Thailand ICU Research

January 31, 2014 at 8:02 pm | Posted in Research | Leave a comment

Peritonitis in a Temporary Peritoneal Dialysis in Intensive Care Unit: An Analysis of Contribution Factors and Pathogens

Objectives:

1.     To study an incidence of peritonitis in the temporary peritoneal dialysis in an adult intensive care unit at Mukdahan Hospital Thailand  in 1997-2001

2.     To analyse the organism causing the peritonitis

3.     To examine the factors that contribute to causing peritonitis

Design 

1.     This study examined all patients who had a temporary peritoneal dialysis prospectively.   The study was conducted from 1st December 1997 to 30th December 2001.

2.     The demographic and clinical characteristic data were collected from patient clinical notes.

3.     Obtaining the peritoneal dialysis fluid for gram stain and culture was performed according to the Monitoring Incidence of Peritonitis in Temporary Peritoneal Dialysis Protocol in Mudahan Hospital in Thailand.

4.     The Statistical Package for Social Sciences, Window Version 8 (SPSS Window V. 8) was used to analyse the data.

Setting: A 10 bed general intensive care unit in Thailand in 1997-2001

Inclusion criteria:

1.     All patients who had the temporary peritoneal dialysis treatment from 1st December 1997 to 30th December 2001 in intensive care unit in Mukdahan Hospital.

 

Exclusion Criteria:

1.     The patient died while having peritoneal dialysis treatment with no microbiology data.

2.     The patient was discharged home voluntarily by next of kin and family.

3.     The patient whose peritoneal fluid culture data was unable to be collected or followed up.

Participants:

Patients admitted with acute renal failure, for which the temporary peritoneal dialysis treatments were required. There were 104 patients enrolled in the study only 63 patients met the inclusion criteria of the study35 were male and 28 were female.

Results:

1.     Thirty six and half percent of patients undergoing temporary peritoneal dialysis were infected. Fifty-six and half percent of infected cases were men and 43.5 percent were women.

 

2.     Mortality rate in infected peritonitis patient was 43.5 precent (10 cases) compared to non-peritonitis patients the rate was 35 precent (14 cases). There were nine peritonitis cases (a thirty- nine percent) and 26 non-peritonitis cases (60 percent) clinically improved and were transferred to wards only four cases were transferred to another hospital for further management.

 

3.     The number of peritoneal catheter insertion time is only the single factor that statically and significantly contributes to cause peritonitis (p=0.001) comparing to age, gender, diagnostic comorbidities, and number of cycles and length of the treatment.

 

4.     There were 17 episodes of gram- negative microorganism peritonitis (73 precent) which contributed by Acenectobactor spp. 26 percent, Pseudomonas aeruginosa 22 percent, Klebsiella spp.13 percent, Enterobacter spp. 9 precent and Moraxella spp. 4 percent respectively.

 

To the best of my knowledge this is the first study that found budding yeast caused peritonitis, the incidence was up to four episodes, which is 17 precent and the rest of two episodes, were causing by other microorganisms.

Conclusion:

Multiple times of peritoneal catheter insertions is the significant factor contribution to the infected peritonitis, and a gram-negative bacteria being the majority of microorganism responsible for causing peritonitis. Sixty five precent of non-infected peritonitis patients showed significant clinical improvement and were discharged from intensive care unit. Further studies are needed to evaluate the factors that causing the peritoneal catheters to be removed and reinserted.

 

Arisara Patthum

Currently practice as a critical care nurse in intensive care unit in the South Australia Health

Copyright: For a full article and reproduced permission can be sought directly from the author,and it is free for education purpose.

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