Changes before and after COVID-19 pandemic on the personal hygiene behaviors and incidence of peritonitis in peritoneal-dialysis patients: a multi-center retrospective study

The effect of COVID-19 pandemic on personal hygiene behavior and the frequency of peritonitis in peritoneal dialysis patients

INTRODUCTION AND AIM

Peritonitis is a critical complication in peritoneal dialysis (PD) patients, making compliance with personal hygiene essential. This study examines the impact of the COVID-19 (Coronavirus Disease 2019) pandemic on hygiene behaviors and peritonitis incidence in PD patients.

MATERIALS AND METHODS

Fifty-two PD patients were assessed for hygiene behaviors, demographic, and medical data. Laboratory parameters and peritonitis culture results were compared before and after COVID-19.

RESULTS

Post-COVID-19, significant improvements were observed in 11 hygiene behaviors, including hand washing (p < 0.001). The peritonitis rate decreased from 28.8.% to 13.5%, though this was not statistically significant (p = 0.093). Among those without post-COVID peritonitis, hand washing before connecting the transfer set and regular exit site dressing were more frequent.

CONCLUSION

Following COVID-19, PD patients demonstrated improved hygiene behaviors and reduced peritonitis rates. Emphasis on hand washing and exit site care is recommended in all PD programs.

Prevalence, microbiology, and outcome of peritonitis in peritoneal dialysis patients in vietnam: a multicenter study

BACKGROUND

Chronic kidney disease (CKD) is a substantial contributor to global mortality, requiring interventions like kidney transplantation and dialysis. Peritoneal dialysis (PD) has emerged as an effective dialytic modality despite the susceptibility to peritonitis. The study aimed to determine the prevalence of peritonitis among PD patients, elucidating pivotal factors affecting its occurrence, causative bacterial agents, and treatment outcomes (mortality rates, removal of the Tenckhoff catheter, and switch to hemodialysis).

METHODS

A retrospective cohort study was conducted, which included patients who underwent PD between January 2019 and December 2021 at nine dialysis centers in Vietnam. The prevalence rate of peritonitis was estimated as the quotient of total peritonitis episodes and cumulative patient-years. The association of peritonitis with factors such as age, care (self-care or helper-assisted PD), comorbidities, education level was analyzed using regression analysis. Peritonitis outcomes including mortality rate, Tenckhoff catheter removal, and transitions to hemodialysis were evaluated. PD-related infections were assessed. Additionally, the causative bacterial agents and the negative culture rate were determined.

RESULTS

A total of 691 PD patients from nine centers from the south of Vietnam were recruited for the study. Peritonitis was reported in 32.42% of the patients during the study period of 2019-2021. An increase in the number of patients reporting peritonitis was observed over the years. A significant association (p = 0.01) between peritonitis rate and level of literacy was found. The mortality rate among patients who underwent PD was 2.68%. About 16.18% of patients with peritonitis had to have the Tenckhoff catheter removed and needed to be switched to hemodialysis. Around 46.98% of the peritonitis cases were culture-positive.

CONCLUSION

The prevalence of peritonitis among PD patients in Vietnam increased from 2019 to 2021. Lower literacy positively correlated with peritonitis, regardless of the type of PD. The high prevalence of culture-negative peritonitis cases indicated gaps in diagnostic procedures or the presence of unusual pathogens. These outcomes highlight the need for improved education, diagnostic practices, and interventions to reduce peritonitis risks and enhance patient care in PD programs in Vietnam.

Trends in chlorine and chloramine gas exposures reported to United States poison centers

INTRODUCTION

Chlorine and chloramine gas inhalation can occur when household cleaners are mixed. The increased emphasis on disinfecting practices during the COVID-19 pandemic may have contributed to an increase in chlorine and chloramine gas exposures in the United States, which has not been studied.

METHODS

In a retrospective review, reported data on chlorine and chloramine gas exposures in the National Poison Data System were collected from January 1, 2015, to December 31, 2022. Data included demographics and exposure details, including location, dose, formulation, co-exposures, treatments, and outcomes. Demographic analyses and descriptive statistics were conducted.

RESULTS

During the study period, 85,104 total exposures to chlorine and chloramine gas were reported, consisting of 79,281 isolated exposures and 5,823 co-exposures. Total exposures increased by 61% from 8,385 in 2015 to 13,503 in 2022, with the largest increase of 38.3% occurring from 2019 to 2020. Total exposures remained increased through 2022 with no return to pre-pandemic levels. Most exposures occurred in "own residence" (n = 72,213, 84.9%), with a larger proportion of exposures occurring at home peri-pandemic versus pre-pandemic (88.4% versus 81.7%). One percent (n = 1,030) of exposures were admitted to a non-critical care unit, 0.73% (n = 619) were admitted to a critical care unit, and 0.03% (n = 26) resulted in death.

