Morrisette Taylor, Canada Robert B, Padgett Danielle, Hudson Joanna Q
University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
University of Tennessee Health Science Center, Memphis, TN, USA.
Hosp Pharm. 2020 Feb;55(1):50-57. doi: 10.1177/0018578718817944. Epub 2018 Dec 7.
Peritonitis remains a complication of peritoneal dialysis (PD) and contributes to morbidity. Adherence to evidence-based recommendations should resolve peritonitis within 5 days; however, hospital length of stay (LOS) for patients with PD-associated peritonitis (PDAP) varies. Factors contributing to increased LOS and vigilance with antimicrobial stewardship (ASP) in this population are not well described. This was a system-wide, retrospective cohort of adult patients presenting with PDAP from August 2012 to August 2017. Patients were divided into 2 groups based on LOS: <7 days (reduced LOS) versus ≥7 days (prolonged LOS). Patient demographics, resolution of peritonitis by day 5, intensive care unit (ICU) admission, infectious diseases (ID) consultation, changes in dialysis modality, blood glucose, and pathogen/antimicrobial characteristics were compared. In-hospital mortality and 30-day readmissions were also evaluated. Of the 401 patients screened, 90 were included: 53% women, 88% African American, age 52 ± 2 years (reduced LOS: 46 patients; prolonged LOS: 44 patients). Increased LOS was associated with ICU admission ( = .014), ID consultation ( = .015), PD catheter removal ( = .001), hemodialysis conversion ( < .001), antifungal therapy ( = .021), and days with blood glucose >180 mg/dL ( = .028). Opportunities for antimicrobial de-escalation were identified in 24 (52%) and 22 (50%) patients in the reduced and prolonged LOS groups, respectively; however, de-escalation occurred in only 5 (21%) and 6 (27%) of these patients. There were no differences in mortality or 30-day readmissions. Longer LOS was influenced by acuity of illness and possibly lack of enforced ASP. Improvement of ASP within the PDAP population is necessary.
腹膜炎仍然是腹膜透析（PD）的一种并发症，会导致发病。遵循循证建议应能在5天内治愈腹膜炎；然而，PD相关腹膜炎（PDAP）患者的住院时长（LOS）各不相同。该人群中导致住院时长增加的因素以及抗菌药物管理（ASP）的警惕性尚未得到充分描述。这是一项全系统的回顾性队列研究，研究对象为2012年8月至2017年8月期间出现PDAP的成年患者。根据住院时长将患者分为两组：<7天（住院时长缩短组）与≥7天（住院时长延长组）。比较了患者的人口统计学特征、第5天腹膜炎的治愈情况、重症监护病房（ICU）收治情况、传染病（ID）会诊情况、透析方式的改变、血糖水平以及病原体/抗菌药物特征。还评估了院内死亡率和30天再入院率。在筛查的401例患者中，90例被纳入研究：女性占53%，非裔美国人占88%，年龄52±2岁（住院时长缩短组：46例患者；住院时长延长组：44例患者）。住院时长增加与ICU收治（P = 0.014）、ID会诊（P = 0.015）、PD导管拔除（P = 0.001）、血液透析转换（P < 0.001）、抗真菌治疗（P = 0.021）以及血糖>180 mg/dL的天数（P = 0.028）相关。住院时长缩短组和延长组分别有24例（52%）和22例（50%）患者存在抗菌药物降阶梯治疗的机会；然而，这些患者中仅有5例（21%）和6例（27%）实现了降阶梯治疗。死亡率和30天再入院率没有差异。较长的住院时长受疾病严重程度影响，可能还与未严格执行ASP有关。有必要在PDAP人群中改善ASP。
