Peritoneal dialysis-related infections in patients on peritoneal dialysis and measures designed to prevent them

Abstract

Individuals with end-stage kidney disease have the treatment options of receiving conservative care, dialysis or a kidney transplant. There are two main types of dialysis – haemodialysis and peritoneal dialysis. For a peritoneal dialysis (PD) program to be successful, close attention must be paid to preventing PD-related infections. A common and serious complication of PD is peritonitis. Peritonitis is a contributing cause of death in about 16% of PD patients and is a major cause of PD technique failure, which results in patients having to switch to long-term haemodialysis. The peritonitis rates of different renal centres are known to vary widely both within and between countries. Explanations for this variation are likely related to patient selection, patient training and infection-prevention protocols. This is a thesis by publication containing published and submitted work related to identifying barriers in practice to the uptake of relevant guideline recommendations, identifying current antimicrobial prophylaxis practice patterns in Australian and New Zealand (ANZ) PD units, assessing the evidence base for the antimicrobial agents used to prevent PD-related infections, and exploring patient experiences and beliefs about peritonitis. Chapter one is a general introduction to the topic. Chapter two is a narrative review of the literature relating to the prevention of PD-related infections. Chapter three is an original baseline study which assesses current practice and barriers to antimicrobial prophylaxis at 8 PD units. Chapter four is a systematic review of trials which have used various antimicrobial agents to prevent peritonitis in PD patients. Chapter five is an original survey study which assesses current antimicrobial prophylaxis practice at ANZ PD units. Chapter six is an original qualitative study that explores patients’ needs, experiences and beliefs about the prevention and treatment of peritonitis. The main aim of this thesis was to assess the current evidence base for the antimicrobial agents used, to establish current antimicrobial prophylaxis practice in ANZ PD units, to identify barriers to the uptake of guideline recommendations, and to explore patient experiences and beliefs about peritonitis and use the findings to suggest ways to improve the care and support they receive.