly in P2. The multiple factor analysis included eight factors: sex, age group, ESRD, DM, catheter implantation (nephrologist, surgeon), modality treatment (CAPD, CCPD), manufacturer and prophylaxis period as possible predictors of the catheter infections, the specific microorganisms and the peritonitis. That analysis revealed the prophylaxis period as the main predictive factor of the improvements found (p<0.02,- p<0.001). In contrast, the Corynebacteria spp. increased significantly (P=0.008) throughout the three periods. One half of the Corynebacteria in each period could be considered colonisers. The other half caused true infections, but not one of those episodes required catheter intervention. The non-diphtheria Corynebacteria increase was found related with the continuous cycling Peritoneal Dialysis treatment in multiple factor analysis (p=0.0023) and in the proportion analysis (P=0.039, c2). CONCLUSION: The progressive protocol applied obtained good results, without the continued use of local antiseptics or antibiotics at the exit-site. However, the non-diphtheria Corynebacteria sp. infection increment favours the consideration of an antiseptic agent for the exit-site care.

Patrón microbiológico de la infección del catéter peritoneal: ¿aumento de corynebacterium sp? / The microbial pattern of the catheter exit-site infection in peritoneal dialysis: a non-diphteria corynebacteria emergence?

En un estudio de cohorte se observaron prospectivamente los gérmenes causantes de infección en el catéter peritoneal en tres protocolos de profilaxis consecutivos, de 3 años cada uno. Pacientes con más de un mes de permenencia en Diálisis Peritoneal: 48 en el período 1 (P1), 48 en el período 2 (P2) y 54 en el período 3 (P3). Métodos: La profilaxis de infección del catéter fue: P1: Peróxido de hidrógeno o Povidona yodada y apósito no oclusivo; P2: Agua estéril (hervida), apósito semipermeable para la ducha y mupirocina nasal para los portadores de Staf. aureus; P3: igual que en el período anterior añadiendo antibióticos locales para los orificios equivocos de infección y aplicación de nitrato de plata en el tejido de granulación. Análisis estadístico: regresión de Poisson, ��2 y ANOVA. Resultados: A través de los 3 períodos hubo una disminución significativa de la tasa de infecciones totales (aguda, crónica y del manguito) (p = 0,0035), agudas (p < 0,001), las causadas por Staph. aureus (p = 0,003) y también de las peritonitis (p = 0,0025). Las infecciones por Pseudomonas aer. (p = 0,006) y por gérmenes gram negativos (p = 0,023) disinuyeron significativamente en el P2. El análisis multifactorial confirmó el período de profilaxis como el principal factor predictivo de los cambios en las tasas de infección y de los microorganismos específicos (p entre < 0,02 y < 0,001). Sin embargo las infecciones por Corynebacterium sp aumentaron significativamente (p = 0,008) a través de los tres períodos. En el análisis de factores este aumento de infecciones por Corynebacterium sp se halló relacionado con el tratamiento con Diálisis Peritoneal continua cíclica (DPCC) en el análisis multifactorial (p = 0,0023) y en el de proporciones (p = 0,039). Conclusión: El protocolo de profilaxis de la infección del orificio del catéter de DP aplicado, sin usar continuadamente antisépticos o antibióticos locales, ha demostrado buenos resultados para la mayoría de microorganismos. Sin embargo el aumento de infecciones por Corynebacterium sp obliga a considerar la aplicación de antisépticos locales

Background: A prospective cohort study was undertaken to compare the rates of the infecting microorganisms of the peritoneal catheter exit-site in three periods of the prophylactic protocol of a peritoneal dialysis program. All patients treated for more than one month on Peritoneal Dialysis were included: Fourty-eight in Period 1 (P1), 48 in Period 2 (P2), and 54 in Period 3 (P3). Each period was of 3 years. Methods: Infection prophylaxis protocol: P1: hydrogen peroxide or povidone iodine and non-occlusive dressing; P2: sterile water (boiled water) instead of antiseptic agents, semi-permeable dressing for taking showers, and nasal mupirocine prophylaxis for Staphylococcus aureus carriers; P3: equal to P2, plus local application of antibiotics in equivocal exit-site for infection and argentic nitrate in granulation tissue. Main outcome measure: the rates of catheter infection and microorganisms causing infection were analysed by means of the Poisson regression method. Chi-square and ANOVA when appropiate. Results: The proportion of catheters implanted by nephrologist or surgeon (p < 0.01) and modality treatment by CAPD or CCPD (p < 0.0001) were significantly different in the three periods, while the Staph. Aureus carrieres was in the limit of significance (p = 0.048). Throughout the three periods, a significantly decreasing rate of total (P = 0.0035) and acute infections (P < 0.001), Staph. aureus (P = 0.003) and peritonitis (P = 0.0025) were found. The Pseudomonas aer. (P = 0.006) and Gram negative Bacteria (P = 0.023) decreased significantly in P2. The multiple factor analysis included eight factors: sex, age group, ESRD, DM, catheter implatation (nephrologist, surgeon), modality treatment (CAPD, CCPD), manufacturer and prophylaxis period as possible predictors of the catheter infections, the specific microorganisms and the peritonitis. That analysis revealed the prophylaxis period as the main predictive factor of the improvements found (p < 0.02,- p < 0.001). In contrast, the Corynebacteria spp increased significantly (P=0.008) throughout the three periods. One half of the Corynebacteria in each period could be considered colonisers. The other half caused true infections, but not one of those episodes required catheter intervention. The non-diphtheria Corynebacteria increase was found related with the continuous cycling Peritoneal Dialysis treatment in multiple factor analysis (p = 0.0023) and in the proportion analysis (P = 0.039, ��2). Conclusion: The progressive protocol applied obtained good results, without the continued use of local antiseptics or antibiotics at the exit-site. However, the nondiphtheria Corynebacteria sp infection increment favours the consideration of an antiseptic agent for the exit-site care

