Abstract
Background and significance: Peritoneal dialysis (PD)-related peritonitis is a common serious complication among PD patients leading to technical failure and a significant cause of morbidity, mortality, and healthcare costs. For the treatment of peritoneal dialysis (PD)-relatedperitonitis, intraperitoneal (IP) administration of antimicrobial agents is recommended due to its higher concentrations at the target site and more success compare to intravenous administration. Besides, prevention strategies of PD-related infection are still unclear. This research programs consists of three research topics. Objectives: 1) To (1) systematically review and meta-analyses the effectiveness of different empirical treatment options for PD-related peritonitis and (2) to examine the temporal trends, potential predictors, microbiological pattern with antimicrobial susceptibility rates, treatment patterns, and clinical outcomes of PD-related peritonitis. 2) To (1) systematically review bundles all published stability and compatibility of data on IP administration of antimicrobial agents via PD solutions and (2) to investigate the physical and chemical stability of selected antimicrobial namely: imipenem, meropenem, ertapenem, cefazolin/ceftazidime, and cefoperazone/sulbactam in 6 type of commercial PD solutions with polyvinyl chloride container that available in Thailand (Extraneal®, Dianeal® PD2: 1.36%, 2.27%, and Dianeal® Low calcium: 1.36%, 2.27%, 3.86%) at different temperatures for various time points. 3) To compare effectiveness, safety, and cost-utility of chlorhexidine gluconate (CHG)-soaked cloths to mupirocin ointment and exit site usual care (normal saline) with aseptic technique in prevention of PD-related infection. Conclusions: In contemporary review, evidence of antimicrobial for treatment of PD-related peritonitis is limited. No specific antimicrobial in terms of route, dose, schedules, and optimal antimicrobial agent or regimen appear to have superior efficacy for treatment of PD-related peritonitis. There was a downward trend in PD-related peritonitis incidence over this past 10 years to 0.39 episode per patient-years. Causative organisms for peritonitis of gram positive bacteria decreased, but gram negative bacteria increased over time. In daily practice, a combination of cefazolin and ceftazidime is suitable for mixed with icodextrin-based and glucose-based PD solutions at least 24 hours at body temperature. Carbapenems group appear insuitable for IP administration. Likewise, to concern the degradation products, a combination of cefoperazone with sulbactam should not be mixed with PD solutions. In addition, the study to compare effectiveness, safety, and cost-utility of chlorhexidine gluconate (CHG)-soaked cloths to mupirocin ointment and exit site usual care (normal saline) with aseptic technique in prevention of PD-related infection is ongoing to the second year.
