scholarly journals Brevundimonas vesicularis Peritonitis in a Chronic Peritoneal Dialysis Patient

2021 ◽  
pp. 314-320
Author(s):  
Vijayakumar Paramasivam ◽  
Armando Paez ◽  
Ashish Verma ◽  
Daniel Landry ◽  
Gregory L. Braden
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Dialysis Patient ◽  
Chronic Peritoneal Dialysis ◽  
Peritoneal Catheter ◽  
Gram Negative ◽  
Initial Symptoms ◽  
Continuous Cycling ◽  
Amoxicillin Clavulanate ◽  
Brevundimonas Vesicularis ◽  
Culture Negative

Gram-negative peritonitis in chronic peritoneal dialysis patients is difficult to treat and may result in catheter loss. <i>Brevundimonas vesicularis</i> is a Gram-negative rod bacterium which rarely causes infections in humans. A 41-year-old male receiving continuous cycling peritoneal dialysis for 5 months developed culture-negative peritonitis. He failed initial empiric treatment with intraperitoneal vancomycin and levofloxacin and thereafter intravenous gentamicin. <i>B. vesicularis</i> resistant to levofloxacin was isolated from the peritoneal fluid 21 days after his initial symptoms. Despite treatment with intravenous ceftriaxone and oral amoxicillin-clavulanate, the infection persisted, which required removal of the peritoneal catheter in order to cure this infection. We describe the features of <i>B. vesicularis</i> infection in our patient and the rarely reported additional cases.

Infected Intra-Abdominal Hematoma Associated with an Indwelling Tenckhoff Catheter

1984 ◽  
Vol 4 (4) ◽  
pp. 249-250
Author(s):  
Gregory L. Braden ◽  
Michael J. Germain ◽  
Vincent A. Guardione ◽  
John P. Fitzgibbons
Keyword(s):  
Peritoneal Dialysis ◽  
Chronic Peritoneal Dialysis ◽  
Peritoneal Catheter ◽  
Outflow Obstruction ◽  
End Stage Renal Failure ◽  
Tenckhoff Catheter ◽  
Continuous Cycling ◽  
Surgical Evacuation ◽  
Tract Infections ◽  
End Stage

Two months after cessation of continous cycling peritoneal dialysis a pa tient developed an infected intra abdominal hematoma while a Tenck hoff catheter was still present in the abdomen. The hematoma required surgical evacuation. This complication suggests that we should consider early removal of Tenckhot T catheters after successful renal transplanta tion or after switching to hemo dialysis. The chronic peritoneal catheter pioneered by Tenckhoff has made it possible to treat thousands of patients with end stage renal failure by chronic peritoneal dialysis. The complications of Tenckhoff catheters include dialysate leakage, outflow obstruction, pelvic pam, hydrothorax, dacron cuff extrusion, tract infections, combined inflow outflow obstruction, abdominal or in guinal hernias, and hydroceles (1–6). This paper describes a patient who developed abdominal pain and an in fected intra-abdominal hematoma two months after being transferred from continuous cycling peritoneal dialysis (CCPD) to hemodialysis. The appear ance of this complication two months after discontinuing peritoneal dialysis raises the question: When should one remove a Tenckhoff catheter after transfer to hemodialysis or successful renal transplantation?

scholarly journals The Effect of Exit-Site Antibacterial Honey versus Nasal Mupirocin Prophylaxis on the Microbiology and Outcomes of Peritoneal Dialysis-Associated Peritonitis and Exit-Site Infections: A Sub-Study of the Honeypot Trial

2015 ◽  
Vol 35 (7) ◽  
pp. 712-721 ◽  
Author(s):  
Lei Zhang ◽  
Sunil V. Badve ◽  
Elaine M. Pascoe ◽  
Elaine Beller ◽  
Alan Cass ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Site Infection ◽  
Control Groups ◽  
Exit Site ◽  
Exit Site Infection ◽  
Gram Negative ◽  
Nasal Mupirocin ◽  
And Control ◽  
Technique Failure ◽  
Culture Negative

