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One-dose cefuroxime i.v. and i.p. reduces microbial growth in PD patients after catheter insertion
A M Wikdahl1, U Engman, B G Stegmayr
1Department of Internal Medicine, University Hospital, Umeå, Sweden.
Insights
Prophylactic cefuroxime antibiotics reduced microbial growth in dialysis fluid after peritoneal dialysis catheter insertion. This perioperative antibiotic therapy significantly lowered the risk of postoperative infection and peritonitis in patients undergoing peritoneal dialysis (PD).
Area of Science:
- Nephrology
- Infectious Disease
- Surgical Procedures
Background:
- Peritoneal dialysis (PD) catheter insertion carries risks of postoperative wound infection and peritonitis.
- Immediate initiation of PD post-catheter insertion may heighten these risks.
- Evaluating prophylactic antibiotic therapy is crucial to mitigate postoperative complications.
Purpose of the Study:
- To assess the efficacy of prophylactic antibiotic therapy in reducing microbial growth post-PD catheter insertion.
- To determine if cefuroxime administration can lower the incidence of postoperative peritonitis.
Main Methods:
- Prospective, randomized study involving 38 patients undergoing PD catheter insertion.
- 18 patients received cefuroxime (intravenous preoperatively, intraperitoneal in the first dialysis bag).
- 20 patients served as a control group without prophylactic antibiotics.
Main Results:
- No microbial growth was observed in the dialysis fluid of the cefuroxime group.
- 30% of patients in the control group experienced microbial growth (P = 0.021).
Conclusions:
- Perioperative cefuroxime prophylaxis (intravenous and intraperitoneal) can reduce microbial growth.
- This antibiotic strategy may decrease the risk of peritonitis following Tenckhoff catheter insertion.
Background:
When a peritoneal dialysis catheter is inserted intra-abdominally in a patient starting peritoneal dialysis (PD) there is always a risk for postoperative wound infection and peritonitis. At our centre, PD is started immediately after the dialysis catheter is inserted. This may increase the postoperative risk for peritonitis and wound infection. The aim of this prospective, randomized, study was to evaluate whether the incidence of microbial growth postoperatively (within 10 days) after catheter insertion could be reduced by prophylactic antibiotic therapy.
Subjects And Methods:
During a period of 27 months, 38 patients, who consecutively entered the PD programme, (11 women and 27 men, mean age 57 years) were included in the study. Eighteen patients were given cefuroxime 1.5 g i.v. preoperatively and 250 mg i.p. in the first dialysis bag (containing 1 litre fluid) as prophylaxis. Twenty patients were not given prophylactic antibiotics (control group). All catheter insertions were performed in an operating theatre by the same surgeons using the same technique.
Results:
In the test group, none of the patients showed microbial growth in the dialysis fluid during the post-operative period, while in the control group six of 20 patients (30%) suffered from such growth (P = 0.021).
Conclusion:
Prophylactic treatment by cefuroxime i.v. pre- and i.p. perioperatively may reduce the risk for microbial growth and peritonitis after insertion of a Tenckhoff catheter.