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.

Vancomycin and Ciprofloxacin: Systemic Antibiotic Administration for Peritoneal Dialysis-Associated Peritonitis

2004 ◽  
Vol 24 (5) ◽  
pp. 433-439 ◽  
Author(s):  
Eric Goffin ◽  
Laurence Herbiet ◽  
Dominique Pouthier ◽  
Jean-Michel Pochet ◽  
Jean-Jacques Lafontaine ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Antibiotic Therapy ◽  
First Generation ◽  
Close Monitoring ◽  
First Line ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Gram Negative ◽  
Oral Ciprofloxacin ◽  
Susceptibility Rate

Objectives Peritonitis due to peritoneal dialysis (PD) is best treated empirically while waiting for the results of the dialysate culture. Thus, antibiotic therapy must cover both gram-positive and gram-negative micro-organisms. First, over a period of 9 years in a multicenter study we evaluated the efficiency of a vancomycin and ciprofloxacin combination given as the first-line treatment protocol for PD peritonitis. Second, we evaluated whether a systemic route of administration of the antibiotics could be an interesting alternative to the usual cumbersome intraperitoneal drug administration. Methods Vancomycin 15 mg/kg body weight, intravenous, and oral ciprofloxacin 250 mg two times per day (500 mg twice per day if residual creatinine clearance was above 3 mL/minute) were prescribed at diagnosis of peritonitis. Vancomycin injections were repeated (when blood trough level was expected to be below 12 μg/mL) in cases of gram-positive organisms for a total duration of 3 weeks. Ciprofloxacin was given for a total of 3 weeks in cases of gram-negative and a total of 10 days for susceptible gram-positive infections. Results A total of 129 episodes of peritonitis occurred; 28 of them were not included in the study because of protocol violation ( n = 15) or fungal ( n = 7) or fecal ( n = 6) peritonitis, leaving 101 peritonitis episodes for analysis. 52 (51.5%) gram-positive and 28 (27.7%) gram-negative organisms were grown; 38 gram-positive organisms were coagulase-negative staphylococci. No organism was identified in 8 peritonitis episodes, whereas 13 peritonitis episodes were caused by more than 1 organism. 35% of the coagulase-negative staphylococci were resistant to first-generation cephalosporin and methicillin, whereas all were susceptible to vancomycin. For gram-negative bacilli, the susceptibility rate was 96% and 95% for ciprofloxacin and ceftazidime respectively. The overall treatment success rate was 77.2% (78 of the 101 peritonitis episodes): 61.4% at first intention and 15.8% after optimization of the antibiotic therapy (second intention). The protocol failed in 22.8% of the peritonitis episodes. Hospitalization was required in 52% of the peritonitis episodes; average hospitalization was 11 (range 1 – 45) days. Conclusion Systemic vancomycin and ciprofloxacin administration is a simple and efficient first-line protocol antibiotic therapy for PD peritonitis. In our opinion, vancomycin should still be used for gram-positive infections because of its high susceptibility rate compared with first-generation cephalosporins, providing a close monitoring of the local epidemiology. Oral ciprofloxacin provides satisfactory results in gram-negative infections, comparable to those obtained with intraperitoneal ceftazidime or aminoglycosides.

Exserohilum Peritonitis in Peritoneal Dialysis in Northern China: A Case Report

2019 ◽  
Vol 39 (2) ◽  
pp. 175-176
Author(s):  
Yan Liu ◽  
Wenjing Gong ◽  
Yanming Yu ◽  
Lihua Jiang
Keyword(s):  
Peritoneal Dialysis ◽  
Case Report ◽  
Candida Species ◽  
Rare Case ◽  
Northern China ◽  
Catheter Removal ◽  
Fungal Peritonitis ◽  
Anti Fungal

Fungal peritonitis is a catastrophic complication of peritoneal dialysis (PD) and often requires termination of PD. It is usually caused by Candida species. Here we report a rare case of Exserohilum peritonitis. The patient was successfully treated with catheter removal and anti-fungal therapy.

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.

Antibiogram Development for an Outpatient Dialysis Center

2000 ◽  
Vol 35 (3) ◽  
pp. 251-254 ◽  
Author(s):  
Harold J. Manley ◽  
George R. Bailie ◽  
Marianne Neumann
Keyword(s):  
Antibiotic Therapy ◽  
Empiric Antibiotic Therapy ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Susceptibility Data ◽  
Dialysis Center ◽  
Antimicrobial Sensitivity ◽  
Empiric Antibiotic ◽  
Stage Renal Disease ◽  
End Stage

Infection causes significant morbidity and mortality in end-stage renal disease patients. Despite recommendations to the contrary, vancomycin is often used empirically. Antibiograms may aid in the choice of empiric antibiotic therapy. We developed an antibiogram and determined the susceptibility of various microorganisms to cefazolin, gentamicin, and vancomycin. Retrospective review of culture results and susceptibility data from a 21-month time period were used to determine microorganism frequency of identification and antimicrobial sensitivity. A total of 362 microorganisms were identified and 285 cultures performed in 171 patients (144 hemodialysis; 27 peritoneal dialysis). Predominant organisms were coagulase-negative staphylococci (39.8%) and Staphylococcus aureus (24.6%). Gram-positive organisms accounted for 73.5% of isolates. Methicillin-resistant S. aureus and vancomycin-resistant Enterococcus were identified 3.8% and 2.3% of time, respectively. Gram-positive and negative microorganisms were frequently susceptible to cefazolin and gentamicin. Antibiogram interpretation indicates that cefazolin alone or in combination with gentamicin may be appropriate empiric antibiotic therapy in our outpatient dialysis center.

Fungal Peritonitis in Peritoneal Dialysis Patients

2005 ◽  
Vol 25 (3) ◽  
pp. 207-222 ◽  
Author(s):  
Narayan Prasad ◽  
Amit Gupta
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Candida Species ◽  
Fungal Infections ◽  
Diagnostic Techniques ◽  
Catheter Removal ◽  
Prolonged Treatment ◽  
Molecular Diagnostic ◽  
Molecular Diagnostic Techniques ◽  
Fungal Peritonitis

Peritonitis is one of the most frequent complications of peritoneal dialysis (PD) and 1% – 15% of episodes are caused by fungal infections. The mortality rate of fungal peritonitis (FP) varies from 5% to 53%; failure to resume PD occurs in up to 40% of patients. The majority of these FP episodes are caused by Candida species. Candida albicans has historically been reported to be a more common cause than non-albicans Candida species, but in recent reports a shift has been observed and non-albicans Candida may now be more common. Unusual, often “nonpathogenic,” fungi are being increasingly reported as etiologic agents in FP. Clinical features of FP are not different from those of bacterial peritonitis. Phenotypic identification of fungi in clinical microbiology laboratories is often difficult and delayed. New molecular diagnostic techniques ( e.g., polymerase chain reaction) are being developed and evaluated, and may improve diagnosis and so facilitate early treatment of infected patients. Abdominal pain, abdominal pain with fever, and catheter left in situ are risk factors for mortality and technique failure in FP. In programs with high baseline rates of FP, nystatin prophylaxis may be beneficial. Each program must examine its own history of FP to decide whether prophylaxis would be beneficial. Catheter removal is indicated immediately after fungi are identified by Gram stain or culture in all patients with FP. Prolonged treatment with antifungal agents to determine response and attempt clearance is not encouraged. Antifungals should be continued for 10 days to 2 weeks after catheter removal. Attempts at reinsertion should be made only after waiting for 4 – 6 weeks.

Gallbladder Stones, Cholecystitis and Cholecystectomy in Patients on Continuous Ambulatory Peritoneal Dialysis

1984 ◽  
Vol 4 (4) ◽  
pp. 245-248 ◽  
Author(s):  
William Nelson ◽  
Ramesh Khanna ◽  
Raymond Mathews ◽  
Harry Yeung ◽  
George Wu ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Ultrasound Examination ◽  
Clinical Course ◽  
Gallbladder Disease ◽  
Abdominal Ultrasound ◽  
Toronto Western Hospital ◽  
The Past ◽  
Possible Cause ◽  
Abdominal Ultrasound Examination

This paper describes a prospective three-year study using abdominal ultrasound examination in 114 new CAPD patients. Gallbladder disease was common (22.8%) and four of 16 patients with gallstones (25%) required cholecystectomy after 1–14 (i 7.8 months) on CAPD. Two of these four had evidence of peritonitis in association with cholecystitis. Also we analyzed the clinical course of eight patients on chronic PD who underwent cholecystectomy. They had no serious morbidity, and all returned to chronic PD. While abdominal pain is one of the main features of CAPD-related peritonitis, other causes of abdominal pain may be more difficult to evaluate in the patient on peritoneal dialysis (PD); such causes potentially are more serious because they threaten the continuance of PD as a mode of therapy. Cholecystitis related to cholelithiasis is one such possible cause of abdominal pain. However, since ultrasonography can reliably and non-invasively detect the presence of gallstones, we have used it prospectively to screen patients entering our CAPD training program. This paper reports our findings and the subsequent course of those found to have gallstones during a three-year period. In addition we also reviewed the feasibility of cholecystectomy, its hazards and outcome in eight patients on chronic peritoneal dialysis who underwent this procedure at Toronto Western Hospital in the past seven years.

