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Clinical characteristics and outcomes of peritoneal dialysis (PD)-related peritonitis after colonoscopy
Christy Wing Han Au1, Ching Kit Chan1, Chi Kwan Wong1
1Pamela Youde Nethersole Eastern Hospital, Hong Kong.
Insights
Peritoneal dialysis (PD) patients undergoing colonoscopy have a 12.2% risk of developing peritonitis, with polypectomy increasing this risk. Current prophylactic antibiotics show limited effectiveness, necessitating further research for optimal prevention strategies.
Area of Science:
- Nephrology
- Gastroenterology
- Infectious Diseases
Background:
- Colonoscopy is a recognized risk factor for peritonitis in peritoneal dialysis (PD) patients.
- Antibiotic prophylaxis is standard practice before colonoscopy in PD patients.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of PD-related peritonitis following colonoscopy.
- To evaluate the effectiveness of current prophylactic antibiotic regimens.
Main Methods:
- Retrospective review of PD patients who underwent colonoscopy between January 2009 and December 2019.
- Analysis of patient demographics, PD vintage, PD modality, and history of peritonitis.
- Comparison of peritonitis development based on procedural factors, particularly polypectomy.
Main Results:
- 12.2% of PD patients (14 out of 115 colonoscopies) developed peritonitis within one week post-colonoscopy.
- Polypectomy was significantly associated with a higher incidence of peritonitis (78.6% vs. 35.6%, p=0.006).
- Only 33% of Gram-negative bacteria were sensitive to cefuroxime, the prophylactic antibiotic used.
Conclusions:
- Colonoscopy poses a significant risk of peritonitis for PD patients, with polypectomy being a key risk factor.
- Current prophylactic antibiotic strategies, like cefuroxime, demonstrate limited efficacy against common pathogens.
- Further large-scale studies are crucial to establish effective antibiotic prophylaxis protocols for colonoscopy in PD patients.
Abstract:
Colonoscopy is known to be associated with peritonitis in peritoneal dialysis (PD) patients. Antibiotic prophylaxis is recommended before colonoscopy. This study aims to investigate the clinical characteristics and outcomes of patients with PD-related peritonitis after colonoscopy. PD patients who were followed up in Pamela Youde Nethersole Eastern Hospital, with colonoscopy done from 1 January 2009 to 31 December 2019, were included for record review retrospectively. During this period, 74 patients underwent 115 colonoscopies. Fourteen patients (12.2%) developed PD-related peritonitis within 1 week after colonoscopy. There was no statistically significant difference in mean age, PD vintage, PD modality and history of PD-related peritonitis between patients with or without colonoscopy-related peritonitis. Polypectomy was more common in patients who developed peritonitis (78.6%) compared to those without peritonitis (35.6%) (p = 0.006). Ten of the 14 PD patients who had colonoscopy-related peritonitis responded to medical treatment while 4 patients required PD catheter removal. Two patients converted to maintenance haemodialysis and two died. Only 33% of Gram-negative bacteria isolated were sensitive to intravenous cefuroxime which was given as prophylactic antibiotic before colonoscopy. In conclusion, the overall risk of PD patients developing peritonitis post colonoscopy was 12.2%. Polypectomy was associated with higher risk of colonoscopy-related peritonitis. Large-scale study is needed to delineate effective antibiotic prophylaxis for colonoscopy-related peritonitis.
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