The Japanese Journal of Clinical Dialysis Vol.32 No.2(5)

Theme Fatal infections of elderly and super-elderly dialysis patients
Title Refractory PD peritonitis
Publish Date 2016/02
Author Chieko Higuchi Department of Internal Medicine, Tokyo Women's Medical University, Medical Center East
[ Summary ] Elderly patients may be more susceptible to peritonitis because of functional impairments, immunodefi ciency and diverticulitis. However some reports have revealed rates of peritonitis in elderly patients which were similar to rates observed in younger patients. A 2013 retrospective questionnaire survey of Japanese peritoneal dialysis (PD) patients, revealed positive rates of Staphylococcus sp. in peritoneal effluent cultures of elderly patients to be higher than younger patients. Contamination during peritoneal fluid exchange and extension of intra-abdominal cavity infection were more common causes of peritonitis in elderly patients than in younger patients. Statistical analysis exhibited that catheter exit-site infection and frequency of past episodes of peritonitis but not age, were independent factors associated with PD treatment withdrawal. Prognoses for patients grouped in terms of empiric antibiotic administration methods were signifi cantly different statistically. In the intra-abdominal administration group, rates of mortality and catheter replacement were lower. From these results concerning prevention of refractory peritonitis, training for bag exchange, checks for intra-abdominal infection and intra-abdominal administration of antibiotics were important for treatment of elderly patients.
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