Periprocedural Peritonitis Prophylaxis: A Summary of the Microbiology and the Role of Systemic Antimicrobials

Background: Peritonitis is a leading complication of peritoneal dialysis (PD). One strategy that the International Society for Peritoneal Dialysis (ISPD) has used to help mitigate the morbidity and mortality associated with peritonitis is through prevention, including antibiotic prophylaxis utilization in high-risk situations. The aim of this study is to summarize our current understanding of postprocedural peritonitis and discuss the existing data behind periprocedural antibiotic prophylaxis, focusing primarily on PD catheter insertion, dental procedures, colonoscopies, upper endoscopies with gastrostomy, and gynecologic procedures. Summary: The ISPD currently recommends intravenous antibiotics prior to PD catheter insertion, colonoscopies, and invasive gynecologic procedures, though prophylaxis has only demonstrated benefit in a prospective, randomized control setting for PD catheter insertion. However, multiple retrospective studies exist that support the use of antibiotic prophylaxis for the other 2 procedures. No specific antibiotic regimen has been established as most optimal to prevent peritonitis for any of the 3 procedures. Antibiotic coverage should include the Enterobacteriaceae family, as well as Gram-positive organisms commonly found on the skin flora for PD catheter insertion, anaerobes for colonoscopies, and common organisms from the urogenital flora in gynecologic procedures. Additionally, the ISPD currently recommends oral amoxicillin prior to dental procedures. There is currently no ISPD recommendation to provide antibiotic prophylaxis prior to an upper endoscopy with or without gastrostomy, though this is a potential area for research. Key Messages: PD patients are at high risk for developing peritonitis after typical procedures. Antibiotic prophylaxis is a potential strategy that the ISPD utilizes to prevent these infections. However, further research needs to be done to determine the optimal antibiotic regimen.

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Role of Laproscopy in Peritoneal Dialysis Catheter Insertion

Indian Journal of Peritoneal dialysis ◽

10.15582/ijpd/2016/104060 ◽

2016 ◽

Vol 31 (0) ◽

pp. 11

Author(s):

Usman Khalid Cheema ◽

Rajeevalochana Parthasarathy

Keyword(s):

Peritoneal Dialysis ◽

Catheter Insertion ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter

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Antibiotic Prophylaxis Before Dental Procedures Can Reduce ONJ Incidence.

Blood ◽

10.1182/blood.v110.11.3613.3613 ◽

2007 ◽

Vol 110 (11) ◽

pp. 3613-3613 ◽

Cited By ~ 1

Author(s):

Vittorio Montefusco ◽

Francesca Gay ◽

Francesco Spina ◽

Maria Teresa Ambrosini ◽

Massimo Maniezzo ◽

...

Keyword(s):

