An Evaluation of the Empiric Antibiotic Regimen for the Treatment of Peritoneal Dialysis-Associated Peritonitis at Vancouver General Hospital
Bibliographic record
Abstract
Background: Peritonitis is a serious complication of peritoneal dialysis (PD) that may result in hospitalization, peritoneal membrane failure, conversion to hemodialysis or death. At Vancouver General Hospital (VGH), PD-associated peritonitis is treated empirically with intraperitoneal cefazolin plus ceftazidime unless the patient is allergic to cephalosporins or has a history of resistant infection. Fungal peritonitis prophylaxis with fluconazole is prescribed at the nephrologistu2019s discretion. We aimed to evaluate the efficacy of this empiric antibiotic regimen and the need for routine fluconazole prophylaxis based on our centreu2019s fungal peritonitis rate.Methods: We performed a retrospective chart review of PD-associated peritonitis episodes at VGH from January 1, 2013 to December 31, 2017. The infecting pathogen(s) and antimicrobial sensitivities were characterized for each episode. Outcomes included resolution of infection, refractory, relapse and recurrent infections, PD tube removal, transfer to hemodialysis, and death. Results: We identified 62 PD-associated peritonitis episodes. Cefazolin and ceftazidime were utilized as empiric therapy in 48 (77.4%) and 51 (82.3%) episodes, respectively. The predominant organisms isolated from dialysate fluid included staphylococci (39.2%), gram negative bacteria (29.7%), streptococci (17.6%), and enterococci (8.1%). The isolated organisms were sensitive to empiric antibiotics in 55 (88.7%) episodes and resolution of infection was achieved in 50 (80.6%) episodes. Fluconazole prophylaxis was prescribed in 15 (24.2%) episodes with no documented fungal peritonitis episodes. Conclusions: Intraperitoneal cefazolin plus ceftazidime is an appropriate empiric antibiotic regimen for the treatment of PD-associated peritonitis at VGH. Routine fluconazole prophylaxis is unnecessary given there were no episodes of fungal peritonitis.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.000 | 0.003 |
| Open science | 0.005 | 0.002 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".