Study: Peritonitis Event Reporting with a Surveillance System

The ability to accurately and consistently identify peritonitis (PTN) events is necessary to make comparisons across and between peritoneal dialysis (PD) programs. This type of surveillance system also allows monitoring of efforts to reduce PTN rates. In August 2015, the Home Dialysis team of DaVita Kidney Care introduced a standardized approach to surveillance in order to improve the consistency and accuracy of PTN event identification across affiliated programs in the United States. An analysis was then conducted to examine the impact of this surveillance system on the reporting of PTN events.

Under the standardized surveillance system, patients with PTN are identified based on standard diagnostic criteria (positive culture, positive cell count and/or abdominal pain), infection-related hospitalization, and/or intraperitoneal (IP) antibiotic dosing (> 8 days, > 2 vancomycin doses within 8 days, or > 5 doses of non-vancomycin within 8 days). An exemption process exists for PTN events identified based on the IP antibiotic dosing rule alone: PTN events identified based on IP antibiotic dosing during each month are reviewed during the last 7 days of the month and may be reclassified. From August 2015 to December 2017, a total of 10,814 cases of PTN were identified. Of this total, 58.1% were identified by standard diagnostic rules, 25.8% were identified based on hospitalization and 16.1% based on receipt of IP antibiotics. Although the proportion of PTN episodes identified by standard diagnostic rules was constant over time, the proportion of events identified based on hospitalization slightly increased and the proportion of events based on receipt of an IP antibiotic decreased with time. Exemption filings have remained relatively constant over time.

By providing a consistent approach for the identification of PTN events, use of the surveillance system will allow accurate comparisons of rates between practices in the United States and across large dialysis organizations and different countries.

For more information, read the research poster (which was presented at ASN), here.