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Evaluation of perioperative antibiotics at the time of dialysis catheter placement
K M Sardegna1, A M Beck, C F Strife
1Children's Hospital Medical Center and University of Cincinnati College of Medicine, Ohio 45229, USA.
Insights
Prophylactic antibiotics significantly reduce peritonitis risk after peritoneal dialysis catheter placement. This study highlights the importance of perioperative antibiotic use in preventing surgical site infections and improving patient outcomes.
Area of Science:
- Nephrology
- Infectious Disease
- Surgical Outcomes
Background:
- Peritonitis is a significant complication following peritoneal dialysis catheter placement.
- Preventing early-onset peritonitis is crucial for successful dialysis initiation and patient well-being.
Purpose of the Study:
- To evaluate the efficacy of prophylactic antibiotics in reducing peritonitis incidence within 14 days of surgical peritoneal dialysis catheter insertion.
- To identify factors associated with postoperative peritonitis in pediatric patients.
Main Methods:
- Retrospective review of medical records for 73 pediatric patients undergoing 89 Tenckhoff catheter insertions over 6 years.
- Chi-squared analysis and step-wise logistic regression were used to compare factors influencing peritonitis occurrence.
- Exclusion criteria included rapid catheter loss, unavailable charts, eosinophilic peritonitis, and delayed antibiotic administration.
Main Results:
- 17% (13 of 77) of catheter insertions resulted in postoperative peritonitis.
- Peritonitis was significantly more frequent in patients not receiving perioperative antibiotics (7 of 16) compared to those who did (P < 0.001).
- No association was found between peritonitis and patient factors like nephrotic syndrome, immunosuppression, recent surgery, or age.
Conclusions:
- Perioperative prophylactic antibiotics are effective in significantly reducing the incidence of peritonitis following surgical peritoneal dialysis catheter placement.
- The benefit was observed across different antibiotic classes, suggesting a general protective effect.
- Antibiotic prophylaxis should be considered a standard measure to minimize infectious complications in this patient population.
Abstract:
The effect of prophylactic antibiotics on the occurrence of peritonitis in the 14 days following surgical peritoneal dialysis catheter placement was evaluated. Medical records from 73 pediatric patients who had 89 Tenckhoff catheters inserted over 6 years were reviewed. Twelve catheter procedures were excluded for rapid catheter loss, unavailable charts, eosinophilic peritonitis, and antibiotic administration > 3 h postoperatively. Chi-squared analysis for non-continuous variables compared factors at the time of catheter placement with outcome (peritonitis). Thirteen patients developed postoperative peritonitis when 77 catheter insertions were analyzed (17%). Peritonitis was significantly more common in patients who did not receive perioperative antibiotics (7 of 16 catheter placements) (chi(2) = 12.48, P < or = 0.001). The reduced incidence of peritonitis was not specific to any one antibiotic class. Using step-wise logistic regression analysis, no association was found between peritonitis incidence and nephrotic syndrome, immunosuppression, recent surgery (< 14 days), acute versus chronic use, year of catheter placement, surgeon, or patient age. Catheter type, implantation technique, exit site care, and operative wound care did not vary. These results indicate that perioperative peritonitis episodes can be significantly reduced by the use of prophylactic antibiotics prior to or at the time of surgery.