[A burden questionnaire for caregivers of peritoneal dialysis patients]. / Cuestionario de sobrecarga de cuidadores de pacientes de diálisis peritoneal.

INTRODUCTION: Despite the interest generated by the increasing number of studies that measure Quality of Life among patients and caregivers, few of these studies measure the caregivers burden in Peritoneal Dialysis (PD). OBJECTIVE: The main target of this study was to create a burden measure questionnaire applicable amongst caregivers of PD patients. INCLUSION CRITERIA: 1) Patients had to be in PD treatment for more than 3 months; 2) Patients had to receive help with the PD treatment from a caregiver. The study was divided into 3 phases: 1st) design and use of the initial questionnaire; 2nd) a test-retest on a modified scale; and 3rd) to provide the questionnaire-3 to two collaborative centres with similar PD programs. Four groups of caregivers were established: A1:23, A2:17, B:7 and C:16 caregivers. We applied 5 scales (5): 1--Patient Dependence on caregiver, from caregivers' view (D); 2--Complete caregiver burden (CB), including 12 items which measure the caregivers' subjective burden, 3--Reduced caregiver burden (RB), as the one before but with only 8 items, 4--Repercussions on the caregiver (R), which measures objective burden; 5--Specific PD tasks (ST), a scale that measures the effort the tasks implied in the PD treatment represent for the caregiver. RESULTS: We studied 63 caregivers (table I): mean age: 53.43 (SD = 12.3); Sex: Females: 86.4%, Males: 13.6%, corresponding to 63 patients: mean age: 59.79 (SD = 15.9); Sex: Males: 80.3%, Females: 19.7%. Valuable results for reliability, unidimensionality, and discrimination were obtained in the 1st and 2nd phases, except for burden scale which was compound of two factors; then one of those factors was suppressed. In the 3rd phase, ANOVA did not show any differences between centres (table II). Consequently, all caregivers could be analysed together. Reliability results for each one of the third phase scales (table III) were: D: Cronbach alpha = 0,886; CB: alpha = 0,894; RB: alpha = 0,857; R: alpha = 0,892; ST: alpha = 0,62. Although the ST scale obtained an acceptable reliability, it was suppressed in the 3rd phase due to the low correlation with other scales and the fact that it was not applicable to all caregivers. Finally, a direct correlation was found between third phase scales (table IV): D-RB: r = 0.502, p < or = 0.001; D-R: r = 0.599, p < or = 0.001; RB-R: r = 0.775, p < or = 0.001. We must headlight that both Burden scales, and the Repercussion scale, obtained a direct correlation with the Dependency scale. CONCLUSION: A questionnaire has been created to measure burden and repercussions on caregivers of peritoneal dialysis patients. It can already be applied, as requirements of both reliability and validity are fulfilled. This questionnaire can be a useful tool to prevent caregivers' burnout.

Cuestionario de sobrecarga de cuidadores de pacientes de diálisis peritoneal / A burden questionnaire for caregivers of peritoneal dialysis patients

