Isolation of methicillin-resistant coagulase-negative staphylococci from patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and comparison of different molecular techniques for discriminating isolates of Staphylococcus epidermidis

2003 ◽  
Vol 45 (1) ◽  
pp. 13-22 ◽  
Author(s):  
Elaine Marques de Mattos ◽  
Lenise Arneiro Teixeira ◽  
Vanda Maria Morgado Alves ◽  
Cleide Aparecida Ferreira Rezenda e Resende ◽  
Marcus Vinícius da Silva Coimbra ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Staphylococcus Epidermidis ◽  
Molecular Techniques ◽  
Coagulase Negative Staphylococci ◽  
Methicillin Resistant

scholarly journals Pharmacokinetics of Quinupristin-Dalfopristin in Continuous Ambulatory Peritoneal Dialysis Patients

1999 ◽  
Vol 43 (1) ◽  
pp. 152-156 ◽  
Author(s):  
Curtis A. Johnson ◽  
Claude A. Taylor ◽  
Stephen W. Zimmerman ◽  
William E. Bridson ◽  
Paul Chevalier ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Pharmacokinetic Parameters ◽  
Maximal Concentration ◽  
Coagulase Negative Staphylococci ◽  
Primary Metabolites ◽  
Methicillin Resistant ◽  
Pharmacokinetic Profiles ◽  
Vancomycin Resistant ◽  
Total Body

ABSTRACT Quinupristin-dalfopristin may be useful for treatment of organisms causing peritoneal dialysis-related peritonitis, including methicillin-resistant coagulase-negative staphylococci, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci. The pharmacokinetic profiles of single intravenous doses of this combination streptogramin antibiotic of 7.5 mg/kg of body weight were characterized for eight noninfected patients receiving continuous ambulatory peritoneal dialysis. Comparison was made to pharmacokinetic profiles determined for eight healthy volunteers matched by age, sex, and race. Drug was measured in dialysate up to 6 h following the dose. Plasma and dialysate were assayed for parent compounds and metabolites. Mean pharmacokinetic parameters were compared between groups. No statistically significant differences were observed between groups for maximal concentrations in plasma, times to maximal concentration, areas under the curve, distribution volumes, rates of total body clearance, or half-lives in plasma for quinupristin and dalfopristin. No statistically significant differences were observed in maximal concentrations in plasma, times to maximal concentration, areas under the curve, or half-lives for cysteine, the glutathione conjugates of quinupristin, or the pristinamycin IIA metabolite of dalfopristin. The measurements in dialysate of the parent and most metabolites were below the expected MICs. Dialysis clearance was insignificant. Quinupristin-dalfopristin was well tolerated in both groups, causing only mild adverse events that resolved prior to discharge from the study. The disposition of quinupristin, dalfopristin, or their primary metabolites following a single dose was unaltered in patients receiving peritoneal dialysis. Intravenous dosing of this antibiotic combination is unlikely to be adequate for the treatment of peritonitis associated with peritoneal dialysis.

Scanning Electron Microscopy of Staphylococcus Epidermidis Adherence to Continuous Ambulatory Peritoneal Dialysis Catheters

1985 ◽  
Vol 43 ◽  
pp. 520-521
Author(s):  
William J. Lamoreaux ◽  
David L. Smalley ◽  
Larry M. Baddour ◽  
Alfred P. Kraus
Keyword(s):  
Electron Microscopy ◽  
Scanning Electron Microscopy ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Staphylococcus Epidermidis ◽  
Sterile Saline ◽  
Intravascular Devices ◽  
Capd Patient ◽  
Scanning Electron

Infections associated with the use of intravascular devices have been documented and have been reported to be related to duration of catheter usage. Recently, Eaton et al. reported that Staphylococcus epidermidis may attach to silastic catheters used in continuous ambulatory peritoneal dialysis (CAPD) treatment. The following study presents findings using scanning electron microscopy (SEM) of S. epidermidis adherence to silastic catheters in an in vitro model. In addition, sections of polyvinyl chloride (PVC) dialysis bags were also evaluated by SEM.The S. epidermidis strain RP62A which had been obtained in a previous outbreak of coagulase-negative staphylococcal sepsis at local hospitals was used in these experiments. The strain produced surface slime on exposure to glucose, whereas a nonadherent variant RP62A-NA, which was also used in these studies, failed to produce slime. Strains were grown overnight on blood agar plates at 37°C, harvested from the surface and resuspended in sterile saline (0.85%), centrifuged (3,000 rpm for 10 minutes) and then washed twice in 0.1 M phosphate-buffered saline at pH 7.0. Organisms were resuspended at a concentration of ca. 106 CFU/ml in: a) sterile unused dianeal at 4.25% dextrose, b) sterile unused dianeal at 1.5% dextrose, c) sterile used dialysate previously containing 4.25% dextrose taken from a CAPD patient, and d) sterile used dialysate previously containing 1.5% dextrose taken from a CAPD patient.

