{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:33:00Z","timestamp":1760059980405,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T00:00:00Z","timestamp":1753315200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Introduction\/Objective: Peritonitis remains a serious complication in patients undergoing automated peritoneal dialysis (APD), requiring prompt and effective antibiotic administration. This study evaluated whether delivering antibiotics directly through APD bags is as effective as administering them via an additional manual daytime exchange. Methods: We conducted a randomized, single-blind, non-inferiority clinical trial involving patients diagnosed with peritonitis. Participants were randomly assigned to receive Ceftazidime and Vancomycin, either via APD bags or through a combined approach of continuous ambulatory peritoneal dialysis (CAPD) plus APD. A total of 64 patients (32 per group) were enrolled, with comparable baseline demographic and clinical profiles, including laboratory markers of infection severity and dialysis history. Results: Peritonitis resolved in 90.6% of the patients treated via APD bags and in 81.3% of those receiving antibiotics through manual exchange plus APD. Although this difference did not reach statistical significance (p = 0.281), the observed absolute difference of 9.3% was well within the predefined non-inferiority margin of 30%, supporting the clinical non-inferiority of the APD-only method. The mean time to resolution was similar between groups (p = 0.593). Post hoc power analyses indicated limited statistical power (18.5% for the resolution rate and 9.2% for time to resolution), suggesting that modest differences may not have been detectable given the sample size. Nevertheless, the high resolution rates observed in both groups reflect valid and encouraging clinical outcomes. Conclusion: Antibiotic administration via APD bags demonstrated comparable clinical effectiveness to the combined manual exchange plus APD method for treating peritonitis. Given its operational simplicity and favorable results, the APD-only strategy may offer a pragmatic alternative in routine care. Further studies with larger sample sizes are recommended to confirm these findings and optimize treatment protocols. Trial registration: NCT04077996. Funding source: None to declare.<\/jats:p>","DOI":"10.3390\/antibiotics14080747","type":"journal-article","created":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T14:11:44Z","timestamp":1753366304000},"page":"747","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Simplifying Antibiotic Management of Peritonitis in APD: Evidence from a Non-Inferiority Randomized Trial"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9826-1895","authenticated-orcid":false,"given":"Jes\u00fas","family":"Venegas-Ram\u00edrez","sequence":"first","affiliation":[{"name":"Coordinaci\u00f3n Auxiliar M\u00e9dica de Investigaci\u00f3n en Salud, Jefatura de Servicios de Prestaciones M\u00e9dicas, Instituto Mexicano del Seguro Social, Colima 28030, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8306-0137","authenticated-orcid":false,"given":"Benjam\u00edn","family":"Trujillo-Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Universidad de Colima, Colima 28040, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen Citlalli","family":"Castill\u00f3n-Flores","sequence":"additional","affiliation":[{"name":"Hospital General de Zona No. 1, Instituto Mexicano del Seguro Social, Villa de \u00c1lvarez 28984, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernanda Janine","family":"Land\u00edn-Herrera","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Universidad Aut\u00f3noma de Guadalajara, Zapopan 44100, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erika","family":"Herrera-Oliva","sequence":"additional","affiliation":[{"name":"Unidad de Medicina Familiar No. 3, Instituto Mexicano del Seguro Social, Armer\u00eda 28300, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8432-0997","authenticated-orcid":false,"given":"Patricia","family":"Calvo-Soto","sequence":"additional","affiliation":[{"name":"Coordinaci\u00f3n de Planeaci\u00f3n y Enlace Institucional, Jefatura de Servicios de Prestaciones M\u00e9dicas, Instituto Mexicano del Seguro Social, Colima 28030, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0256-9052","authenticated-orcid":false,"given":"Rosa","family":"Tapia-Vargas","sequence":"additional","affiliation":[{"name":"Coordinaci\u00f3n de Planeaci\u00f3n y Enlace Institucional, Jefatura de Servicios de Prestaciones M\u00e9dicas, Instituto Mexicano del Seguro