DISCUSSION

The onset of the COVID-19 pandemic and increased emphasis on cleaning practices were likely contributing factors to the marked increase in exposures in 2020, which persisted through 2022. Cleaning practices that developed during the beginning of the pandemic likely persisted despite returning to more normal daily routines, which may explain the ongoing increase in reported exposures. Most reported exposures were unintentional, mild in symptomatology, and required the use of non-invasive therapies, if any.

CONCLUSIONS

Future efforts should focus on public education on the safe use of cleaning products to prevent exposure to toxic chlorine and chloramine gases.

Effect of a Management Algorithm for Wet Contamination of Peritoneal Dialysis System on the Prevention of Peritonitis: A Prospective Observational Study

Introduction

Wet contamination was a common problem of peritoneal dialysis (PD) system. We developed a management algorithm for wet contamination of PD system (wet contamination) on the basis of the related research literature and clinical practice experience. The purpose of this study was to observe clinical effect of the management algorithm on the prevention of peritonitis.

Methods

Patients treated wet contamination in a single PD center between October 2017 and September 2022 were included. A management algorithm was established to treat wet contamination. It comprised identification of the contamination type, addressing contaminated or aging catheters, prophylactic antibiotics, and retraining. Demographic data and clinical data about wet contamination were collected and compared.

Results

One hundred and forty-one cases of wet contamination were included in this study. The mean age was 51.7 ± 14.1 years, and 49.6% were female. The proportion of diabetic nephropathy was 9.9%. The median PD duration was 27.0 (1.7-79.7) months. Eighteen episodes (12.8%) of wet contamination-associated peritonitis developed after wet contamination. The main pathogenic bacteria of peritonitis were Gram-positive bacteria (33.3%) and Gram-negative bacteria (27.8%). The incidence of wet contamination-associated peritonitis in the compliance with the management algorithm group was significantly lower than that in the non-compliance with the management algorithm group (0.9 vs. 48.6%; p < 0.001). Non-compliance with management algorithm (OR = 185.861, p < 0.001) together with advance age (OR = 1.116, p < 0.001) and longer distance from home to hospital (OR = 1.007, p < 0.001) were independent risk factors for wet contamination-associated peritonitis.

Conclusion

The management algorithm for wet contamination of PD system could reduce the risk of peritonitis.

Peritoneal Dialysis-associated Peritonitis Due to Streptococcus oralis Three Weeks after Peritoneal Dialysis Initiation

A 60-year-old man with end-stage renal disease due to nephrosclerosis had a peritoneal dialysis catheter (PD) embedded with stepwise initiation of peritoneal dialysis using Moncrief and Popovich's technique three months ago. PD was initiated three weeks after creating an exit site. He presented with abdominal pain and fever a day before admission and was diagnosed with PD-associated peritonitis caused by Streptococcus oralis. Medical consultation after admission revealed a history of wisdom tooth extraction following PD catheter placement, resulting in delayed wound healing. Transient bacteremia can occur after tooth extraction, leading to PD-associated peritonitis. Contemplating the oral milieu in patients undergoing PD is pertinent.

Impact of Enhanced in-Hospital Infection Prevention During the COVID-19 Pandemic on Postoperative Pneumonia in Older Surgical Patients

Purpose

We aimed to investigate the impact of enhanced in-hospital infection prevention during the coronavirus disease 2019 (COVID-19) pandemic on postoperative pneumonia in older surgical patients.

Patients and Methods

We retrospectively reviewed the electronic medical records of consecutive patients ≥70 years who underwent elective surgery between 2017 and 2021 at our institution. All perioperative variables were retrieved from the electronic medical records. The primary outcome was new-onset postoperative pneumonia during the hospitalization period. Since February 2020, our institution implemented a series of policies to enhance infection prevention, hence patients were divided into groups according to whether they underwent surgery before or during the COVID-19 pandemic. An interrupted time series analysis was performed to evaluate the difference between pre- and post-intervention slopes of the primary outcome.

Results

Among the 29,387 patients included in the study, 10,547 patients underwent surgery during the COVID-19 pandemic. Although there was a decreasing trend of the monthly incidence rate of postoperative pneumonia compared to before the COVID-19 pandemic, there was no statistical significance in the trend (slope before COVID-19 period: β-coefficient, -0.007; 95% CI, -0.022 to 0.007).

Conclusion

Our study revealed that enhanced in-hospital infection prevention implemented to manage the COVID-19 pandemic did not significantly affect the decreasing trend of postoperative pneumonia at our institution.

