Background Peritonitis is the leading cause of technique failure among peritoneal dialysis (PD) patients. The study aimed to examine the microbiological characteristics of PD-related peritonitis in a tertiary hospital in Singapore.

Methods A retrospective, cross-sectional study was performed at Singapore General Hospital (SGH). Data of patients diagnosed with PD-related peritonitis from January 2011 to December 2014 were collected. Microbiological characteristics of PD-related peritonitis were reported using descriptive statistics.

Results A total of 377 episodes of peritonitis occurred in 247 patients. The average peritonitis rate in the centre was 0.23 episodes per patient year. There were 118 (31.2%) Gram-positive, 98 (26.0%) Gram-negative, 58 (15.4%) polymicrobial, 16 (4.2%) fungal, 2 (0.5%) mycobacterium and 85 (22.6%) culture-negative, PD-related peritonitis episodes.

The three main Gram-positive micro-organisms isolated from peritoneal fluid cultures were Coagulase-negative Staphylococcus aureus (CoNS) (n=70, 17.6%), Streptococcus spp. (n=52, 13.1%) and Enterococcus spp. (n=28, 7.1%), while the three main Gram-negative isolates were Escherichia coli (n=50, 12.6%), Klebsiella spp. (n=46, 11.6%) and Enterobacter spp. (n=27, 6.8%). Candida parapsilosis (n=9, 1.9%) was the commonest fungus identified.

Only 33 (47.1%) CoNS strains were sensitive to cefazolin, which was used in the institution for empiric coverage of Gram-positive micro-organisms in PD-peritonitis. All Streptococcus strains were sensitive to cefazolin (n=52). The majority of Escherichia coli (n=38, 76%), Klebsiella spp. (n=37, 80.4%) and Enterobacter spp. (n=18, 66.7%) strains were sensitive to gentamicin, the empiric antibiotic used for coverage of Gram-negative micro-organisms.

Conclusions Our findings highlight the importance of regular monitoring of micro-organisms and their antimicrobial sensitivities in determining appropriate, centre-specific empirical antibiotics.

Background Treatment non-adherence may be prevalent in patients requiring haemodialysis (HD). Health literacy plays an important role in self-management. However, most research has only assessed basic literacy skills in the haemodialysis cohort.

Aim To determine the association between a multidimensional concept of health literacy and self-reported treatment adherence in HD patients.

Method A cross-sectional survey was undertaken with 42 maintenance HD patients from two South Australian dialysis centres. The Functional, Communicative and Critical Health Literacy (FCCHL) tool was used to assess health literacy. Treatment adherence was measured using a self-report tool developed by the researchers.

Results Higher overall health literacy was associated with increased adherence to food (OR 3.66; 95% CI 1.08–12.43; p=0.038), fluid (OR 4.92; 95% CI 1.13–21.35; p=0.033) and medications (OR 11.88; 95% CI 2.26–62.44; p=0.003).

Conclusion Interventions should be designed to facilitate a multidimensional concept of health literacy to assist patients to follow treatment recommendations.

Background The rate of multidrug-resistant organisms (MDRO) colonisation in dialysis populations has increased over time. This study aimed to assess the effect of contact precautions and isolation on quality of life and mood for haemodialysis (HD) patients colonised with MDRO.

Methods Patients undergoing facility HD completed the Kidney Disease Quality of Life (KDQOL–SF^TM), Beck Depression Inventory (BDI) and Personal Wellbeing-Index Adult (PWI-A). Patients colonised with MDRO were case-matched by age and gender with patients not colonised.

Results A total of 16 MDRO-colonised patients were matched with 16 controls. Groups were well matched for demographics and co-morbidities, other than a trend for older dialysis vintage in the MDRO group [7.2 years (interquartile range 4.6–10.0) compared to 3.2 (1.4–7.6) years, p=0.05]. Comparing MDRO-positive with negative patients, physical (30.5±10.7 vs. 34.6±7.3; p=0.2) and mental (46.5±11.2 vs. 48.5±12.5; p = 0.6) composite scores were not different between groups. The MDRO group reported poorer sleep quality (p=0.01) and sleep patterns (p=0.05), and lower social function (p=0.02). BDI scores were similar (MDRO-positive 10(3.5–21.0) vs. MDRO-negative 12(6.5–16.0), p=0.6). PWI-A scores were also similar in both groups; however, MDRO patients reported lower scores for “feeling safe”, p=0.03.

Conclusion While overall scores of quality of life and depression were similar between groups, the MDRO group reported poorer outcomes in sleep and social function. A larger cohort and qualitative interviews may give more detail of the impact of contact precautions and isolation on HD patients. The necessity for contact precautions for different MDRO needs consideration.

Pregnancy occurring in the setting of chronic kidney disease requires timely care co-ordination to promote best outcomes. When multiple other co-morbidities exist, the need for strong and effective communication links become essential to supporting best outcomes. The role of the nurse practitioner or advanced practice nurse is well suited to supporting the needs of the pregnant woman and her family, especially when dialysis is required. This paper explores the role of the nurse practitioner during a rare clinical scenario. Clinical considerations, including co-ordination, monitoring and management of intensive renal, diabetic, obstetric, ophthalmic and complex psychosocial care are discussed. The importance of multidisciplinary collaboration, incorporating medical, nursing and allied health professionals from each specialty area underpins the case presented in this educational supplement.