Social, Colima 28030, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alejandro","family":"Figueroa-Guti\u00e9rrez","sequence":"additional","affiliation":[{"name":"Hospital General de Zona No. 1, Instituto Mexicano del Seguro Social, Villa de \u00c1lvarez 28984, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eder Fernando","family":"R\u00edos-Bracamontes","sequence":"additional","affiliation":[{"name":"Hospital General de Zona No. 1, Instituto Mexicano del Seguro Social, Villa de \u00c1lvarez 28984, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karina Esmeralda","family":"Espinoza-Mej\u00eda","sequence":"additional","affiliation":[{"name":"Hospital General de Zona No. 1, Instituto Mexicano del Seguro Social, Villa de \u00c1lvarez 28984, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iris Anecxi","family":"Jim\u00e9nez-Vieyra","sequence":"additional","affiliation":[{"name":"Hospital General de Zona No. 1, Instituto Mexicano del Seguro Social, Villa de \u00c1lvarez 28984, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5256-5263","authenticated-orcid":false,"given":"Luis Antonio","family":"Berm\u00fadez-Aceves","sequence":"additional","affiliation":[{"name":"Hospital General de Zona No. 1, Instituto Mexicano del Seguro Social, Villa de \u00c1lvarez 28984, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Blanca Judith","family":"\u00c1vila-Flores","sequence":"additional","affiliation":[{"name":"Unidad de Medicina Familiar No. 19, Instituto Mexicano del Seguro Social, Colima 28000, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1118-498X","authenticated-orcid":false,"given":"Efr\u00e9n","family":"Murillo-Zamora","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Universidad de Colima, Colima 28040, Mexico"},{"name":"Unidad de Investigaci\u00f3n en Epidemiolog\u00eda Cl\u00ednica, Instituto Mexicano del Seguro Social, Villa de \u00c1lvarez 28984, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1038\/s41581-022-00623-7","article-title":"Epidemiology of peritoneal dialysis outcomes","volume":"18","author":"Bello","year":"2022","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Venegas-Ram\u00edrez, J., Barrios-Mora, K.E., R\u00edos-Bracamontes, E.F., Guzm\u00e1n-Esquivel, J., C\u00e1rdenas-Rojas, M.I., and Murillo-Zamora, E. (2023). Ten-Year Single-Center Study Examining Patient Survival after Commencing Long-Term Peritoneal Dialysis. J. Clin. Med., 12.","DOI":"10.3390\/jcm12237283"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.2215\/CJN.14631218","article-title":"Peritoneal Dialysis-Associated Peritonitis","volume":"14","author":"Szeto","year":"2019","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1177\/08968608211069231","article-title":"Practice variations in antibiotic administration for the management of peritonitis in patients on automated peritoneal dialysis in Australia and New Zealand","volume":"42","author":"Ling","year":"2022","journal-title":"Perit. Dial. Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1177\/08968608231172740","article-title":"ISPD Catheter-related Infection Recommendations: 2023 Update","volume":"43","author":"Chow","year":"2023","journal-title":"Perit. Dial. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.xkme.2020.04.010","article-title":"Peritoneal Dialysis-Associated Peritonitis: Suggestions for Management and Mistakes to Avoid","volume":"2","author":"Bargman","year":"2020","journal-title":"Kidney Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S25","DOI":"10.3747\/pdi.2017.00235","article-title":"The Effect of Automated Versus Continuous Ambulatory Peritoneal Dialysis on Mortality Risk In China","volume":"38","author":"Li","year":"2018","journal-title":"Perit. Dial. Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4547036","DOI":"10.1155\/2020\/4547036","article-title":"A Simple Tenckhoff Catheter Placement Technique for Continuous Ambulatory Peritoneal Dialysis (CAPD) Using the Bandung Method","volume":"2020","author":"Jonny","year":"2020","journal-title":"Int. J. Nephrol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1007\/s11255-020-02678-6","article-title":"APD or CAPD: One glove does not fit all","volume":"53","author":"Roumeliotis","year":"2021","journal-title":"Int. Urol. Nephrol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.vhri.2019.10.004","article-title":"Cost-Utility Analysis of Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis for Thai Patients With End-Stage Renal Disease","volume":"21","author":"Thaweethamcharoen","year":"2020","journal-title":"Value Health Reg. Issues"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1111\/cts.13182","article-title":"Intraperitoneal pharmacokinetics of vancomycin in patients on automated peritoneal dialysis","volume":"15","author":"Lam","year":"2022","journal-title":"Clin. Transl. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1177\/0896860819889774","article-title":"Vancomycin in peritoneal dialysis: Clinical pharmacology considerations in therapy","volume":"40","author":"Lam","year":"2020","journal-title":"Perit. Dial. Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"39","DOI":"10.3747\/pdi.2009.00235","article-title":"Similar peritonitis outcome in CAPD and APD patients with dialysis modality continuation during peritonitis","volume":"31","author":"Ruger","year":"2011","journal-title":"Perit. Dial. Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1080\/0886022X.2016.1209025","article-title":"Comparison of peritonitis rates and patient survival in automated and continuous ambulatory peritoneal dialysis: A 10-year single center experience","volume":"38","author":"Nassef","year":"2016","journal-title":"Ren. Fail."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Falbo Dos Reis, P., Barretti, P., Marinho, L., Balbi, A.L., Awdishu, L., and Ponce, D. (2021). Pharmacokinetics of Intraperitoneal Vancomycin and Amikacin in Automated Peritoneal Dialysis Patients With Peritonitis. Front. Pharmacol., 12.","DOI":"10.3389\/fphar.2021.658014"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1177\/08968608221080586","article-title":"ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment","volume":"42","author":"Li","year":"2022","journal-title":"Perit. Dial. Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1177\/0896860819893820","article-title":"Intraperitoneal cefazolin and ceftazidime during short-dwell exchange in peritoneal dialysis patients with peritonitis","volume":"40","author":"Triyawatanyu","year":"2020","journal-title":"Perit. Dial. Int."},{"key":"ref_18","unstructured":"Mexican Social Security Institute (2023, September 13). Diagnosis and Treatment of Infectious Peritonitis in Chronic Peritoneal Dialysis in Adults. (In Spanish)."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Moher, D., and Chan, A.W. (2014). SPIRIT (standard protocol items: Recommendations for interventional trials). Guidelines for Reporting Health Research: A User\u2019s Manual, Wiley.","DOI":"10.1002\/9781118715598.ch7"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.jclinepi.2010.03.004","article-title":"Consolidated Standards of Reporting Trials Group. CONSORT 2010 explanation and elaboration: Updated guidelines for reporting parallel group randomized trials","volume":"63","author":"Moher","year":"2010","journal-title":"J. Clin. Epidemiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"343","DOI":"10.2307\/2529990","article-title":"A simple approximation for calculating sample sizes for comparing independent proportions","volume":"36","author":"Fleiss","year":"1980","journal-title":"Biometrics"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1002\/pst.1716","article-title":"Practical guide to sample size calculations: Non-inferiority and equivalence trials","volume":"15","author":"Flight","year":"2016","journal-title":"Pharm. Stat."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S76","DOI":"10.1038\/sj.ki.5002606","article-title":"Improved patient\/technique survival and peritonitis rates in patients treated with automated peritoneal dialysis when compared to continuous ambulatory peritoneal dialysis in a Mexican PD center","volume":"73","author":"Sanchez","year":"2008","journal-title":"Kidney Int. Suppl."},{"key":"ref_24","unstructured":"ATCC (2025, July 15). Reference Strains: How Many Passages Are Too Many?. Available online: https:\/\/www.atcc.org\/resources\/technical-documents\/reference-strains-how-many-passages-are-too-many."},{"key":"ref_25","unstructured":"Bio-Rad (2025, July 15). Laboratory Proficiency Testing\u2014EQAS Program Overview. Available online: https:\/\/www.bio-rad.com\/es-mx\/a\/qm\/proficiency-testing-eqas."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/8\/747\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:15:29Z","timestamp":1760033729000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/8\/747"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,24]]},"references-count":25,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["antibiotics14080747"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14080747","relation":{},"ISSN":["2079-6382"],"issn-type":[{"type":"electronic","value":"2079-6382"}],"subject":[],"published":{"date-parts":[[2025,7,24]]}}}