scholarly journals Ewingella americana Peritonitis in a Patient on Peritoneal Dialysis: A Case Report and Review of the Literature

2020 ◽  
Vol 10 (3) ◽  
pp. 147-153
Author(s):  
Shriya Khurana ◽  
Christina Chemmachel ◽  
Ramesh Saxena
Keyword(s):  
Peritoneal Dialysis ◽  
Complete Recovery ◽  
The United States ◽  
Domestic Water ◽  
Total Period ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Root Cause ◽  
Ewingella Americana ◽  
End Stage

Most episodes of peritoneal dialysis (PD)-associated peritonitis are caused by skin-dwelling gram-positive bacteria and gram-negative bacteria colonizing gut and urinary tract. Occasionally, however, uncommon bacteria can cause peritonitis in PD patients. We describe a case of <i>Ewingella americana</i> peritonitis, the first such case reported from the United States. A 68-year-old woman with end-stage kidney disease due to hypertension was initiated on PD 2 years prior to the present event. She presented with abdominal pain associated with nausea and vomiting. She was afebrile and hemodynamically stable. Abdomen was diffusely tender with guarding and rebound. No obvious root cause was apparent. Initial PD fluid white count was 502/mm<sup>3</sup> with 87% neutrophils. Gram stain was negative. Culture grew gram-negative rods, which were later identified as <i>Ewingella americana</i>, resistant to ampicillin and cefazolin but sensitive to gentamicin, ceftazidime, and cefepime. After empiric intraperitoneal vancomycin and gentamicin, she was continued on intraperitoneal gentamicin for a total period of 21 days. She responded to the treatment rapidly with complete recovery. PD fluid on day four showed 40 nucleated cells with 12% neutrophils. Patient remained on PD without consequences. <i>Ewingella americana</i> is a gram-negative facultative anaerobic bacillus that can survive in water, including domestic water. Inadequate hand hygiene is a potential root cause of infection. Although rare, <i>Ewingella</i> peritonitis can be observed in PD patients and is treatable. Clinicians should be aware of <i>Ewingella</i> as a potential cause of PD peritonitis.

Acid–Base Disturbances

2014 ◽  
pp. 594-602
Author(s):  
Julian L. Seifter
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
End Stage Renal Disease ◽  
The United States ◽  
Cardiovascular Complications ◽  
Diabetic Patients ◽  
Stage Renal Disease ◽  
End Stage

According to projections from the United States Renal Data Service (USRDS), 〉600,000 individuals in the United States will have end-stage renal disease (ESRD) by 2010. The leading cause of ESRD in the United State is diabetes, followed by hypertension. As the care of diabetic patients has improved, particularly in the area of cardiovascular disease, they are living through their cardiovascular complications long enough to develop ESRD. As a consequence, since the inception of the Medicare ESRD program. the dialysis population has gradually become older with increasing numbers of comorbid conditions. Renal replacement therapy in the form of hemodialysis or peritoneal dialysis may serve as a bridge to the best form of renal replacement, renal transplantation. The demand for suitable kidneys for transplantation far exceeds the supply, leaving many patients on dialysis for extended periods of time.

scholarly journals COVID-19 in Hospitalized Patients on Chronic Peritoneal Dialysis: A Case Series

2020 ◽  
Vol 51 (8) ◽  
pp. 669-674 ◽  
Author(s):  
Mala Sachdeva ◽  
Nupur N. Uppal ◽  
Jamie S. Hirsch ◽  
Jia H. Ng ◽  
Deepa Malieckal ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Course ◽  
Case Series ◽  
The United States ◽  
Hospitalized Patients ◽  
End Stage Kidney Disease ◽  
Entire Cohort ◽  
End Stage ◽  
Culture Negative ◽  
Descriptive Statistical Analysis

