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Polymicrobial outbreak of intermittent peritoneal dialysis peritonitis during external wall renovation at a dialysis
Objective:
To investigate an outbreak of peritonitis in intermittent peritoneal dialysis (IPD) patients.
Design:
An outbreak investigation was performed to identify the etiology of the polymicrobial outbreak, and a retrospective case-control study was conducted to assess the risk factors for development of peritonitis.
Setting:
Renal dialysis center.
Patients:
Ten episodes of peritonitis occurred in 8 of 61 patients over a 6-month period in which 669 IPD procedures were analyzed.
Interventions:
Field visit to renal dialysis center to examine the entire IPD procedure, inspect the hospital environment, and perform air bacterial count.
Main Outcome Measures:
The environmental factors and risk factors contributing to the polymicrobial peritonitis outbreak in IPD patients. The incidence of IPD peritonitis was determined before and after interventions.
Results:
The causative organisms included Acinetobacter baumanii (6), Stenotrophomonas maltophilia (2), Pseudomonas aeruginosa (1), Candida albicans (1), C. tropicalis (1), Enterococcus (3), and Enterobacteriaceae (2). Four episodes of peritonitis involved infection by more than one organism. Air sampling of the environment detected a median of 110 colony forming units of bacteria per cubic meter of air, 10% of which were found to be Acinetobacter baumanii. The source of this polymicrobial outbreak was attributed to the bamboo scaffolding structure covering the external wall of the hospital during renovation. A retrospective case-control study indicated that the absence of the flush-before-fill step was a risk factor for development of peritonitis.
Conclusion:
In addition to invasive aspergillosis in transplant or oncology patients, Acinetobacter peritonitis in dialysis patients should be considered another microbial cause of outbreak associated with hospital renovation.
Insights
Hospital renovation triggered a peritonitis outbreak in intermittent peritoneal dialysis (IPD) patients, primarily caused by Acinetobacter baumanii. Omitting the flush-before-fill step significantly increased peritonitis risk.
Area of Science:
- Nephrology
- Infectious Diseases
- Hospital Epidemiology
Background:
- Peritonitis is a serious complication for patients undergoing intermittent peritoneal dialysis (IPD).
- Outbreaks of peritonitis can significantly impact patient outcomes and healthcare resources.
Purpose of the Study:
- To investigate the etiology and risk factors of a polymicrobial peritonitis outbreak in IPD patients.
- To identify environmental and procedural factors contributing to the outbreak.
Main Methods:
- Conducted an outbreak investigation including environmental sampling and a retrospective case-control study.
- Analyzed 10 episodes of peritonitis in 8 patients over 6 months.
- Assessed risk factors, including procedural steps like flush-before-fill.
Main Results:
- Identified Acinetobacter baumanii as a primary causative agent, linked to hospital renovations and contaminated air.
- Detected a high bacterial count in the air, with Acinetobacter baumanii being prevalent.
- The absence of the flush-before-fill step was identified as a significant risk factor for peritonitis.
Conclusions:
- Hospital renovations can lead to peritonitis outbreaks in dialysis patients, similar to invasive aspergillosis risks in other patient groups.
- Emphasizes the importance of environmental control during renovations and adherence to sterile procedures, like flush-before-fill, to prevent peritonitis.
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