2819 The Role of Prophylactic Antibiotics in Peritoneal Dialysis Patients Undergoing Colonoscopy: A Systematic Review and Meta-Analysis

Abstract

INTRODUCTION: 

End stage renal disease patients on peritoneal dialysis (PD) are at risk of peritonitis due to possible bacterial translocation from the colon during preparation for colonoscopy or during performing colonoscopy. ASGE guidelines and ISPD (International Society for Peritoneal Dialysis) guidelines suggest antibiotic prophylaxis while European Society of Gastroenterology does not give a clear guideline in this regard. ASGE guidelines in this regard is based on weak evidence. We attempted to conduct a systematic literature review and a meta-analysis to provide more evidence in this area.

METHODS: 

A systematic search of PubMed, Medline, Web of Science, and Google Scholar through April 2019 using PRISMA and MOOSE guidelines identified 3 studies that reported on the occurrence of peritonitis during colonoscopy in patients on peritoneal dialysis. Case reports were excluded. Only prospective and retrospective large series studies were included. Random-effects pooled odds ratio and 95% confidence intervals were estimated. Heterogeneity was measured by Cochrane Q and I² statistics.

RESULTS: 

A total of 3 studies reporting on 216 colonoscopy procedures performed on patients undergoing peritoneal dialysis were included in the final analysis. The mean age ranged from 44 to 64 years. The pooled Odd's ratio of developing peritonitis while on antibiotics during colonoscopy was 0.68 (95% 0.19-2.4, I² = 0, P = 0.56). This was not statistically significant. No heterogeneity was noted in the analysis.

CONCLUSION: 

Based on our study, the administration of antibiotics does not seem to affect the incidence of peritonitis in PD patients undergoing colonoscopy. However, this is based on very limited number of studies and unequal sample-size in comparison groups. We, therefore, cannot recommend or refute the usage of prophylactic antibiotics in PD patients undergoing colonoscopy. This analysis shows the paucity of data available at this time in this regard. More robust studies with similar comparison groups are warranted to guide decision making.