scholarly journals Peritonitis Associated with Vancomycin-ResistantLactobacillus rhamnosus in a Continuous Ambulatory Peritoneal Dialysis Patient: Organism Identification, Antibiotic Therapy, and Case Report

1998 ◽  
Vol 36 (6) ◽  
pp. 1781-1783 ◽  
Author(s):  
Günter Klein ◽  
Edith Zill ◽  
Ralf Schindler ◽  
Jacobus Louwers
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Dialysis Patient ◽  
Susceptibility Testing ◽  
Lactobacillus Rhamnosus ◽  
Peritoneal Dialysis Patient ◽  
Antibiotic Susceptibility Testing ◽  
Coagulase Negative Staphylococci ◽  
Pure Cultures ◽  
Organism Identification

A case of Lactobacillus rhamnosus-associated peritonitis in a patient undergoing continuous ambulatory peritoneal dialysis is reported. The patient was treated with vancomycin after isolation of glycopeptide-susceptible coagulase-negative staphylococci. After a skin rash developed, vancomycin was discontinued and replaced with teicoplanin. Seven weeks after the glycopeptide therapy was discontinued, a Lactobacillus strain was isolated in pure cultures. The isolate was identified first incorrectly as L. acidophilus but later correctly as L. rhamnosus. Antibiotic susceptibility testing showed that the isolate was resistant to glycopeptides but susceptible to several other antibiotics. The antibiotic treatment was then switched to imipenem and was successful.

Comparison of the in Vitro Activity of Daptomycin and four other Antimicrobial Agents against Staphylococci Associated with CAPD Peritonitis

1988 ◽  
Vol 8 (4) ◽  
pp. 277-279
Author(s):  
Wendy L. Vaudry ◽  
Claudia Gratton ◽  
Kinga Kowalewska ◽  
Wanda M. Wenman
Keyword(s):  
Peritoneal Dialysis ◽  
Minimum Inhibitory Concentration ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Antimicrobial Agents ◽  
Inhibitory Concentration ◽  
Vitro Activity ◽  
In Vitro Activity ◽  
Coagulase Negative Staphylococci ◽  
Vancomycin Resistant

The minimum inhibitory concentration (MIC) of daptomycin was compared with that of four other antimicrobial agents against clinically relevant staphylococci. Sixtyfive isolates were obtained from patients on continuous ambulatory peritoneal dialysis (CAPD) who contracted peritonitis. These isolates comprised 29 S. Sureus strains (all sensitive to oxacillin); 25 S. epidermidis strains (14 sensitive and 9 resistant to oxacillin); and 11 unspeciated coagulase-negative staphylococci (2 sensitive and 11 resistant to oxacillin). All of the oxacillin susceptible strains were inhibited by ≤2 mg/L of the five antibiotics tested. The oxacillin resistant staphylococci were also resistant to cefuroxime and variably resistant to cefamandole, but were uniformly susceptible to both vancomycin and daptomycin. Daptomycin possesses equivalent in vitro activity to vancomycin against strains of S. Sureus and coagulase negative staphylococci associated with CAPD peritonitis. If vancomycin resistance becomes a significant problem in these patients, and daptomycin is shown to be active against vancomycin resistant organisms, then it would have potential usefulness as an alternative to vancomycin in the treatment of peritonitis caused by multiply -resistant staphylococci.

scholarly journals Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis.

1992 ◽  
Vol 5 (1) ◽  
pp. 36-48 ◽  
Author(s):  
A von Graevenitz ◽  
D Amsterdam
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Antimicrobial Agents ◽  
Positive Culture ◽  
Bloodstream Infections ◽  
Peritoneal Macrophages ◽  
Gram Stain ◽  
Coagulase Negative Staphylococci ◽  
Safe Alternative ◽  
Skin Flora

The process of continuous ambulatory peritoneal dialysis has provided a useful, relatively inexpensive, and safe alternative for patients with end-stage renal disease. Infectious peritonitis, however, has limited a more widespread acceptance of this technique. The definition of peritonitis in this patient population is not universally accepted and does not always include the laboratory support of a positive culture (or Gram stain). In part, the omission of clinical microbiological findings stems from the lack of sensitivity of earlier microbiological efforts. Peritonitis results from decreased host phagocytic efficiency with depressed phagocytosis and bactericidal capacity of peritoneal macrophages. During episodes of peritonitis, fluid movement is reversed, away from the lymphatics and peritoneal membrane and toward the cavity. As a result, bloodstream infections are rare. Most peritonitis episodes are caused by bacteria. Coagulase-negative staphylococci are the most frequently isolated organisms, usually originating from the skin flora, but a wide array of microbial species have been documented as agents of peritonitis. Clinical microbiology laboratories need to be cognizant of the diverse agents so that appropriate primary media can be used. The quantity of dialysate fluid that is prepared for culture is critical and should constitute at least 10 ml. The sensitivity of the cultural approach depends on the volume of dialysate, its pretreatment (lysis or centrifugation), the media used, and the mode of incubation. The low concentration of microorganisms in dialysate fluids accounts for negative Gram stain results. Prevention of infection in continuous ambulatory peritoneal dialysis patients is associated with the socioeconomic status of the patient, advances in equipment (catheter) technology, and, probably least important, the application of prophylactic antimicrobial agents.

scholarly journals Correlation of Oxacillin MIC with mecAGene Carriage in Coagulase-Negative Staphylococci

2000 ◽  
Vol 38 (2) ◽  
pp. 752-754 ◽  
Author(s):  
Zafar Hussain ◽  
Luba Stoakes ◽  
Viki Massey ◽  
Deb Diagre ◽  
Viivi Fitzgerald ◽  
...  
Keyword(s):  
Staphylococcus Epidermidis ◽  
Clinical Laboratory ◽  
National Committee ◽  
Dilution Method ◽  
Agar Dilution Method ◽  
Coagulase Negative Staphylococci ◽  
Methicillin Resistant ◽  
Mueller Hinton ◽  
Mueller Hinton Agar ◽  
Agar Dilution

The National Committee for Clinical Laboratory Standards has recently changed the oxacillin breakpoint from ≥4 mg/liter to ≥0.5 mg/liter to detect methicillin-resistant coagulase-negative staphylococci (CoNS) because the previous breakpoint lacked sensitivity. To determine the correlation between the new oxacillin breakpoint and the presence of themecA gene, 493 CoNS of 11 species were tested. The presence of the mecA gene was determined by PCR, and oxacillin susceptibility was determined by the agar dilution method with Mueller-Hinton agar containing 2% NaCl and oxacillin (0.125 to 4.0 mg/liter). The new breakpoint correctly classified all CoNS strains with mecA as methicillin resistant and strains ofStaphylococcus epidermidis, S. haemolyticus, and S. hominiswithout mecA as methicillin susceptible. The breakpoint of ≥0.5 mg/liter was not specific for S. cohnii, S. lugdunensis, S. saprophyticus, S. warneri, and S. xylosus, in that it categorized 70 of 74 strains of these species withoutmecA (94.6%) as methicillin resistant. The results of this study indicate that the new oxacillin breakpoint accurately identifies strains of CoNS with mecAbut is not specific for strains of certain species of CoNS withoutmecA.

A 12-Month Review of Peritoneal Dialysis-Related Peritonitis in Western Australia: Is Empiric Vancomycin Still Indicated for Some Patients?

2003 ◽  
Vol 23 (5) ◽  
pp. 465-468 ◽  
Author(s):  
George W. Kan ◽  
Mark A.B. Thomas ◽  
Christopher H. Heath
Keyword(s):  
Peritoneal Dialysis ◽  
Western Australia ◽  
Methicillin Resistance ◽  
Patient Characteristics ◽  
Empiric Therapy ◽  
University Hospitals ◽  
Coagulase Negative Staphylococci ◽  
Fungal Peritonitis ◽  
Specific Patient ◽  
Methicillin Resistant

Background The International Society for Peritoneal Dialysis (ISPD) guidelines recommend empiric therapy with cefazolin and ceftazidime for peritoneal dialysis (PD)-related peritonitis. Empiric cefazolin therapy may have diminishing efficacy because of emerging methicillin resistance in gram-positive bacteria (GPB). Western Australia also has large numbers of Aboriginal and isolated regional patients, where giving these antimicrobials can be impractical. Objectives To evaluate, based on local antimicrobial resistance patterns, the feasibility of following ISPD guidelines in Western Australia and to identify any subgroups of PD peritonitis patients that may benefit from alternative empiric intraperitoneal antibiotics ( e.g., vancomycin). Study Design Retrospective study of all PD peritonitis episodes in Western Australia from 1 February 2000 to 31 January 2001. Setting Three adult tertiary referral university hospitals and their PD patients in metropolitan Perth and regional Western Australia. Patients All adults on PD in Western Australia. Main Outcome Measure Isolates and antibiograms were analyzed versus patient characteristics, including race and patient demographics. Results 293 patients (28% Aborigines, 32% regional patients) received PD. 145 episodes of PD peritonitis occurred during the study. The overall PD peritonitis rate was 1 episode/16 patient months, with Aborigines having 1 episode/10.5 patient months versus non-Aborigines having 1 episode/17 patient months p (< 0.001). 36% of isolates from PD peritonitis episodes were resistant to cefazolin or ceftazidime. 22% were methicillin-resistant GPB (MR-GPB) [18% coagulase-negative staphylococci (CoNS), 1.6% MR Staphylococcus aureus]; 2.5% were multidrug-resistant gram-negative bacteria (MDR-GNB); 5.7% were polymicrobial (MR-GPB and/or MDR-GNB); and 5.7% were fungal. 63% of CoNS were methicillin resistant. Non-Aboriginal patients yielded MR-GPB in 22% of isolates versus 23% in Aborigines ( p = 0.9). Six of seven cases of fungal peritonitis occurred inAboriginal patients ( p < 0.001). Conclusions In our study population the ISPD guidelines were appropriate for 64% of patients with PD peritonitis. We could not identify specific patient subgroups where empiric cefazolin use could be more effective. High proportions of MR-GPB PD peritonitis episodes, along with local factors, make empiric cefazolin unsuitable for many regional PD patients in Western Australia.

Campylobacter Peritonitis Complicating Continuous Ambulatory Peritoneal Dialysis: Report of Three Cases and Review of the Literature

2010 ◽  
Vol 30 (1) ◽  
pp. 99-104 ◽  
Author(s):  
Sittana S. Elshafie ◽  
Muhammad Asim ◽  
Adel Ashour ◽  
Abdul Haleem Elhiday ◽  
Thoraya Mohsen ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Molecular Techniques ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Culture Techniques ◽  
Oxidase Test ◽  
Campylobacter Species ◽  
Micro Organisms ◽  
Better Than

BackgroundThe micro-organisms involved in continuous ambulatory peritoneal dialysis (CAPD) peritonitis are usually gram-positive cocci of cutaneous origin. Campylobacter species are rarely implicated as a cause of CAPD peritonitis.MethodsA retrospective review of 100 consecutive episodes of peritonitis was carried out in patients undergoing CAPD or automated PD in our hospital from June 2004 to December 2007. Collection of dialysate and microbial examination was done according to ISPD guidelines. Identification of the organism was made on the basis of Gram smear morphology, positive oxidase test, and biochemical reactions using API Campi (BioMérieux, Marcy l'Étoile, France). Susceptibility testing was performed using E-test (AB Biodisc, Solna, Sweden) and confirmation was done by molecular techniques.ResultsThe causative organisms in 23 of these episodes were gram-negative bacteria, 3 of which were identified as Campylobacter species using special culture techniques. The clinical presentation in our patients with Campylobacter peritonitis (CP) was different from that of patients with peritonitis from other organisms in that all 3 had diarrhea at presentation. Among patients with CP, no subspecies-specific feature was identified. Good response to the antibiotic treatment was observed; there was no relapse/recurrence of peritonitis, catheter loss, or death.ConclusionIncidence of CP remains low and, regardless of the subtype, clinical outcomes are better than those seen with other gram-negative bacteria such as Pseudomonas. The presence of diarrhea at presentation and the finding of curved or spiral gram-negative bacilli in the Gram smear of peritoneal dialysis effluent should make one think of CP. The use of appropriate microbiology techniques in this situation will increase the isolation of this organism.

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