Background: The COVID-19 pandemic has affected the end-stage kidney disease (ESKD) population, with high mortality rates reported among patients on hemodialysis. However, the degree to which it has affected the peritoneal dialysis (PD) population in the United States has not yet been elucidated. In this report, we describe the clinical characteristics, presentations, clinical course, and outcomes of ESKD patients on PD hospitalized with COVID-19. Methods: We describe the characteristics, presentation, and outcomes of adult ESKD patients on chronic PD hospitalized with CO­VID-19 in our 13 major hospitals in the NY health system using descriptive statistical analysis. Results: Of 419 hospitalized patients with ESKD, 11 were on chronic PD therapy (2.6%). Among those 11, 3 patients required mechanical ventilation, 2 of whom died. Of the entire cohort, 9 of the 11 patients (82%) were discharged alive. While fever was a common presentation, more than half of our patients also presented with diarrhea. Interestingly, 3 patients were diagnosed with culture-negative peritonitis during their hospitalization. Seven patients reported positive SARS-CoV-2 exposure from a member of their household. Conclusion: Hospitalized patients on PD with COVID-19 had a relatively mild course, and majority of them were discharged home.

scholarly journals CDC Group EO-4 and Candida tropicalis Peritonitis in a Patient on Peritoneal Dialysis after Upper Endoscopy, Colonoscopy and Coil Embolization of the Gastroduodenal Artery

2016 ◽  
Vol 10 (3) ◽  
pp. 728-732 ◽  
Author(s):  
Shameek Gayen ◽  
Yonah Ziemba ◽  
Shikha Jaiswal ◽  
Adam Frank ◽  
Yasmin Brahmbhatt
Keyword(s):  
United States ◽  
Peritoneal Dialysis ◽  
Coil Embolization ◽  
The United States ◽  
Annual Data ◽  
Fungal Peritonitis ◽  
First Case ◽  
Ct Angiogram ◽  
Stage Renal Disease ◽  
End Stage

Peritoneal dialysis (PD) is an excellent form of renal replacement therapy for many patients with end-stage renal disease (ESRD). Over 10,000 patients receive PD in the United States [United States Renal Data System: 2015 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States, 2015]. PD has superior outcomes compared to hemodialysis in the first 2 years of ESRD [Sinnakirouchenan and Holley: Adv Chronic Kidney Dis 2011;18: 428–432]. However, peritonitis is a known complication and may result in significant morbidity and necessitate transition to hemodialysis, which increases medical costs [Holley and Piraino: Semin Dial 1990;3: 245–248]. We report the first case of a PD patient who underwent endoscopy, colonoscopy and CT angiogram with coil embolization for gastrointestinal bleeding without antibiotic prophylaxis and subsequently developed CDC group EO-4 organism and fungal peritonitis.

scholarly journals Risk of Dementia in Peritoneal Dialysis Patients Compared with Hemodialysis Patients

2015 ◽  
Vol 35 (2) ◽  
pp. 189-198 ◽  
Author(s):  
Dawn F. Wolfgram ◽  
Aniko Szabo ◽  
Anne M. Murray ◽  
Jeff Whittle
Keyword(s):  
Cognitive Impairment ◽  
Peritoneal Dialysis ◽  
The United States ◽  
Dialysis Modality ◽  
Dialysis Patients ◽  
Incident Dementia ◽  
National Cohort ◽  
Stage Renal Disease ◽  
End Stage ◽  
Incidence Of Dementia