Mobile Phones: Reservoirs of Resistant Bacteria during the COVID-19 Pandemic in Abu Dhabi, United Arab Emirates

BACKGROUND

Mobile phones are excessively used even though microbes' ability to survive on phone surfaces was confirmed. During the COVID-19 pandemic, heavy hygiene practices have been applied to mobile surfaces. Therefore, it is interesting to evaluate the emergence of antimicrobial-resistant bacteria on mobile phone surfaces.

METHODS

A random sampling technique was utilized on residents in Abu Dhabi, UAE between May and June 2021. A swab sample from each participant's mobile phone was collected and transported to the microbiology laboratory for bacterial culture and antimicrobial susceptibility tests. Furthermore, a cross-sectional study was conducted via a self-administered questionnaire filled by participants. The questionnaire was used to collect sociodemographic data, phone frequency usage and cleaning methods.

RESULTS

One hundred two-sample swabs and data have been included in the study. The majority of participants (91.1%) reported cleaning their mobile phones with wipes and alcohol. However, 100% of participants had a mobile phone contaminated by bacteria such as S. aureus, E. coli, Coagulase-negative staphylococci, Micrococcus, Bacillus, Streptococcus, Citrobacter, Proteus, Enterococcus, klebsiella, Pseudomonas and Actinobacteria. Interestingly, most of these potentially pathogenic bacteria were found to be resistant to ampicillin, ceftazidime and cefotaxime.

CONCLUSION

The continuous hand and mobile disinfectant have contributed to the emergence of resistant bacteria.

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

Peritoneal dialysis (PD)-associated peritonitis is a serious complication of PD and prevention and treatment of such is important in reducing patient morbidity and mortality. The ISPD 2022 updated recommendations have revised and clarified definitions for refractory peritonitis, relapsing peritonitis, peritonitis-associated catheter removal, PD-associated haemodialysis transfer, peritonitis-associated death and peritonitis-associated hospitalisation. New peritonitis categories and outcomes including pre-PD peritonitis, enteric peritonitis, catheter-related peritonitis and medical cure are defined. The new targets recommended for overall peritonitis rate should be no more than 0.40 episodes per year at risk and the percentage of patients free of peritonitis per unit time should be targeted at >80% per year. Revised recommendations regarding management of contamination of PD systems, antibiotic prophylaxis for invasive procedures and PD training and reassessment are included. New recommendations regarding management of modifiable peritonitis risk factors like domestic pets, hypokalaemia and histamine-2 receptor antagonists are highlighted. Updated recommendations regarding empirical antibiotic selection and dosage of antibiotics and also treatment of peritonitis due to specific microorganisms are made with new recommendation regarding adjunctive oral N-acetylcysteine therapy for mitigating aminoglycoside ototoxicity. Areas for future research in prevention and treatment of PD-related peritonitis are suggested.

SARS-CoV-2 Antibody Response After a Third Dose of the BNT162b2 Vaccine in Patients Receiving Maintenance Hemodialysis or Peritoneal Dialysis

Rationale & Objective

Recent studies showed that antibody titers after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the dialysis population are diminished as compared with the general population, suggesting the possible value of a third booster dose. We characterized the humoral response after 3 doses of the BNT162b2 vaccine in patients treated with either maintenance hemodialysis (HD) or peritoneal dialysis (PD).

Study Design

Case series.

Setting & Participants

69 French patients (38 HD and 31 PD) treated at a single center who received 3 doses of the BNT162b2 vaccine.

Findings

Humoral response was evaluated using plasma levels of anti-SARS-CoV-2 spike protein S1 immunoglobulin measured after the second dose and at least 3 weeks after the third dose of the BNT162b2 vaccine. Patients (median age 68 years [interquartile range (IQR), 53-76 years], 65% men) had a median anti-S1 antibody level of 284 [IQR, 83-1190] AU/mL after the second dose, and 7,554 [IQR, 2,268-11,736] AU/mL after the third dose. Three patients were nonresponders (anti-S1 antibody level < 0.8 AU/mL), and 12 were weak responders (anti-S1 antibody level 0.8-50 AU/mL) after the second vaccine dose. After the third dose, 1 of the 3 initial nonresponders produced anti-spike antibody, and all the 12 initial weak responders increased their antibody levels. Patients with a greater increase in anti-S1 antibody levels after a third dose had lower antibody levels after the second dose, and a longer time interval between the second and the third dose. Adverse events did not seem to be more common or severe after a third vaccine dose.

Limitations

Observational study, small sample size. Relationship between antibody levels and clinical outcomes is not well understood.

Conclusions

A third dose of the BNT162b2 vaccine substantially increased antibody levels in patients receiving maintenance dialysis and appeared to be as well tolerated as a second dose.