GASTROINTESTINAL ENDSOCPY ASSOCIATED PD PERITONITIS IN AUSTRALIA AND NEW ZEALAND OVER A 15-YEAR PERIOD
Dharmenaan Palamuthusingam1, Sivasaaini Sivakumaran1, David Johnson2, Carmel Hawley2, Elaine Pascoe3, Magid Fahim2 1Royal Brisbane and Womens Hospital, Herston, QLD, Australia2Princess Alexandra Hospital, Woollongabba, Queensland, Australia3University of Queensland, St Lucia, Queensland, Australia
Abstract
Peritoneal dialysis (PD) peritonitis following upper or lower gastrointestinal (GI) endoscopy is a known complication. This study examines the risk and microbiology of post-procedural PD peritonitis over a 15-year period.
Using linked data between Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and jurisdictional hospital admission datasets, this bi-national population cohort study evaluated all patients on PD between 2000 and 2015 who underwent a GI endoscopy. Logistic regression was used to estimate risk of peritonitis. Cox regression was used to determine the association of procedure-associated PD peritonitis (within 7 days) and permanent modality change at 30-days, with death as a competing risk.
Results:
Overall, 5,090 GI gastrointestinal endoscopies were performed in 3,676 patients. There were 133 episodes of post-procedural peritonitis. The risks following gastroscopy, gastroscopy with intervention (e.g., biopsy, diathermy or polypectomy), colonoscopy, colonoscopy with intervention, and both upper and lower gastrointestinal endoscopies, were 3.0%, 2.0%, 3.0%, 2.9%, and 3.2%, respectively. The risks were no different across eras, centre sizes, body mass index, age or presence/absence of diabetes mellitus. Emergency endoscopy had the highest risk (HR 1.8, 95%CI 1.2-2.8) for peritonitis. Thirty-six episodes of peritonitis did not report an organism. Of the remaining 97 cases, 79 were culture negative (21%) followed by E.coli (16%) and coagulase negative staphylococci (10%). E.coli and coagulase negative staphylococci were identified in a third of the 18 cases of polymicrobial peritonitis, followed by klebsiella species (28%). Polymicrobial peritonitis (HR 89.0, 95%CI 31.8-248.7) had the highest risk for a permanent modality change at 30-days.
The risk of PD peritonitis is 3% following GI endoscopies and is not different between upper or lower GI endoscopy. Culture negative peritonitis is most common.
Biography
Dr. Dharmenaan Palamuthusingam is a senior staff specialist in Nephrology at the Royal Brisbane and Womens Hospital, Brisbane