Background Compared with similarly aged controls, patients with end-stage renal disease (ESRD) have a higher prevalence of cognitive impairment and more rapid cognitive decline, which is not explained by traditional risk factors alone. Since previous small studies suggest an association of cognitive impairment with dialysis modality, we compared incident dementia among patients initiating hemodialysis (HD) vs peritoneal dialysis (PD) in a large national cohort. Methods This is a retrospective cohort study of incident dialysis patients in the United States from 2006 to 2008 with no diagnosis of dementia prior to beginning dialysis. We evaluated the effect of initial dialysis modality on incidence of dementia, diagnosed by Medicare claims data, adjusted for baseline demographic and clinical data from the USRDS registry. Results Our analysis included 121,623 patients, of whom 8,663 initiated dialysis on PD. The mean age of our cohort was 69.2 years. Patients who initiated PD had a lower cumulative incidence of dementia than those who initiated HD (1.0% vs 2.7%, 2.5% vs 5.3%, and 3.9% vs 7.3% at 1, 2, and 3 years, respectively). The risk of dementia for patients who started on PD was lower compared with those who started on HD, with a hazard ratio (HR) = 0.46 [0.41, 0.53], in an unadjusted model and HR 0.74 [0.64, 0.86] in a matched model. Conclusions Dialysis modality is associated with incident dementia in a cohort of older ESRD patients. This finding warrants further investigation of the effect of dialysis modality on cognitive function and evaluation for possible mechanisms.

scholarly journals Retrospective single-center analysis of the reasons and serious complications of peritoneal-related peritonitis in patients with end-stage renal disease undergoing peritoneal dialysis treatment

2018 ◽  
Vol 128 (3) ◽  
pp. 103-106
Author(s):  
Agnieszka M. Grzebalska ◽  
Anna Steć ◽  
Izabela Ławnicka ◽  
Anna Bednarek-Skublewska ◽  
Andrzej Książek
Keyword(s):  
Peritoneal Dialysis ◽  
Medical Center ◽  
Gram Positive ◽  
Dialysis Treatment ◽  
Gram Negative ◽  
Antibiotics Use ◽  
Stage Renal Disease ◽  
End Stage ◽  
Culture Negative ◽  
Dialysis Discontinuation

Abstract Introduction. Peritonitis is still a serious complication of peritoneal dialysis (PD). Consequences of peritonitis can be severe. The most severe are peritoneal dialysis discontinuation and patient’s death. In majority, peritonitis is bacterial in the origin. Mainly there is a gram-positive infection, less commonly gram-negative one. Some peritonitis are culture-negative, because of former antibiotics use. In minority, fungal, tuberculous or even viral peritonitis are observed. Aim. The aim of the present study is to analyze the number, origin and serious complications of peritoneal-related peritonitis cases found in our PD center. Material and methods. We performed a retrospective five-years evaluation of medical records. The total number of peritonitis episodes was 56 cases, underwent by 30 adult patients on chronic peritoneal dialysis. Peritonitis was diagnosed according to ISPD recommendations. Causes and serious complications of peritoneal-related peritonitis were analyzed in every single year. Etiology of peritonitis was classified on the basis of the result of effluent dialysate culture as: gram-positive, gram-negative and culture negative. Peritoneal dialysis discontinuation or patient’s death were defined as serious complications. Results. Among 56 cases of peritoneal-related peritonitis 44.6% were gram-positive, 26.8% gram-negative and 28.6% culture-negative. No fungal or tuberculosis peritonitis were found. Because of the peritonitis complications in the evaluated period, six patients discontinued peritoneal dialysis and were switched to hemodialysis (20%), two others died (6.7%). Conclusion. The further improvement in peritonitis’ causes identification and treatment is needed in order to reduce number of serious complications in our medical center.

scholarly journals Recalibration of the Antimicrobial MIC

2021 ◽  
Vol 2 (4) ◽  
pp. 01-02
Author(s):  
Daniel Amsterdam
Keyword(s):  
Antibiotic Resistance ◽  
The United States ◽  
World Health ◽  
Gram Negative Bacteria ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
The World ◽  
Health Organization ◽  
Laboratory Assay

In 2009, the World health organization (WHO) referred to the problem of antibiotics and antibiotic resistance stating, “Antibiotic Resistance – one of the three greatest threats to human health.” In 2019 (i.e., just as the COVID-19 pandemic was evolving), more than 2.8 million antibiotic-resistant infections were identified in the United States, resulting in more than 35,000 deaths (CDC 2019). The initial laboratory assay which demonstrated the activity of an antibacterial compound was performed by Alexander Fleming. He showed that an extract from the mold, Penicillium rubens, could inhibit the growth of several species of Gram-positive bacteria – but not Gram-negative bacteria that were cross-streaked on agar against the diffused Penicillium compound.