Justificación: En Diálisis Peritoneal pocos estudios miden la sobrecarga del cuidador.Objetivo: proporcionar una herramienta de medida de sobrecarga aplicable acuidadores de pacientes en Diálisis Peritoneal.Material y métodos: Condiciones de inclusión: 1) mínimo 3 meses en tratamiento;2) participación del cuidador. Estudio dividido en 3 fases: 1) cuestionarioinicial; 2) test-retest; 3) administración del cuestionario fase 3 a 2 centros colaboradores.Se establecieron 4 grupos de cuidadores: 2 del hospital A: A1: n = 23,A2: n = 17; B: n = 7, C: n = 16. Se aplicaron 5 escalas: 1- Dependencia del paciente,2- Sobrecarga del cuidador completa, 3- Sobrecarga del cuidador reducida,4- Repercusiones sobre el cuidador, 5- Tareas específicas de Diálisis Peritoneal.Resultados: Estudiados 63 cuidadores, edad: 53,43 (SD = 12,3); 86,4% mujeres,13,6% hombres correspondientes a 63 pacientes, edad: 59,79 (SD = 15,9);80,3% hombres, 19,7% mujeres. En fases 1 y 2, se obtuvieron fiabilidades y unidimensionalidadeselevadas de cada escala y discriminaciones adecuadas de losítems de cada escala, excepto en la escala de sobrecarga que resultó estar compuestapor dos factores, por lo que se eliminó uno de ellos. En la fase 3, la ANOVAno mostró diferencias entre centros, por lo que todos los cuidadores se analizaronconjuntamente. Fiabilidad de las escalas-3: Dependencia: alfa de Cronbach = 0,886;Sobrecarga Completa: alfa = 0,894; Sobrecarga Reducida: alfa = 0,857; Repercusiones:alfa = 0,892; y Tareas específicas: alfa = 0,620. La Escala de Tareas específicas,con moderada fiabilidad, guardó baja relación con las escalas anteriores y no fueaplicable a todos los cuidadores; por ello se suprimió en la fase 3. Hubo correlaciónpositiva moderada entre las escalas fase 3: Dependencia-Sobrecarga Reducida:r = 0,502, p = < 0,001; Dependencia-Repercusiones: r = 0,599, p = < 0,001;Sobrecarga Reducida-Repercusiones: r = 0,775, p = < 0,001, siendo destacableque las escalas de Sobrecarga y la de Repercusiones tuvieron correlación positivay elevada con la de Dependencia.Conclusión: Se ha creado un cuestionario para medir la sobrecarga y repercusiones,en los cuidadores de pacientes de Diálisis Peritoneal, que cumple con losrequisitos de fiabilidad y validez para ser aplicado. Puede ser una herramienta útilen la prevención del agotamiento del cuidador

Introduction: Despite the interest generated by the increasing number of studiesthat measure Quality of Life among patients and caregivers, few of these studiesmeasure the caregivers burden in Peritoneal Dialysis (PD).Objective: The main target of this study was to create a burden measure questionnaireapplicable amongst caregivers of PD patients.Methodology: Inclusion criteria: 1) Patients had to be in PD treatment for morethan 3 months; 2) Patients had to receive help with the PD treatment from a caregiver.The study was divided into 3 phases:1st) design and use of the initial questionnaire;2nd) a test-retest on a modified scale; and 3rd) to provide the questionnaire-3 to two collaborative centres with similar PD programs. Four groups ofcaregivers were established: A1:23, A2:17, B:7 and C:16 caregivers. We applied5 scales (S): 1- Patient Dependence on caregiver, from caregivers’ view (D); 2-Complete caregiver burden (CB), including 12 items which measure the caregivers’subjective burden, 3- Reduced caregiver burden (RB), as the one before butwith only 8 items, 4- Repercussions on the caregiver (R), which measures objectiveburden; 5- Specific PD tasks (ST), a scale that measures the effort the tasksimplied in the PD treatment represent for the caregiver.Results: We studied 63 caregivers (table I): mean age: 53.43 (SD = 12.3); Sex:Females: 86.4%, Males: 13.6%, corresponding to 63 patients: mean age: 59.79(SD = 15.9); Sex: Males: 80.3%, Females: 19.7%.Valuable results for reliability, unidimensionality, and discrimination were obtainedin the 1st and 2nd phases, except for burden scale which was compound oftwo factors; then one of those factors was suppresed. In the 3rd phase, ANOVAdid not show any differences between centres (table II). Consequently, all caregiverscould be analysed together. Reliability results for each one of the third phasescales (table III) were: D: Cronbach alpha = 0,886; CB: alpha = 0,894; RB: alpha =0,857; R:alpha = 0,892; ST: alpha = 0,62. Although the ST scale obtained an acceptable reliability,it was suppresed in the 3rd phase due to the low correlation with other scales andthe fact that it was not applicable to all caregivers. Finally, a direct correlation wasfound between third phase scales (table IV): D-RB: r = 0.502, p <= 0.001; D-R: r= 0.599, p <= 0.001; RB-R: r = 0.775, p <= 0.001. We must headlight that both Burdenscales, and the Repercussion scale, obtained a direct correlation with the Dependencyscale.Conclusion: A questionnaire has been created to measure burden and repercussionson caregivers of peritoneal dialysis patients. It can already be applied, asrequirements of both reliability and validity are fulfilled. This questionnaire can bea useful tool to prevent caregivers’ burnout