Case 23

2020 ◽  
pp. 151-157
Author(s):  
Hilary Humphreys
Keyword(s):  
Peritoneal Dialysis ◽  
Recurrent Infection ◽  
Positive Culture ◽  
Personal Hygiene ◽  
Peritoneal Dialysis Catheter ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Fungal Peritonitis ◽  
Gram Positive Bacteria ◽  
Culture Negative

Infection is one of the commonest complications of continuous ambulatory peritoneal dialysis (CAPD) which often presents with a cloudy bag and sometimes abdominal pain. Gram-positive bacteria, such as coagulase negative staphylococci, are the commonest cause. The diagnosis is confirmed by markedly elevated white cells in the CAPD fluid and a positive culture. Empiric antibiotics should cover Gram-positive and Gram-negative bacteria—e.g intra-peritoneal vancomycin and gentamicin—which are modified when culture and antibiotic susceptibility results are available. Removal of the peritoneal dialysis catheter is indicated in pseudomonal and fungal peritonitis and when there is recurrent infection. Culture-negative CAPD infection may be due to tuberculosis. Minimizing infection is largely achieved through good standards of personal hygiene, patient training and education, and home visits.

IncreasingStaphylococcusSpecies Resistance in Peritoneal Dialysis-Related Peritonitis Over a 10-Year Period in a Single Taiwanese Center

2018 ◽  
Vol 38 (4) ◽  
pp. 266-270 ◽  
Author(s):  
Ho-Ching Chen ◽  
Chi-Chang Shieh ◽  
Junne-Ming Sung
Keyword(s):  
Peritoneal Dialysis ◽  
Methicillin Resistance ◽  
Removal Rate ◽  
Staphylococcal Infection ◽  
Resistance Rate ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Methicillin Resistant ◽  
Gram Positive Bacteria ◽  
Southern Taiwan

BackgroundPeritonitis is a major complication of peritoneal dialysis (PD). Staphylococcus species are gram-positive bacteria that are most commonly associated with peritoneal peritonitis. The increasing antimicrobial resistance rate is a severe burden when considering the initial choice of antibiotics. This investigation examined the trends of staphylococcal infection as well as the resistance rate and clinical outcomes from 2006 to 2015 in southern Taiwan.MethodsWe retrospectively investigated all PD-related peritonitis episodes in southern Taiwan between January 2006 and December 2015 and evaluated the clinical characteristics of peritonitis, microbiological prevalence and resistance of Staphylococcus species, and outcomes in patients.ResultsAmong 244 episodes of peritonitis, Staphylococcus species accounted for approximately 65% of the gram-positive bacteria that caused the infection. The methicillin resistance rate among Staphylococcus species substantially increased to 64% by 2015 in both Staphylococcus aureus and coagulase-negative staphylococci in southern Taiwan. Notably, patients with methicillin-resistant staphylococcal infection exhibited a significantly higher hospitalization rate than those with methicillin-sensitive staphylococcal infection. However, the catheter removal rate and transfer to hemodialysis exhibited no differences between the 2 groups.ConclusionPeritonitis is the most serious complication in patients on PD, and microbiological trends have changed over the past 10 years at a single center in southern Taiwan. The number of methicillin-resistant Staphylococcus species has substantially increased. Empirical initial antibiotic therapy should be adapted on the basis of the growing microbiological resistance.

The culture from peritoneal dialysis catheter enhances yield of microorganism identification in peritoneal dialysis-related peritonitis

2020 ◽  
Vol 40 (1) ◽  
pp. 93-95
Author(s):  
Talerngsak Kanjanabuch ◽  
Pongpratch Puapatanakul ◽  
Thunvarat Saejew ◽  
Preeyarat Pavatung ◽  
Wasin Manuprasert ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Positive Culture ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Dialysis Fluid ◽  
Negative Rate ◽  
Peritoneal Dialysis Fluid ◽  
Microorganism Identification ◽  
Refractory Peritonitis ◽  
Culture Negative

An additional yield of culture from the removed peritoneal dialysis (PD) catheter in diagnosis of pathogen causing refractory peritonitis was assessed in 118 eligible patients from 7 PD centers. Peritoneal dialysis fluid (PDF) culture identified organisms in 86 (72.9%) patients, while the catheter culture identified organisms in 55 (46.6%) patients. PD catheter culture could additionally identify organisms in 19 patients whose PDF culture were negative, increasing the positive culture rate to 89%, in other word 16.1% reducing the culture-negative rate. PD catheter culture provided additional yield, especially in fungal and enterococcal infections.

Peritoneal dialysis-associated peritonitis caused by Enterococcus avium

2021 ◽  
Vol 14 (3) ◽  
pp. e240272
Author(s):  
Rita Calça ◽  
Francisca Gomes da Silva ◽  
Ana Rita Martins ◽  
Patrícia Quadros Branco
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Antibiotic Therapy ◽  
Rare Case ◽  
Clinical Course ◽  
Catheter Removal ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Laboratory Findings ◽  
Microbial Agents

Peritonitis remains a common and serious complication of peritoneal dialysis. Peritonitis caused by gram-positive organisms includes coagulase-negative staphylococci, Streptococcus spp and Enterococcus spp. We present a rare case of peritoneal dialysis-associated peritonitis, where persisting abdominal pain and worsening laboratory findings despite antibiotic therapy led to the identification of Enterococcus avium, requiring Tenckoff catheter removal and temporary transfer to haemodialysis. The available literature reports only few cases where peritonitis is caused by this agent, underlining the need to consider atypical microbial agents when heterogeneous clinical course is presented.

Diagnostic Value of Effluent Endotoxin Level in Gram-Negative Peritonitis in Capd Patients

2001 ◽  
Vol 21 (2) ◽  
pp. 154-158 ◽  
Author(s):  
Khalifa Omar Muhammed ◽  
Çetin Özener ◽  
Emel Akoglu
Keyword(s):  
Diagnostic Value ◽  
Teaching Hospitals ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Diagnostic Usefulness ◽  
Common Center ◽  
Work Up ◽  
Culture Negative ◽  
Lal Assay

Objective To evaluate the diagnostic usefulness of effluent endotoxin by Limulus amoebocyte lysate (LAL) assay in gram-negative peritonitis patients on continuous ambulatory peritoneal dialysis (CAPD) therapy. Design Prospective study with patients serving as their own controls. Standard microbiologic work up and endotoxin analysis of effluents (night dwell) were done during the pre- and posttreatment phases. Setting Specimens from three teaching hospitals were processed and tested at a common center. Patients were left for treatment at their respective centers without intervention. Patients 32 clinical peritonitis and 40 infection-free CAPD patients were studied. Results 75% ( n = 24) of cultures were positive: 41.6% ( n = 10) gram-negative and 58.4% ( n = 14) gram-positive bacteria. Effluents of pre- and posttreated gram-negative cultures had endotoxin levels of 1.53 ± 0.169 and 0.214 ± 0.085 endotoxin units (EU)/mL, respectively ( p < 0.0001); pre- and posttreated gram-positive levels of 0.102 ± 0.06 and 0.122 ± 0.052 EU/mL, respectively ( p > 0.05); pre- and posttreated culture-negative peritonitis levels of 0.110 ± 0.025 and 0.087 ± 0.031 EU/mL, respectively ( p > 0.05); peritonitis-free effluents contained 0.117 ± 0.079 EU/mL. The diagnostic specificity and the sensitivity of LAL assay were 100% and 98.2% respectively. Conclusion Where initial microbiological work-up cannot demonstrate a pathogen, effluent endotoxin determined by quantitative LAL assay is a useful marker for diagnosis and management, within safe time limits, of gram-negative peritonitis in CAPD patients.

Multicentre registry data analysis comparing outcomes of culture-negative peritonitis and different subtypes of culture-positive peritonitis in peritoneal dialysis patients

2020 ◽  
Vol 40 (1) ◽  
pp. 47-56 ◽  
Author(s):  
Htay Htay ◽  
Yeoungjee Cho ◽  
Elaine M Pascoe ◽  
Carmel Hawley ◽  
Philip A Clayton ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Primary Outcome ◽  
Catheter Removal ◽  
Dialysis Patients ◽  
Gram Positive ◽  
Pseudomonas Species ◽  
Gram Negative Organisms ◽  
Culture Positive ◽  
Culture Negative ◽  
Related Mortality

Background: The outcomes of culture-negative peritonitis in peritoneal dialysis (PD) patients have been reported to be superior to those of culture-positive peritonitis. The current study aimed to examine whether this observation also applied to different subtypes of culture-positive peritonitis. Methods: This multicentre registry study included all episodes of peritonitis in adult PD patients in Australia between 2004 and 2014. The primary outcome was medical cure. Secondary outcomes were catheter removal, hemodialysis transfer, relapsing/recurrent peritonitis and peritonitis-related death. These outcomes were analyzed using mixed effects logistic regression. Results: Overall, 11,122 episodes of peritonitis occurring in 5367 patients were included. A total of 1760 (16%) episodes were culture-negative, of which 77% were medically cured. Compared with culture-negative peritonitis, the odds of medical cure were lower in peritonitis caused by Staphylococcus aureus (adjusted odds ratio (OR) 0.62, 95% confidence interval (CI) 0.52–0.73), Pseudomonas species (OR 0.20, 95% CI 0.16–0.26), other gram-negative organisms (OR 0.48, 95% CI 0.41–0.56), polymicrobial organisms (OR 0.30, 95% CI 0.25–0.35), fungi (OR 0.02, 95% CI 0.01–0.03), and other organisms (OR 0.61, 95% CI 0.49–0.76), while the odds were similar in other (non-staphylococcal) gram-positive organisms (OR 1.11, 95% CI 0.97–1.28). Similar results were observed for catheter removal and hemodialysis transfer. Compared with culture-negative peritonitis, peritonitis-related mortality was significantly higher in culture-positive peritonitis except that due to other gram-positive organisms. There was no difference in the odds of relapsing/recurrent peritonitis between culture-negative and culture-positive peritonitis. Conclusion: Culture-negative peritonitis had superior outcomes compared to culture-positive peritonitis except for non-staphylococcal gram-positive peritonitis.

Risk Factors and Prevention of Peritoneal Dialysis-Related Peritonitis

2019 ◽  
Vol 39 (2) ◽  
pp. 119-125 ◽  
Author(s):  
Liliana Gadola ◽  
Carla Poggi ◽  
Patricia Dominguez ◽  
María V. Poggio ◽  
Eliana Lungo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Educational Program ◽  
Positive Culture ◽  
Major Complication ◽  
Free Survival ◽  
Gram Positive Bacteria ◽  
Cox Analysis ◽  
And Staphylococcus Aureus

Background Peritonitis is a major complication and the main cause of peritoneal dialysis (PD) failure. The aim of the present study was to evaluate peritonitis risk factors and its prevention with a new peritoneal educational program (NPEP). Methods We performed a retrospective analysis of a cohort of chronic PD patients, older than 16 years, who began PD in the period 1 January 1999 to 31 December 2015 at a Uruguayan PD center, with follow-up until 31 December 2016. Results The population included 222 cases (219 patients, 128 men), median age 59 (interquartile range [IQR] 47.0 – 72.0) years, median time on PD 17.5 (IQR 6.0 – 36.2) months. Ninety-five patients suffered 1 or more episodes of peritonitis, and they had been on PD for a longer period and had nasal-positive culture more frequently. A NPEP started in September 2008; patients who trained with it, as well as younger patients, had longer peritonitis-free survival. After the NPEP, global peritonitis rates decreased significantly (from 0.48 to 0.29 episodes/patient-year, respectively), particularly gram-positive bacteria and Staphylococcus aureus / coagulase-negative (CoNS) (from 0.26 to 0.12 and 0.21 to 0.07 episodes/patient-year, respectively). In the multivariate Cox analysis of peritonitis risk factors, survival to first peritonitis was significantly associated only with age (hazard ratio [HR] 1.024, 95% confidence interval [CI] 1.007 – 1.397, p = 0.007) and the NPEP (HR 0.600, 95% CI 0.394 – 0.913, p = 0.017). Conclusion A multidisciplinary peritoneal educational program may improve peritonitis rates, independently of other risk factors.

A Prospective Study of the Efficacy of Local Application of Gentamicin versus Mupirocin in the Prevention of Peritoneal Dialysis Catheter-Related Infections

2008 ◽  
Vol 28 (5) ◽  
pp. 505-508 ◽  
Author(s):  
Kwok Hong Chu ◽  
Wai Yee Choy ◽  
Chi Chung William Cheung ◽  
Ka Shun Fung ◽  
Hon Lok Tang ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Prospective Study ◽  
Hospital Admissions ◽  
Local Application ◽  
Peritoneal Dialysis Catheter ◽  
Exit Site ◽  
Gram Positive ◽  
Gram Negative ◽  
A Prospective Study

Background Peritoneal dialysis (PD)-related infections are the major cause of technique failure. Exit-site infections (ESI) can be prevented by local application of antibiotics. Mupirocin (M) is the most extensively studied drug for this application. Long-term use can result in the development of resistance. Gentamicin (G) is an attractive alternative, with both gram-positive and gram-negative activities. We studied the comparative efficacy of G cream versus M ointment in the prevention of PD-related infections in a Chinese cohort. Methods This was a prospective study of adult PD patients of the Princess Margaret Hospital, Hong Kong. Patients were excluded if they had active infection, recent ESI or peritonitis, history of allergy to either drug, or were unable to apply the drug or give consent. Patients were taught to apply the drug daily to the exit site after routine exit-site care. Records were tracked prospectively during hospital admissions and clinic follow-ups. Results 95 patients were recruited; 14 discontinued the study. The ESI rates were 0.38 and 0.20 episodes/patient-year for the G group and the M group respectively ( p = 0.36). Gram-positive ESI rates were 0.18 and 0 episodes/patient-year for the G group and the M group respectively. Gram-negative ESI rates were 0.20 episodes/patient-year for both groups ( p = 0.62). The overall peritonitis rates were similar in the two groups ( p = 0.91). Discussion In addition to good perioperative care and strict exit-site care, local antibiotic application can prevent ESI. Mupirocin has been extensively studied and shown to be effective. Similar if not superior effects of G cream have been demonstrated. In this study, neither antibiotic gave significantly better results in the prevention of either ESI or peritonitis. Conclusions Both gentamicin and mupirocin were effective as prophylaxis for ESI. Longer study is required to determine the long-term efficacy and the potential beneficial effect on the prevention of peritonitis.

scholarly journals Comparative Surveillance Study of Telavancin Activity against Recently Collected Gram-Positive Clinical Isolates from across the United States

2008 ◽  
Vol 52 (7) ◽  
pp. 2383-2388 ◽  
Author(s):  
Deborah C. Draghi ◽  
Bret M. Benton ◽  
Kevin M. Krause ◽  
Clyde Thornsberry ◽  
Chris Pillar ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Clinical Isolates ◽  
Surveillance Study ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Gram Positive Bacteria ◽  
Serious Infections ◽  
Wide Range ◽  
Vancomycin Resistant

ABSTRACT Telavancin is an investigational, rapidly bactericidal lipoglycopeptide antibiotic that is being developed to treat serious infections caused by gram-positive bacteria. A baseline prospective surveillance study was conducted to assess telavancin activity, in comparison with other agents, against contemporary clinical isolates collected from 2004 to 2005 from across the United States. Nearly 4,000 isolates were collected, including staphylococci, enterococci, and streptococci (pneumococci, beta-hemolytic, and viridans). Telavancin had potent activity against Staphylococcus aureus and coagulase-negative staphylococci (MIC range, 0.03 to 1.0 μg/ml), independent of resistance to methicillin or to multiple agents. Telavancin activity was particularly potent against all streptococcal groups (MIC90s, 0.03 to 0.12 μg/ml). Telavancin had excellent activity against vancomycin-susceptible enterococci (MIC90, 1 μg/ml) and was active against VanB strains of vancomycin-resistant enterococci (MIC90, 2 μg/ml) but less active against VanA strains (MIC90, 8 to 16 μg/ml). Telavancin also demonstrated activity against vancomycin-intermediate S. aureus and vancomycin-resistant S. aureus strains (MICs, 0.5 μg/ml to 1.0 μg/ml and 1.0 μg/ml to 4.0 μg/ml, respectively). These data may support the efficacy of telavancin for treatment of serious infections with a wide range of gram-positive organisms.

scholarly journals In Vitro Antimicrobial Activities of Novel Anilinouracils Which Selectively Inhibit DNA Polymerase III of Gram-Positive Bacteria

2000 ◽  
Vol 44 (8) ◽  
pp. 2217-2221 ◽  
Author(s):  
Jennifer S. Daly ◽  
Theodore J. Giehl ◽  
Neal C. Brown ◽  
Chengxin Zhi ◽  
George E. Wright ◽  
...  
Keyword(s):  
Dna Polymerase ◽  
Antimicrobial Activities ◽  
Dna Polymerase Iii ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
New Agents ◽  
Gram Positive Bacteria ◽  
Polymerase Iii ◽  
Time Kill

ABSTRACT The 6-anilinouracils are novel dGTP analogs that selectively inhibit the replication-specific DNA polymerase III of gram-positive eubacteria. Two specific derivatives, IMAU (6-[3′-iodo-4′-methylanilino]uracil) and EMAU (6-[3′-ethyl-4′-methylanilino]uracil), were substituted with either a hydroxybutyl (HB) or a methoxybutyl (MB) group at their N3 positions to produce four agents: HB-EMAU, MB-EMAU, HB-IMAU, and MB-IMAU. These four new agents inhibited Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus faecalis, and Enterococcus faecium. Time-kill assays and broth dilution testing confirmed bactericidal activity. These anilinouracil derivatives represent a novel class of antimicrobials with promising activities against gram-positive bacteria that are resistant to currently available agents, validating replication-specific DNA polymerase III as a new target for antimicrobial development.

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