the relationship between presentation and the time of initial administration of antibiotics with outcomes of peritonitis in peritoneal dialysis patients: the prompt study

Clicks: 319
ID: 182006
2016
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Abstract
The impact of time to treatment on clinical outcome is an established precept in infectious disease but is not established in peritoneal dialysis–related peritonitis (PDRP). Methods: In a prospective multicenter study of PDRP, symptom-to-contact time (SC), contact-to-treatment time (CT), defined as the time from health care presentation to initial antibiotic, and symptom-to-treatment time (ST) were determined. Results: One hundred sixteen patients had 159 episodes of PDRP. Median SC for all episodes was 5.0 hours (first to third quartile [Q1–Q3]: 1.3–13.9); CT, 2.3 hours (Q1–Q3: 1.2–4.0); and ST, 9.0 hours (Q1–Q3: 4.7–25.3). Thirty-eight (23.9%) patient episodes (28 catheter removals and 10 deaths) met the primary composite outcome of PD failure at 30 days (PD-fail). The risk of PD-fail increased by 5.5% for each hour of delay of administration of antibiotics (odds ratio [OR] for CT: 1.055; 95% confidence interval [CI]: 1.005–1.109; P = 0.032). Neither SC (OR: 1.00; 95% CI: 0.99–1.01; P = 0.74) nor ST (OR: 1.00; 95% CI: 0.99–1.01; P = 0.48) was associated with PD-fail. In a multivariable analysis, only CT for presentation to a hospital-based facility compared with a community facility (OR: 1.068; 95% CI: 1.013–1.126; P = 0.015) and female sex (OR: 2.4; 95% CI: 1.1–5.4; P = 0.027) were independently associated with PD-fail. Each hour of delay in administering antibacterial therapy from the time of presentation to a hospital facility increased the risk of PD failure or death by 6.8%. Discussion: Strategies targeted to expedited antibiotic treatment should be implemented to improve outcomes from PDRP.
Reference Key
muthucumarana2016kidneythe Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;Kalindu Muthucumarana;Prue Howson;Doug Crawford;Sally Burrows;Ramyasuda Swaminathan;Ashley Irish
Journal Soft matter
Year 2016
DOI
10.1016/j.ekir.2016.05.003
URL
http://www.sciencedirect.com/science/article/pii/S2468024916300092
Keywords
antibiotics outcomes peritoneal dialysis urology

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