Recovery of Renal Function and the Discontinuation of Dialysis in Patients Treated with Continuous Peritoneal Dialysis

2003 ◽  
Vol 23 (2) ◽  
pp. 151-156 ◽  
Author(s):  
Adam Goldstein ◽  
Alan S. Kliger ◽  
Fredric O. Finkelstein
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
New England ◽  
The United States ◽  
New Haven ◽  
Continuous Peritoneal Dialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Criteria For Selection

Objective Previous studies have shown that patients with end-stage renal disease (ESRD) treated with continuous peritoneal dialysis (CPD) have better preservation of endogenous renal function than patients treated with hemodialysis (HD). We wondered if this better preservation of endogenous renal function seen with CPD patients translates into the improved likelihood of recovery of endogenous renal function in those patients with potentially reversible causes of renal failure. Methods To evaluate this question, we reviewed the records of all 1200 patients that completed CPD training at a large, freestanding peritoneal dialysis center in New Haven, Connecticut, between 1979 and 1999, and the records of all patients completing CPD training in New England between 1993 and 1998. In New Haven, about half the new patients with ESRD were started on CPD compared to only 15% in New England. We then compared the chances of recovery of renal function in these two cohorts of CPD patients to the chances of recovery of renal function in two groups of HD patients. The first group consisted of all patients that started on HD in New England between 1993 and 1998. The second group consisted of all patients that started HD in our HD unit in New Haven, Connecticut, between 1993 and 1999. The data on the New England patients were provided by the ESRD Network of New England. All patients entered into the present study had to have been on dialysis for a minimum of 3 months, as in the United States Renal Data System database, and had to have recovered sufficient renal function to be able to be maintained off dialysis for a minimum of 30 days. Results 29 of 1200 CPD patients (2.4%) trained in New Haven recovered sufficient renal function to permit the discontinuation of dialysis for a minimum of 30 days. In comparison, only 305 of 19 032 patients (1.6%) managed with HD in New England ( p < 0.05 compared to New Haven CPD patients) and 3 of 430 patients (0.7%) in our HD center ( p < 0.05 compared to New Haven CPD patients) recovered sufficient glomerular filtration rate (GFR) to allow the discontinuation of dialysis for at least 30 days. If only those CPD patients that initiated dialysis between 1993 and 1999 in New Haven were analyzed, 15 of 369 (4.1%) recovered sufficient GFR to allow discontinuation of dialysis for at least 30 days ( p < 0.025 compared to both groups of HD patients). Of the 2924 patients completing CPD training in New England, 60 (2.1%) recovered renal function; this percentage is not significantly different from the percent of HD patients in New England recovering renal function. Conclusion Although the present study is a retrospective study and the actual criteria for selection of CPD and HD therapy are not controlled for, the data raise the question of whether there may be a therapeutic advantage to treating newly diagnosed ESRD patients, that have a potentially reversible cause of renal failure, with CPD.

Clinical Pharmacology of Antibiotics: The Use of Intraperitoneal Antibiotics to Treat Dialysis-Associated Peritonitis

1988 ◽  
Vol 9 (1) ◽  
pp. 37-39
Author(s):  
Terrill G. Washington ◽  
Mark Eggleston
Keyword(s):  
Peritoneal Dialysis ◽  
End Stage Renal Disease ◽  
Pediatric Patients ◽  
Fungal Infections ◽  
Major Complication ◽  
Gram Negative Bacteria ◽  
Gram Positive Bacteria ◽  
Widespread Acceptance ◽  
Stage Renal Disease ◽  
End Stage