Background The HONEYPOT study recently reported that daily exit-site application of antibacterial honey was not superior to nasal mupirocin prophylaxis for preventing overall peritoneal dialysis (PD)-related infection. This paper reports a secondary outcome analysis of the HONEYPOT study with respect to exit-site infection (ESI) and peritonitis microbiology, infectious hospitalization and technique failure. Methods A total of 371 PD patients were randomized to daily exit-site application of antibacterial honey plus usual exit-site care ( N = 186) or intranasal mupirocin prophylaxis (in nasal Staphylococcus aureus carriers only) plus usual exit-site care (control, N = 185). Groups were compared on rates of organism-specific ESI and peritonitis, peritonitis-and infection-associated hospitalization, and technique failure (PD withdrawal). Results The mean peritonitis rates in the honey and control groups were 0.41 (95% confidence interval [CI] 0.32 – 0.50) and 0.41 (95% CI 0.33 – 0.49) episodes per patient-year, respectively (incidence rate ratio [IRR] 1.01, 95% CI 0.75 – 1.35). When specific causative organisms were examined, no differences were observed between the groups for gram-positive (IRR 0.99, 95% CI 0.66 – 1.49), gram-negative (IRR 0.71, 95% CI 0.39 – 1.29), culture-negative (IRR 2.01, 95% CI 0.91 – 4.42), or polymicrobial peritonitis (IRR 1.08, 95% CI 0.36 – 3.20). Exit-site infection rates were 0.37 (95% CI 0.28 – 0.45) and 0.33 (95% CI 0.26 – 0.40) episodes per patient-year for the honey and control groups, respectively (IRR 1.12, 95% CI 0.81 – 1.53). No significant differences were observed between the groups for gram-positive (IRR 1.10, 95% CI 0.70 – 1.72), gram-negative (IRR: 0.85, 95% CI 0.46 – 1.58), culture-negative (IRR 1.88, 95% CI 0.67 – 5.29), or polymicrobial ESI (IRR 1.00, 95% CI 0.40 – 2.54). Times to first peritonitis-associated and first infection-associated hospitalization were similar in the honey and control groups. The rates of technique failure (PD withdrawal) due to PD-related infection were not significantly different between the groups. Conclusion Compared with standard nasal mupirocin prophylaxis, daily topical exit-site application of antibacterial honey resulted in comparable rates of organism-specific peritonitis and ESI, infection-associated hospitalization, and infection-associated technique failure in PD patients.

Effluent lipopolysaccharide is a prompt marker of peritoneal dialysis-related gram-negative peritonitis

2020 ◽  
Vol 40 (5) ◽  
pp. 455-461
Author(s):  
Hao Yan ◽  
Dahua Ma ◽  
Shuang Yang ◽  
Zhaohui Ni ◽  
Wei Fang
Keyword(s):  
Peritoneal Dialysis ◽  
Roc Analysis ◽  
Operating Characteristic ◽  
Leukocyte Count ◽  
The Other ◽  
Cutoff Value ◽  
Gram Negative ◽  
Lower Blood ◽  
Blood Leukocyte ◽  
Culture Negative

Background: To investigate the value of effluent lipopolysaccharide (LPS) for early detection of gram-negative peritonitis (GNP) in peritoneal dialysis (PD) patients. Methods: PD-related peritonitis episodes occurring between January 2016 and December 2018 were included in the study. Effluent LPS and the other infectious parameters were measured at peritonitis presentation, and peritonitis was categorized as GNP, non-GNP, and culture-negative peritonitis. Receiver operating characteristic (ROC) analysis was employed to evaluate the efficacy of effluent LPS to distinguish GNP. Results: A total of 161 peritonitis episodes were analyzed, including 49 GNP episodes and 82 non-GNP episodes. In contrast with non-GNP, GNP presented with higher effluent leukocyte count (3236 (1497–6144) vs. 1904 (679–4071) cell mm−3, p = 0.008), increased effluent LPS (1.552 (0.502–2.500) vs. 0.016 (0.010–0.030) EU mL−1, p < 0.001), lower blood leukocyte count (9.95 ± 3.18 vs. 11.56 ± 4.37 × 109 L−1, p = 0.017), greater neutrophil predominance (87.1 ± 4.6% vs. 83.4 ± 7.7%, p = 0.001), and greater “procalcitonin” (PCT, 4.90 (2.20–12.60) vs. 1.00 (0.51–4.07) µg L−1, p < 0.001). It took 5.2 ± 3.1 h to report the results of effluent LPS. Effluent LPS cutoff value of >0.035 EU mL−1 showed an area under the ROC curve of 0.972 (95% CI 0.951–0.994, p < 0.001) in differentiating GNP from non-GNP with a sensitivity of 100% and a specificity of 80.5%, and its joint utilization with PCT further increased the specificity (91.4%) to discriminate GNP. Conclusions: PD effluent LPS could be an applicable early marker of gram-negative organism-related peritonitis in PD patients.

