Background: Peritonitis is a relevant complication in peritoneal dialysis (PD). The initial empirical antibiotic therapy depends on the center-specific distribution of microorganisms and the microbial susceptibility profiles. However, data on the locoregional germ spectrum in Germany are insufficient regarding the current recommended empirical antibiotic regimens of either cefepime as monotherapy or the combination of cefazolin and ceftazidime. Methods: This retrospective single-center study of routine clinical patient data analyzes the range of infecting organisms causing PD-associated peritonitis and their corresponding antimicrobial resistances during the 2015 to 2022 timeframe. We used Ordinary Least-Squares regression to model trends in the detection of microbiological spectrum samples. The ‘reporting of studies conducted using observational routinely collected health data’ (RECORD) statement was acknowledged. Results: There were 80 documented peritonitis episodes with 99 causal etiologies sampled. Of those, eighty-seven were bacterial, three were fungi (3%), eight had no microbial growth (8%), and one more had missing data. The largest group of microorganisms detected were Gram-positive bacteria (N = 56, 56.6%), predominantly sampled as Staphylococcacea, Enterococcaceae, and Streptococcaceae (Staphylococcus aureus, 14.1%). Gram-negative bacteria were found in 31.3% of samples (N = 31), predominantly Enterobacteriaceae (Escherichia coli, 9%). In total, 34 different microorganisms were identified. On one occasion, methicillin-resistant Staphylococcus epidermidis and one sample of multi-resistant Serratia marcescens were identified. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci were not detected. Fungi were found in three peritonitis episodes. Regression analyses did not indicate changes in the general microbiological spectrum during the observational timeframe. The center-specific peritonitis rates were below the recommended rates of the International Society for Peritoneal Dialysis for all years studied. Conclusions: The recommended empiric therapy was suitable at our center, with a few exceptions for non-specific pathogens and for those with β-lactamases or enterococci. When there is no clinical response to empiric therapy, alternative antibiotics should be considered accordingly. The retrospective data are limited to the reported outcome measures.

Background: Methodological and technical education of nurses is required to address challenges of technology integration in peritoneal dialysis (PD). We analysed the nature of therapy interrupting system errors in automated peritoneal dialysis (APD) cyclers of a German PD reference care centre and provide applicable resolution proposals. Methods: We documented therapy interrupting system errors of HomeChoice Pro and HomeChoice Claria cyclers (Baxter, BX, Unterschleißheim, Germany) including the years 2015-2023. We systematically characterise and suggest resolution strategies to these errors based on routinely collected health data and user experience to safely guide nephrology professionals and patients during troubleshooting. The ‘reporting of studies conducted using observational routinely collected health data’ (RECORD)-statement was considered. Results: We identified 49 different therapy interrupting system errors which were assigned to eight major categories: Errors associated to the pressure chamber (N=18), the Digitalboard/EEPROM (N=18, Electrically Erasable Programmable Read Only Memory), air in set (N=3), opening of the set’s door (N=3), those associated to the energy system (N=3), the heater system (N=3) and a variety of errors resulting in an abrupt termination or non-commencement of the treatment session without clear group assignment (undefined, N=1) or without sufficient documentation. In total, 138 error incidents were documented during the observational timeframe. In frequential order errors were attributed to the pressure chamber (21.74%,), and air in set (19.57%) where specifically error 2240 occurred in 17.39% of total cases, the Digitalboard/EEPROM (17.39%), the energy or battery (16.67%; No. 1032 in 19/23 cases), the set’s door (7.25%) and the heater (4.35%). In 17 cases (12.32%) no error number was documented by the patient or staff. One error cause was registered as undefined (0.72%). Overall, errors were rarely occurring in <0.25% of treatment sessions performed in the observational timeframe. Conclusion: These findings may be useful to guide training purposes for nephrology personnel and persons doing APD. For the manufacturer, the information provided may be helpful to improve error management and information transmission to the persons doing APD with the HomeChoice devices.