Risk Factors ◽

Zoledronic Acid ◽

High Risk ◽

Antibiotic Prophylaxis ◽

Low Risk ◽

Dental Procedure ◽

Dental Procedures ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Osteonecrosis of the jaw (ONJ) is a frequent complication in bisphosphonate-treated multiple myeloma (MM) patients. The pathogenesis is unclear, and major risk factors are duration of bisphosphonate treatment and dental procedures. The histology of osteonecrotic bone shows osteomyelitis and inflammatory infiltrates, and, in most cases, presence of Actynomycetes. Since dental procedures are a major risk factor for ONJ development and oral microflora can be involved in the pathogenesis of the disease, we conducted a retrospective observational trial comparing ONJ occurrence and related risk factors in two groups of MM patients, who received zoledronic acid treatment at two Italian hematological centres. In one centre all patients systematically received as antibiotic prophylaxis amoxicillin-clavulanate 1 gm bid or levofloxacin 500 mg once a day starting from one day before to 3 days after any dental procedure (group A, 52 patients), while in the other centre patients did not receive any prophylaxis (group B, 61 patients). Dental procedures were categorized according to their invasivity and their supposed probability to cause ONJ. Extractions, implants, and professional cleanings were considered at high risk, while fillings were considered low risk procedures. Thirty-three group A patients (63%) and 32 group B patients (52%) received high risk procedures; 4 group A patients (8%) and 5 group B patients (8%) received low risk procedures, while 15 (29%) and 24 (39%) patients, respectively, had a denture. The duration of zoledronic acid exposure differed significantly between the two groups, with a median of 26 months for A patients and 12 months for B patients (p<0.0001). In group A no cases of ONJ were observed, while in group B 8 cases (13%) of ONJ were diagnosed, with a significant difference between the two groups (p=0.007). There was a temporal correlation between dental procedure and ONJ, with a median time of 60 days (range 37–990). The relative risk of ONJ after a dental procedure was 4.8 (p=0.01). The pooled analysis of the two groups showed that age, sex, transplant procedure, and thalidomide therapy did not correlate with ONJ. In both groups the presence of dentures was not associated with ONJ. While in group B incidence of ONJ is consistent with data reported in the literature, which range between 7% and 11%, group A patients had an unexpected low occurrence of this complication, despite a significantly longer exposure to zoledronic acid. This finding suggests a possible role of antibiotic prophylaxis in protecting from ONJ after dental procedures. Further, our observation, along with the correlation between dental procedures and ONJ development, can contribute to the proposal of a comprehensive model of ONJ pathogenesis: trauma of the alveolar bone modified by bisphosphonates induces a bacterial translocation with a subsequent induction of infection, inflammation and necrosis. In this perspective, since antibiotic prophylaxis is a simple and low cost precaution, it’s reasonable to propose it as part of standard care to zoledronic acid treated MM patients before any dental procedure.

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Outcome of Peritoneal Catheter Placement in the High-Risk Patient

Peritoneal Dialysis International ◽

10.1177/089686088400402s12 ◽

1984 ◽

Vol 4 (2_suppl) ◽

pp. 112-114 ◽

Cited By ~ 5

Author(s):

A.S. Levey ◽

G.M. Simon ◽

J. McCauley ◽

T.J. Smith ◽

S. I. Cho ◽

...

Keyword(s):

Peritoneal Dialysis ◽

High Risk ◽

Abdominal Surgery ◽

High Risk Patient ◽

Catheter Insertion ◽

Catheter Placement ◽

Major Abdominal Surgery ◽

Early Complications ◽

Peritoneal Catheter ◽

History Of

Serious early complications of catheter insertion and catheter outcomes are compared in patients with or without a history of major abdominal surgery or peritonitis. Previous major surgery and peritonitis are important risk factors for early serious complications of catheter placement. Despite the higher risk of early complications, subsequent attempts at catheter placement were successful in all but one of the high risk patients. Patients with previous major abdominal surgery or peritonitis generally are considered to be at high risk for complications of permanent peritoneal catheter placement. However, few physicians would refuse to attempt catheter insertion in patients highly motivated to undergo peritoneal dialysis. In this setting, the patient and the physician must decide whether the motivation and potential benefit justify the risk. Unfortunately, extensive quantitative data on the success rate and the likelihood of complications in the high-risk patient are not available. In order to determine the success rate and relative risk, we reviewed the outcome of catheter placement for continuous ambulatory peritoneal dialysis (CAPD) in our patients. In this report, we identify the serious early complications of catheter insertion and compare the outcomes in patients with and without a history of major abdominal surgery or peritonitis.

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Efficacy of Antibiotic Prophylactic Regimens for the Prevention of Bacterial Endocarditis of Oral Origin

Journal of Dental Research ◽

10.1177/154405910708601203 ◽

2007 ◽

Vol 86 (12) ◽

pp. 1142-1159 ◽

Cited By ~ 24

Author(s):

I. Tomás Carmona ◽

P. Diz Dios ◽

C. Scully

Keyword(s):

