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Effect of a Management Algorithm for Wet Contamination of Peritoneal Dialysis System on the Prevention of
Chunyan Yi1,2, Wenbo Zhang3, Qunying Guo1,2
1Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Introduction:
Wet contamination was a common problem of peritoneal dialysis (PD) system. We developed a management algorithm for wet contamination of PD system (wet contamination) on the basis of the related research literature and clinical practice experience. The purpose of this study was to observe clinical effect of the management algorithm on the prevention of peritonitis.
Methods:
Patients treated wet contamination in a single PD center between October 2017 and September 2022 were included. A management algorithm was established to treat wet contamination. It comprised identification of the contamination type, addressing contaminated or aging catheters, prophylactic antibiotics, and retraining. Demographic data and clinical data about wet contamination were collected and compared.
Results:
One hundred and forty-one cases of wet contamination were included in this study. The mean age was 51.7 ± 14.1 years, and 49.6% were female. The proportion of diabetic nephropathy was 9.9%. The median PD duration was 27.0 (1.7-79.7) months. Eighteen episodes (12.8%) of wet contamination-associated peritonitis developed after wet contamination. The main pathogenic bacteria of peritonitis were Gram-positive bacteria (33.3%) and Gram-negative bacteria (27.8%). The incidence of wet contamination-associated peritonitis in the compliance with the management algorithm group was significantly lower than that in the non-compliance with the management algorithm group (0.9 vs. 48.6%; p < 0.001). Non-compliance with management algorithm (OR = 185.861, p < 0.001) together with advance age (OR = 1.116, p < 0.001) and longer distance from home to hospital (OR = 1.007, p < 0.001) were independent risk factors for wet contamination-associated peritonitis.
Conclusion:
The management algorithm for wet contamination of PD system could reduce the risk of peritonitis.
Insights
A new management algorithm for wet contamination in peritoneal dialysis (PD) systems effectively prevents peritonitis. Adhering to this algorithm significantly reduces the risk of infection, improving patient outcomes.
Area of Science:
- Nephrology
- Infectious Disease Management
- Medical Device Safety
Background:
- Wet contamination is a frequent issue in peritoneal dialysis (PD) systems.
- Effective management strategies are crucial to prevent complications like peritonitis.
Purpose of the Study:
- To evaluate the clinical effectiveness of a newly developed management algorithm for wet contamination in PD systems.
- To assess the algorithm's impact on the prevention of peritonitis.
Main Methods:
- A management algorithm was developed based on literature and clinical experience.
- The algorithm includes identification of contamination, catheter management, prophylactic antibiotics, and retraining.
- 141 patients with wet contamination were analyzed, comparing outcomes between compliance and non-compliance groups.
Main Results:
- Eighteen episodes (12.8%) of wet contamination-associated peritonitis occurred.
- The incidence of peritonitis was significantly lower in the group compliant with the management algorithm (0.9% vs. 48.6%).
- Non-compliance, advanced age, and longer travel distance to the hospital were independent risk factors for peritonitis.
Conclusions:
- The developed management algorithm for wet contamination in PD systems is effective in reducing peritonitis risk.
- Algorithm adherence is key to preventing infectious complications in PD patients.
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