Infection Prophylaxis in Peritoneal Dialysis Patients: Results from an Australia/New Zealand Survey

Perit Dial Int. 2017 Mar-Apr;37(2):191-197. doi: 10.3747/pdi.2016.00037. Epub 2017 Jan 17.

Abstract

♦ BACKGROUND: Clinical practice guidelines aim to reduce the rates of peritoneal dialysis (PD)-related infections, a common complication of PD in end-stage kidney disease patients. We describe the clinical practices used by Australian and New Zealand nephrologists to prevent PD-related infections in PD patients. ♦ METHODS: A survey of PD practices in relation to the use of antibiotic and antifungal prophylaxis in PD patients was conducted of practicing nephrologists identified via the Australia and New Zealand Society of Nephrology (ANZSN) membership in 2013. ♦ RESULTS: Of 333 nephrologists approached, 133 (39.9%) participated. Overall, 127 (95.5%) nephrologists prescribed antibiotics at the time of Tenckhoff catheter insertion, 85 (63.9%) routinely screened for nasal S. aureus carriage, with 76 (88.4%) reporting they treated S. aureus carriers with mupirocin ointment. Following Tenckhoff catheter insertion, 79 (59.4%) prescribed mupirocin ointment at the exit site or intranasally, and 93 (69.9%) nephrologists routinely prescribed a course of oral antifungal agent whenever their PD patients were given a course of antibiotics. ♦ CONCLUSIONS: Although the majority of nephrologists prescribe antibiotics at the time of Tenckhoff catheter insertion, less than 70% routinely prescribe mupirocin ointment and/or prophylactic antifungal therapy. This variation in practice in Australia and New Zealand may contribute to the disparity in PD-related infection rates that is seen between units.

Keywords: Antibiotic prophylaxis; antifungal agents; chronic; kidney failure; peritoneal dialysis; practice guideline.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / pharmacology
  • Antibiotic Prophylaxis / statistics & numerical data*
  • Attitude of Health Personnel*
  • Australia
  • Female
  • Health Care Surveys
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Nephrologists / statistics & numerical data
  • New Zealand
  • Outcome Assessment, Health Care*
  • Peritoneal Dialysis / adverse effects*
  • Peritonitis / etiology
  • Peritonitis / microbiology
  • Peritonitis / prevention & control*
  • Practice Patterns, Physicians'
  • Primary Prevention / statistics & numerical data
  • Surveys and Questionnaires*

Substances

  • Anti-Bacterial Agents