MICROBIOLOGY OF PROCEDURE RELATED PD-PERITONITIS FOLLOWING GASTROSCOPY AND COLONOSCOPY: A BINATIONAL DATA-LINKAGE STUDY
Dr Shaun Chandler1,2, Dr Dharmenaan Palamuthusingam1,2, Ms Elaine Pascoe3, Prof Carmel Hawley4,5,6, Prof David Johnson4,5,6, Dr Magid Fahim2,6,7
1Metro-North Kidney Health service, , Australia, 2Faculty of Medicine, University of Queensland, St Lucia, Australia, 3Centre for Health Services Research, University of Queensland , St Lucia, Australia, 4Australasian Kidney Trials Network (AKTN), University of Queensland, Australia, Woollongabba, Australia, 5Translational Research Institute, Brisbane, Australia, 6Metro South Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Brisbane, 7Metro-north health service, Herston, Australia
Aim: To describe the microbiology of post-procedural peritoneal dialysis (PD) peritonitis episodes following gastroscopy and colonoscopy over a 15-year period.
Background: The risk of post-procedural PD peritonitis is well recognised following colonoscopy and current ISPD guidelines recommend prophylactic antibiotics. Current guidelines do not recommend this prior to gastroscopy alone due to low level evidence.
Methods: Data linkage between hospital admission datasets and ANZDATA was performed in all jurisdictions across Australia and New Zealand to identify all registered PD patients who underwent either gastroscopy or colonoscopy. ANZDATA reporting of peritonitis was interrogated to identify cases that occurred within seven days of endoscopy.
Results: There were 4433 admissions (3674 unique patients), of which 2447 were for gastroscopy, 1191 for colonoscopy and 795 for both procedures. Peritonitis within 7 days of these procedures occurred in 51 (2.1%), 24 (2%) and 24 (3.2%), respectively. There were 43 episodes of monomicrobial infection following gastroscopy, of which 44% were not reported or culture negative. Coagulase negative staphylococci (6/43), enterococcus (3/43) and E. coli (3/43) were the most common organisms identified. Post-colonoscopy, there were 24 monomicrobial infections, of which 50% were culture negative or not reported, and most of the remainder were E. coli (7/24). There were 15 episodes of polymicrobial infection, 8 of which were following gastroscopy. Common organisms isolated in polymicrobial infection, regardless of scope type, included coagulase negative staphylococci, E. coli, Klebsiella Sp and fungi (33% polymicrobial peritonitis episodes).
Conclusions: Mono- and poly-microbial peritonitis episodes (including gram negative and positive organisms) are not infrequent following both gastroscopy and colonoscopy. This has implications for current ISPD guideline recommendations.