Peritonitis in Continuous Ambulatory Peritoneal Dialysis

1986 ◽  
Vol 31 (2) ◽  
pp. 85-89 ◽  
Author(s):  
W.G.J. Smith ◽  
D.J. Tsakiris ◽  
B.J.R. Junor ◽  
J.D. Briggs ◽  
S.R. Alcock ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Antimicrobial Therapy ◽  
Exit Site ◽  
Diagnosis And Management ◽  
And Staphylococcus Aureus ◽  
Culture Negative ◽  
Main Complication

The main complication of continuous ambulatory peritoneal dialysis (CAPD) is peritonitis. This paper describes our experience in the diagnosis and management of this complication in 66 patients during the three years to October 1982. The overall incidence of peritonitis was one episode every 6.75 patient months. Staphylococcus albus and Staphylococcus aureus together accounted for 46 per cent of the episodes, and 24 per cent were culture negative. Catheter exit site infections due to Staphylococcus aureus were common and they may have predisposed to peritonitis with gram -ve organisms as well as to staphylococcal peritonitis. Antimicrobial therapy was effective in 60 per cent of peritonitis episodes. The culture negative episodes usually responded to treatment while those due to fungi, though uncommon, did not. Twenty-nine per cent of these CAPD patients were transferred to haemodialysis because of peritonitis which failed to respond to treatment or which recurred repeatedly.

The Impact of Peritonitis on Peritoneal and Systemic Acid-Base Status of Patients on Continuous Ambulatory Peritoneal Dialysis

1994 ◽  
Vol 14 (1) ◽  
pp. 61-65 ◽  
Author(s):  
Jacques J. Sennesael ◽  
Godelieve C. De Smedt ◽  
Patricia Van der Niepen ◽  
Dierik L. Verbeelen
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Acid Base ◽  
Gram Positive ◽  
Gram Negative ◽  
Arterial Blood ◽  
Blood Ph ◽  
Acid Base Status ◽  
And Staphylococcus Aureus

Objective To assess the possible effects of peritonitis on peritoneal and systemic acid-base status. Design pH, pCO2, lactate, and total leukocyte and differential count were simultaneously determined in the overnight dwell peritoneal dialysis effluent (PDE) and arterial blood in noninfected patients (controls) and on days 1, 3, and 5 from the onset of peritonitis. Setting University multidisciplinary dialysis program. Patients Prospective analysis of 63 peritonitis episodes occurring in 30 adult CAPD patients in a single center. Results In controls, mean (±SD) acid-base parameters were pH 7.41 ±0.05, pCO2 43.5±2.6 mm Hg, lactate 2.5±1.5 mmol/L in the PDE, and pH 7.43±0.04, PaCO2 36.8±3.8 mm Hg, lactate 1.4±0.7 mmol/L in the blood. In sterile (n=6), gram-positive (n=34), and Staphylococcus aureus (n=9) peritonitis PDE pH's on day 1 were, respectively, 7. 29±0.07, 7. 32±0.07, and 7.30±0.08 (p<0.05 vs control). In gram -negative peritonitis (n=14) PDE pH was 7.21 ±0.08 (p<0.05 vs all other groups). A two-to-threefold increase in PDE lactate was observed in all peritonitis groups, but a rise in pCO2 was only seen in gram -negative peritonitis. Acid-base profile of PDE had returned to control values by day 3 in sterile, gram -positive and Staphylococcus aureus peritonitis and by day 5 in gramnegative peritonitis. Despite a slight increase in plasma lactate on the first day of peritonitis, arterial blood pH was not affected by peritonitis. Conclusion PDE pH is decreased in continuous ambulatory peritoneal dialysis (CAPD) peritonitis, even in the absence of bacterial growth. In gram-negative peritonitis, PDE acidosis is more pronounced and prolonged, and pCO2 is markedly increased. Arterial blood pH is not affected by peritonitis.

Mycobacterium Chelonei Peritonitis in a Patient Undergoing Continuous Ambulatory Peritoneal Dial ysis (CAPD)

1983 ◽  
Vol 3 (2) ◽  
pp. 86-88 ◽  
Author(s):  
Michel Poisson ◽  
Vincent Beroniade ◽  
Pierre Falardeau ◽  
Carlos Vega ◽  
Richard Morisset
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Antimicrobial Therapy ◽  
Tap Water ◽  
Mycobacterial Infection ◽  
Gram Stain ◽  
Bacterial Peritonitis ◽  
Aerobic And Anaerobic ◽  
Culture Negative

This paper describes a case of Mycobacterium chelonei peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). The patient probably acquired the infection from tap water. He presented with cloudy effluent, abdominal pain and systemic toxicity. Originally, gram stain, Ziehl-Neelsen stain, aerobic and anaerobic cultures were negative. One week later, culture grew an aerobic, fast growing, acid fast bacterium, which later was identified as Mycobacterium chelonei. The peritonitis was treated successfully with erythromycin and catheter removal. The diagnosis of tuberculous and non-tuberculous mycobacterial peritonitis during CAPD can be difficult. Compared to usual bacterial peritonitis associated with CAPD, everything in these cases proves to be nonspecific. Mycobacterial infection should be suspected in all episodes of culture-negative peritonitis especially those which do not respond to usual antimicrobial therapy.