High Risk ◽

Antibiotic Prophylaxis ◽

Bacterial Resistance ◽

Scientific Evidence ◽

Experimental Models ◽

Bacterial Endocarditis ◽

Future Research ◽

Allergic Reactions ◽

Dental Procedures ◽

Alternative Antimicrobials

Despite the controversy about the risk of individuals developing bacterial endocarditis of oral origin, numerous Expert Committees in different countries continue to publish prophylactic regimens for the prevention of bacterial endocarditis secondary to dental procedures. In this paper, we analyze the efficacy of antibiotic prophylaxis in the prevention of bacteremia following dental manipulations and in the prevention of bacterial endocarditis (in both animal models and human studies). Antibiotic prophylaxis guidelines remain consensus-based, and there is scientific evidence of the efficacy of amoxicillin in the prevention of bacteremia following dental procedures, although the results reported do not confirm the efficacy of other recommended antibiotics. The majority of studies on experimental models of bacterial endocarditis have verified the efficacy of antibiotics administered after the induction of bacteremia, confirming the efficacy of antibiotic prophylaxis in later stages in the development of bacterial endocarditis. There is no scientific evidence that prophylaxis with penicillin is effective in reducing bacterial endocarditis secondary to dental procedures in patients considered to be "at risk". It has been suggested that there is a high risk of severe allergic reactions secondary to prophylactically administered penicillins, but, in reality, very few cases have been reported in the literature. It has been demonstrated that antibiotic prophylaxis could contribute to the development of bacterial resistance, but only after the administration of several consecutive doses. Future research on bacterial endocarditis prophylactic protocols should involve the re-evaluation of the time and route of administration of antibiotic prophylaxis, and a search for alternative antimicrobials.

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Antibiotic prophylaxis and prevention of infective endocarditis

ESC CardioMed ◽

10.1093/med/9780198784906.003.0399 ◽

2018 ◽

pp. 1736-1738

Author(s):

Bruno Hoen ◽

Xavier Duval

Keyword(s):

Infective Endocarditis ◽

High Risk ◽

Antibiotic Prophylaxis ◽

Oral Streptococci ◽

Efficacy And Safety ◽

Native Valve ◽

Oral Flora ◽

Cardiac Implantable Electronic Devices ◽

Dental Procedures ◽

Healthcare Associated

Prevention of infective endocarditis has historically focused on oral health because oral streptococci are part of oral flora and once caused most cases of native valve infective endocarditis. Because no randomized clinical trial has ever been conducted to confirm the efficacy and safety of antibiotic prophylaxis of infective endocarditis, it is likely that the debate on indications for antibiotic prophylaxis of infective endocarditis will continue in the coming years. In the meantime, it is reasonable to propose antibiotic prophylaxis to patients at high risk of infective endocarditis before they undergo high-risk dental procedures. Prevention of healthcare-associated infective endocarditis should also be targeted through prevention of healthcare-acquired bacteraemia, and antibiotic prophylaxis before the implantation of cardiac implantable electronic devices. Other prevention options include preservation of good oral hygiene. In the future, prevention of Staphylococcus aureus endocarditis might rely on vaccines, with candidate S. aureus vaccines currently being evaluated in humans.

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Prevention of Peritonitis in Children on Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686080002000608 ◽

2000 ◽

Vol 20 (6) ◽

pp. 625-630 ◽

Cited By ~ 24

Author(s):

Enrico Verrina ◽

Masataka Honda ◽

Bradley A. Warady ◽

Beth Piraino

Keyword(s):

Staphylococcus Aureus ◽

Peritoneal Dialysis ◽

Antibiotic Prophylaxis ◽

Catheter Insertion ◽

Catheter Removal ◽

Training Period ◽

Invasive Procedures ◽

Exit Site ◽

Experienced Surgeon ◽

Considerable Body

We reviewed methods of preventing peritonitis in children. A considerable body of evidence indicates that peritonitis rates are lowest with the use of a double-cuffed catheter, with a downward directed tunnel, placed by an experienced surgeon. Evidence in adults, but lacking in children, suggests that exit-site mupirocin will lower Staphylococcus aureus exit-site infections and thus peritonitis rates. The risk of peritonitis due to contamination can be diminished by the avoidance of spiking and by the provision of a long training period. Catheter removal and replacement for catheter-related peritonitis may be done simultaneously in certain circumstances and is useful in decreasing the risk of recurrent peritonitis. Antibiotic prophylaxis at the time of catheter insertion, for contamination, during dialysate leaks, and for invasive procedures appears to be useful in diminishing peritonitis risk.

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