scholarly journals Chemical peritonitis associated with intraperitoneal vancomycin: A case series

2021 ◽  
Vol 35 (2) ◽  
Author(s):  
José Silvano ◽  
◽  
Luciano Pereira ◽  
Ana Oliveira ◽  
Ana Beco ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Drug Withdrawal ◽  
Clinical Course ◽  
Leukocyte Count ◽  
Case Series ◽  
Aseptic Technique ◽  
Drug Challenge ◽  
Chemical Peritonitis ◽  
Culture Negative

Peritonitis is a serious complication in peritoneal dialysis, usually secondary to an infectious cause. Chemical peritonitis is rarer. No case exclusively attributed to vancomycin has been reported in the last 20 years. Data from 4 consecutive patients diagnosed with culture -negative peritonitis following administration of intraperitoneal vancomycin between May and June 2019 were retrospectively recorded. All patients were treated with 2 grams of intraperitoneal vancomycin after a break in aseptic technique and developed a cloudy effluent. No patient was previously known to be allergic to vancomycin. All had a clear dialysate before vancomycin. All developed an elevated leukocyte count in the dialysate. All had sterile cultures. All resumed a clear effluent with less <100 cells/μL after vancomycin cessation, and in two there were no further administrations. In one, a new drug challenge led to recrudescence of abdominal pain and reappearance of a cloudy sterile effluent. In another, vancomycin from a different lot was administrated 3 days after, no symptoms developed and dialysate cell count remained normal. The pathogenic mechanisms underlying chemical peritonitis are not fully known. The clinical course is typically benign. Management seems to be limited to drug withdrawal. If unrecognized, chemical peritonitis may ultimately lead to unnecessary catheter removal.

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.

Acute Peritonitis Caused by Staphylococcus capitis in a Peritoneal Dialysis Patient

2017 ◽  
Vol 37 (1) ◽  
pp. 115-116 ◽  
Author(s):  
Nikolina Basic-Jukic
Keyword(s):  
Peritoneal Dialysis ◽  
Dialysis Patient ◽  
Peritoneal Dialysis Patient ◽  
Bacterial Identification ◽  
Common Complication ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Acute Peritonitis ◽  
Staphylococcus Capitis

Acute peritonitis remains the most common complication of peritoneal dialysis (PD), with coagulase-negative staphylococci (CoNS) reported to account for more than 25% of peritonitis episodes ( 1 ). Staphylococcus capitis is a gram-positive, catalase-positive CoNS that was originally identified as a commensal on the skin of the human scalp ( 2 ). Advancement of microbiological technologies for bacterial identification enables diagnosis of previously unknown causes of acute peritonitis. This is the first reported case of acute peritonitis in a PD patient caused by S. capitis.

scholarly journals Unusual causes of peritonitis in patients undergoing continuous peritoneal dialysis with emphasis on Listeria monocytogenes.

1992 ◽  
Vol 3 (5) ◽  
pp. 1092-1097
Author(s):  
N M Lunde ◽  
J M Messana ◽  
R D Swartz
Keyword(s):  
Peritoneal Dialysis ◽  
Listeria Monocytogenes ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Antimicrobial Therapy ◽  
Catheter Removal ◽  
Gram Positive ◽  
Gram Negative ◽  
Streptococcus Species ◽  
Continuous Peritoneal Dialysis ◽  
Esrd Patients

Peritonitis remains a significant cause of morbidity in ESRD patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Staphylococcus species, Streptococcus species, and less commonly, gram-negative rods comprise the majority of isolated organisms. Other organisms, including unusual bacteria, fungi, and mycobacteria, comprise 5% or less of cases. Many of the uncommon causes of CAPD peritonitis have been reviewed, with special emphasis on antimicrobial therapy and whether catheter removal was required. The presumed third case of CAPD-associated peritonitis caused by Listeria monocytogenes is also described. In contrast to two other reported cases, our patient was not overtly immunosuppressed. L. monocytogenes infection should therefore be considered in CAPD patients with gram-positive rod peritonitis, even if immunocompetence is presumed.

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