Continuous Ambulatory Peritoneal Dialysis in Egypt: Progression despite Handicaps

2010 ◽  
Vol 30 (3) ◽  
pp. 269-273 ◽  
Author(s):  
Khaled M. Mahmoud ◽  
Hussein A. Sheashaa ◽  
Osama A. Gheith ◽  
Ehab W. Wafa ◽  
Amgad E. Agroudy ◽  
...  
Keyword(s):  
Developing Countries ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Infection Rates ◽  
Exit Site ◽  
Exit Site Infection ◽  
Biochemical Assessment ◽  
And Training ◽  
Culture Negative

♦ BackgroundDespite the well-known advantages of continuous ambulatory peritoneal dialysis (CAPD), it continues to be grossly underutilized in many developing countries. However, some developing countries, such as Mexico, use the modality very effectively. In view of this, we started the first CAPD program in Egypt.♦ MethodsSince its start in 1997, our program has treated 33 patients. Straight double-cuffed Tenckhoff catheters were surgically placed in all patients. Twin-bag systems were used. All patients underwent monthly clinical and biochemical assessment and measurement of Kt/V urea. Peritonitis and exit-site infection rates were monitored.♦ ResultsMost treated patients were adult and female. Mean age was 31.7 years and mean follow-up duration was 18 months. Peritonitis rate was 1 episode /21.3 months and was easily managed in most patients. Staphylococcus aureus was the most commonly isolated organism (24%) but 49% of cases were culture negative. There were no exit-site infections. Mean weekly Kt/V urea was 1.78 ± 0.23.♦ ConclusionWe report the successful development of a small CAPD program in Egypt, made possible by well-established financial support, a motivated team of doctors and nurses, and good patient selection and training.

scholarly journals Nasal mupirocin prevents Staphylococcus aureus exit-site infection during peritoneal dialysis. Mupirocin Study Group.

1996 ◽  
Vol 7 (11) ◽  
pp. 2403-2408
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Treatment Group ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Nasal Carriage ◽  
Control Group ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Nasal Mupirocin

A total of 1144 patients receiving continuous ambulatory peritoneal dialysis in nine European centers was screened for nasal carriage of Staphylococcus aureus. Two hundred sixty-seven subjects were defined as carriers of S. aureus by having had at least two positive swab results from samples taken on separate occasions, and were randomly allocated to treatment or control groups. Members of each group used a nasal ointment twice daily for 5 consecutive days every 4 wk. The treatment group used calcium mupirocin 2% (Bactroban nasal; SmithKline Beecham, Welwyn Garden City, United Kingdom) and the control group used placebo ointment. Patients were followed-up for a maximum period of 18 months. There were 134 individuals in the mupirocin group, and 133 individuals acted as control subjects. There were no differences in demographic data, cause of renal failure, type of catheter, system used, or method of exit-site care between the groups. Similarly, there were no differences in patient outcome or incidence of adverse events between both groups. Nasal carriage fell to 10% in those subjects who received active treatment and 48% in those who used the placebo ointment. There were 55 exit-site infections in 1236 patient-months in the control group and 33 in 1390 patient-months in the treatment group (not significant). S. aureus caused 14 episodes of exit-site infection in the mupirocin group and 44 in the control group (P = 0.006, mixed effects Poisson regression model). There were no differences in the rate of tunnel infection or peritonitis. There was no evidence of a progressive increase in resistance to mupirocin with time. Regular use of nasal mupirocin in continuous ambulatory peritoneal dialysis patients who are nasal carriers of S. aureus significantly reduces the rate of exit-site infections that occurs because of this organism.

CAPD Catheter Exit-Site and Tunnel Infection with Fungal Etiology—Treatment and Catheter Reinsertion for an Extremely Rare Complication

2017 ◽  
Vol 37 (2) ◽  
pp. 237-239
Author(s):  
Manmeet Singh Jhawar ◽  
Jasmin Das ◽  
Pratish George ◽  
Anil Luther
Keyword(s):  
Candida Albicans ◽  
Peritoneal Dialysis ◽  
Case Report ◽  
Fungal Infection ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Rare Complication ◽  
Exit Site ◽  
Duration Of Therapy ◽  
Tunnel Infection ◽  
Few Data

Fungal infection is an extremely rare etiology of exit-site and tunnel infection in patients on continuous ambulatory peritoneal dialysis (CAPD). There are few data available regarding its management—especially choice of antifungals, duration of therapy, and removal of catheter. There are no guidelines pertaining to reinsertion of the CAPD catheter following fungal exit-site and tunnel infection. This case report highlights Candida albicans as a rare cause of exit-site and tunnel infection of the CAPD catheter. The catheter was removed and the patient received appropriate antifungal therapy followed by reinsertion of the CAPD catheter and re-initiation on CAPD.

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.

Tuberculous and Fungal Peritonitis in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 263-266
Author(s):  
Lui Sing Leung ◽  
Chan Tak Mao ◽  
Lai Kar Neng ◽  
Wai Kei Lo
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Features ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Fungal Infections ◽  
Fungal Peritonitis ