Prophylactic Antibiotics for Endoscopy-Associated Peritonitis in Peritoneal Dialysis Patients |
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Authors: | Hsin-Hsu Wu I-Jung Li Cheng-Hao Weng Cheng-Chia Lee Yung-Chang Chen Ming-Yang Chang Ji-Tseng Fang Cheng-Chieh Hung Chih-Wei Yang Ya-Chung Tian |
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Institution: | 1. Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan.; 2. Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao Yuan, Taiwan.; University of Sao Paulo Medical School, Brazil, |
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Abstract: | IntroductionContinuous ambulatory peritoneal dialysis (CAPD) peritonitis may develop after endoscopic procedures, and the benefit of prophylactic antibiotics is unclear. In the present study, we investigated whether prophylactic antibiotics reduce the incidence of peritonitis in these patients.Patients and methodsWe retrospectively reviewed all endoscopic procedures, including esophagogastroduodenoscopy (EGD), colonoscopy, sigmoidoscopy, cystoscopy, hysteroscopy, and hysteroscopy-assisted intrauterine device (IUD) implantation/removal, performed in CAPD patients at Chang Gung Memorial Hospital, Taiwan, between February 2001 and February 2012.ResultsFour hundred and thirty-three patients were enrolled, and 125 endoscopies were performed in 45 patients. Eight (6.4%) peritonitis episodes developed after the examination. Antibiotics were used in 26 procedures, and none of the patients had peritonitis (0% vs. 8.1% without antibiotic use; p = 0.20). The peritonitis rate was significantly higher in the non-EGD group than in the EGD group (15.9% 7/44] vs. 1.2% 1/81]; p<0.005). Antibiotic use prior to non-EGD examinations significantly reduced the endoscopy-associated peritonitis rate compared to that without antibiotic use (0% 0/16] vs. 25% 7/28]; p<0.05). Peritonitis only occurred if invasive procedures were performed, such as biopsy, polypectomy, or IUD implantation, (noninvasive procedures, 0% 0/20] vs. invasive procedures, 30.4% 7/23]; p<0.05). No peritonitis was noted if antibiotics were used prior to examination with invasive procedures (0% 0/10] vs. 53.8% 7/13] without antibiotic use; p<0.05). Although not statistically significant, antibiotics may play a role in preventing gynecologic procedure-related peritonitis (antibiotics, 0% 0/4] vs. no antibiotics, 55.6% 5/9]; p = 0.10).ConclusionAntibiotic prophylaxis significantly reduced endoscopy-associated PD peritonitis in the non-EGD group. Endoscopically assisted invasive procedures, such as biopsy, polypectomy, IUD implantation/removal, and dilatation and curettage (D&C), pose a high risk for peritonitis. Prophylactic antibiotics for peritonitis prevention may be required in colonoscopic procedures and gynecologic procedures. |
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