Pharmacokinetics of Oral Ciprofloxacin in Continuous Cycling Peritoneal Dialysis

2004 ◽  
Vol 24 (5) ◽  
pp. 447-453 ◽  
Author(s):  
Sharon M. Yeung ◽  
Scott E. Walker ◽  
Sandra A.N. Tailor ◽  
Linda Awdishu ◽  
Sheldon Tobe ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Concentration ◽  
Empirical Treatment ◽  
Klebsiella Species ◽  
Maximum Serum ◽  
Gram Negative ◽  
E Coli ◽  
Continuous Cycling ◽  
Maximum Serum Concentration ◽  
Oral Ciprofloxacin

Background In order to avoid aminoglycosides, the International Society for Peritoneal Dialysis recommends cefazolin and ceftazidime for empirical treatment of peritonitis. Ciprofloxacin covers relevant gram-negative pathogens without the resistance associated with ceftazidime. However, ciprofloxacin pharmacokinetic data in patients on continuous cycling peritoneal dialysis (CCPD) are lacking. Objectives ( 1 ) To determine the pharmacokinetics of oral ciprofloxacin in CCPD patients, ( 2 ) to compare serum and dialysate ciprofloxacin concentrations with minimum inhibitory concentrations (MIC) of the gram-negative bacteria associated with peritonitis, and ( 3 ) to establish oral ciprofloxacin dosing guidelines for the empirical treatment of peritonitis in patients receiving CCPD. Methods Eligible CCPD patients received 2 doses of ciprofloxacin: 750 mg orally every 12 hours. Serial blood and end-of-dwell dialysate samples were collected during the first 12-hour interval; an end-of-dwell dialysate sample from the overnight dwell and a final blood sample were collected at the end of the second 12-hour interval. Ciprofloxacin concentrations were determined using a liquid chromatographic (HPLC)-fluorescence method. Pharmacokinetic calculations were completed assuming a one-compartment model. Results Eight patients completed the study. The pharmacokinetic parameters determined for ciprofloxacin were (mean ± SEM) serum half-life 10.1 ± 1.2 hours, maximum serum concentration 2.7 ± 0.5 mg/L, time to maximum serum concentration 1.6 ± 0.1 hours after the first dose, and peritoneal clearance 1.2% ± 0.1% of the mean calculated total body clearance. While all patients achieved serum area under the concentration-time curve: MIC > 125 for Escherichia coli and Klebsiella species after the first dose, only 2 patients achieved this goal for Pseudomonas aeruginosa. End-of-dwell dialysate concentrations were above the MIC for E. coli, Klebsiella spp, and P. aeruginosa after the second dose. Conclusion Ciprofloxacin 750 mg orally every 12 hours in CCPD patients may be useful for empirical gram-negative coverage of CCPD peritonitis and for treatment of documented peritonitis caused by sensitive E. coli or Klebsiella species. While ceftazidime may be required for documented pseudomonal peritonitis, the oral ciprofloxacin regimen achieved adequate serum concentrations to treat systemic gram-negative infections caused by sensitive E. coli or Klebsiella species.

scholarly journals Anterior Ischemic Optical Neuropathy in Children on Chronic Peritoneal Dialysis: Report of 7 Cases

2015 ◽  
Vol 35 (2) ◽  
pp. 135-139 ◽  
Author(s):  
Giacomo Di Zazzo ◽  
Isabella Guzzo ◽  
Lara De Galasso ◽  
Michele Fortunato ◽  
Giovanna Leozappa ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Acute Onset ◽  
Chronic Dialysis ◽  
Ischemic Optic Neuropathy ◽  
Partial Recovery ◽  
Chronic Peritoneal Dialysis ◽  
Increased Risk ◽  
Continuous Cycling ◽  
Ciliary Arteries ◽  
Sudden Blindness

Background Anterior ischemic optic neuropathy (AION) is characterized by infarction of the optic nerve head due to hypoperfusion of the posterior ciliary arteries and causes sudden blindness in adults on chronic dialysis, but has rarely been described in children. Unlike adults, children do not have comorbidities related to aging. Methods We retrospectively analyzed data of 7 children on nocturnal continuous cycling peritoneal dialysis (CCPD) who developed AION identified within the Italian Registry of Pediatric Chronic Dialysis. We also summarized data from 10 cases reported in the literature. Results Our 7 patients suffered from acute onset bilateral blindness. Their mean age was 3.2 years and chronic hypotension had been observed prior the AION in 3 of the 7 children. Low systolic blood pressure (SBP) was associated with higher risk of developing AION according to statistical analysis. None recovered completely. In total, 11 out of 16 experienced a partial recovery and no clear evidence emerged favoring specific treatments. Conclusions Hypotensive children treated with CCPD are at increased risk of developing AION, which often results in irreversible blindness.

scholarly journals A comparison between Chinese finger trap and Roman sandals suturein peritoneal dialysis catheters for chronic kidney disease appliedin veterinary medicine