Peritoneal dialysis has been successfully used in treating patients with end stage renal disease (ESRD) for approximately 40 years. Peritoneal infections are a frequent consequence of this procedure which has diminished its acceptance by physicians and patients alike. Since the development of an improved access catheter and automated dialysate delivery devices, peritoneal analysis has been gaining widespread acceptance as an alternative to hemodialysis in the treatment of patients with ESRD. Despite the improvement in the peritoneal dialysis systems, peritonitis continues to be a major complication for adult and pediatric patients undergoing continuous ambulatory peritoneal dialysis (CAPD).:‘-’ Although most patients have from less than one to four peritonitis episodes per year, some patients have no episodes of' peritonitis or have a significantly high occurrence (greater than four episodes) of peritonitis. Several reports have indicated that two thirds of the total number of ‘peritonitis episodes is due to gram-positive bacteria. Gram-negative bacteria accounts for approximately 15% and fungal infections account for less than 5%.

Gender differences in peritoneal dialysis initiation in the US end-stage renal disease population

2020 ◽  
Vol 40 (1) ◽  
pp. 57-61
Author(s):  
Savannah L Vogel ◽  
Tripti Singh ◽  
Brad C Astor ◽  
Sana Waheed
Keyword(s):  
United States ◽  
Gender Differences ◽  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
The United States ◽  
Mean Value ◽  
Dialysis Modality ◽  
Stage Renal Disease ◽  
End Stage

Background: Overall, a disproportionately small number of end-stage renal disease (ESRD) patients start peritoneal dialysis (PD) in the United States compared to hemodialysis. Little is known about whether gender has an effect on the initial modality of renal replacement therapy utilized by patients; however, prior studies have demonstrated gender disparities in the diagnosis and treatment of various other health conditions, including kidney disease. Methods: Using data from the United States Renal Data System (USRDS), we estimated the proportion of patients utilizing PD as their initial dialysis modality between 2000 and 2014, adjusting estimates to the mean value of all covariates and compared these estimates for women and men. Results: We found that 7.9% of women and 7.5% of men used PD as their initial dialysis modality. The unadjusted odds ratio (OR) of women initiating PD as their initial modality compared to men was 1.04 (95% CI 1.02–1.05, p < 0.001). After adjustment for age, race, ethnicity, cause of ESRD, number of comorbidities, income, employment status, and timing of referral to nephrology, the difference was even more significant, with women being 12% (OR 1.12, CI 1.10–1.14, p < 0.001) more likely to initiate PD than men. However, within different subgroups, older women and women with higher number of comorbidities were less likely to be on PD than their male counterparts. Conclusions: Our results indicate that gender plays a role in the initial dialysis modality used by patients and providers should be cognizant of these gender differences. Further studies are needed to ascertain the cause of this observed difference.

Changing Patterns of Peritoneal Dialysis Utilization in the United States

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 51-52
Author(s):  
Rajnish Mehrotra
Keyword(s):  
United States ◽  
Peritoneal Dialysis ◽  
The United States ◽  
Progressive Increase ◽  
Physician Training ◽  
Automated Peritoneal Dialysis ◽  
Changing Patterns ◽  
Steep Decline ◽  
Stage Renal Disease ◽  
End Stage

The proportion of incident U.S. patients with end-stage renal disease starting chronic peritoneal dialysis (CPD) has historically been low. The low take-on for CPD in the United States is likely multifactorial, but limited physician training and inadequate pre-dialysis patient education appear to be particularly important. Furthermore, two key changes have occurred in the United States: a steep decline in CPD take-on and a progressive increase in the use of automated peritoneal dialysis (APD). The decline in CPD take-on has affected virtually every subgroup examined and has occurred, paradoxically, when the CPD outcomes in the country have improved. Understanding the reasons for historically low CPD take-on and recent steep declines in utilization may allow for plans to reverse these trends to be developed.

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