2020 ◽  
Vol 71 (01) ◽  
pp. 8-11
Author(s):  
BOGDAN ALEXANDRU VIȚĂLARU ◽  
MĂDĂLIN ION RUSU ◽  
CARMEN MIHAI ◽  
ALEXANDRU CHIOTOROIU
Keyword(s):  
Chronic Kidney Disease ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Chronic Treatment ◽  
Chronic Peritoneal Dialysis ◽  
Peritoneal Catheter ◽  
Catheter Migration ◽  
Group A ◽  
Initial Placement ◽  
Group B

Catheters designed for chronic peritoneal dialysis have Dacron cuffs meant to protect the patient against bacterialinfection and catheter migration that may lead to a high peritonitis rate in case of extensive use. Peritoneal catheter isfixed by suturing the skin with a non-absorbable monofilament thread ranging from 4/0 to 2/0. The two types of suturesmost commonly used are Roman sandal and Chinese fingertrap. In this study we selected 44 dogs, both males andfemales with CKD (Chronic Kidney Disease) undergoing peritoneal dialysis. We have created two groups: first group(A) of 22 patients were treated using a peritoneal catheter for chronic treatment, with Roman sandal suture and thesecond group of 22 patients (B) were treated using a peritoneal catheter for chronic treatment, with Chinese fingertrapsuture. All patients from group A kept the catheters until the end of the treatment (22 out of 22, 100%). Eight out of14 patients (36.36%) from group B needed secondary suture. Four out of the eight patients (18.18%) form the group Bneeded secondary suturing because of the suture weakening. Three out of the eight patients (13.63%) form the groupB needed secondary suturing of the catheter because of the skin rupture at the initial placement spot of the suture. Oneof the eight patients (4.54%) form the group B needed secondary suturing of the catheter because of the catheterreplacement, due to the weakening of the suture and its lack of resistance to the aggression manifested by the patients

Microbiology and Outcomes of Peritonitis in Australian Peritoneal Dialysis Patients

2011 ◽  
Vol 31 (6) ◽  
pp. 651-662 ◽  
Author(s):  
Joanna R. Ghali ◽  
Kym M. Bannister ◽  
Fiona G. Brown ◽  
Johan B. Rosman ◽  
Kathryn J. Wiggins ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Single Agent ◽  
Catheter Removal ◽  
Fungal Peritonitis ◽  
Gram Negative ◽  
Single Organism ◽  
Transplant Registry ◽  
Anaerobic Infections ◽  
Gram Negative Organisms ◽  
Culture Negative

We analyzed data from the Australia and New Zealand Dialysis and Transplant Registry for 1 October 2003 to 31 December 2008 with the aim of describing the nature of peritonitis, therapies, and outcomes in patients on peritoneal dialysis (PD) in Australia.At least 1 episode of PD was observed in 6639 patients. The overall peritonitis rate was 0.60 episodes per patient–year (95% confidence interval: 0.59 to 0.62 episodes), with 6229 peritonitis episodes occurring in 3136 patients. Of those episodes, 13% were culture-negative, and 11% were polymicrobial. Gram-positive organisms were isolated in 53.4% of single-organism peritonitis episodes, and gram-negative organisms, in 23.6%. Mycobacterial and fungal peritonitis episodes were rare. Initial antibiotic therapy for most peritonitis episodes used 2 agents (most commonly vancomycin and an aminoglycoside); in 77.2% of episodes, therapy was subsequently changed to a single agent. Tenckhoff catheter removal was required in 20.4% of cases at a median of 6 days, and catheter removal was more common in fungal, mycobacterial, and anaerobic infections, with a median time to removal of 4 – 5 days. Peritonitis was the cause of death in 2.6% of patients. Transfer to hemodialysis and hospitalization were frequent outcomes of peritonitis. There was no relationship between center size and peritonitis rate. The peritonitis rate in Australia between 2003 and 2008 was higher than that reported in many other countries, with a particularly higher rate of gram-negative peritonitis.

Factors Contributing to the Differences in Peritonitis Rates between Centers and Regions

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 281-285 ◽  
Author(s):  
Andrea E. Stinghen ◽  
Pasqual Barretti ◽  
Roberto Pecoits–Filho
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Selection ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Gram Negative ◽  
Significant Percentage ◽  
Technological Advances ◽  
The World ◽  
Culture Negative

Despite improvements in connectology, peritoneal dialysis (PD)–associated peritonitis contributes significantly to morbidity and modality failure in patients maintained on PD therapy. A broad spectrum of organisms—gram-positive, gram-negative, fungal, anaerobic—are involved in this complication. In addition, a significant percentage of episodes involve polymicrobial and culture-negative infection. Technological advances are being developed to minimize the incidence of access-related complications such as peritonitis. Many traditional factors such as exit-site infection and poor technique have been already identified. In the present review, we discuss the geographic, patient selection, and clinical issues that can affect peritonitis rates in different areas of the world and in different centers in the same area.

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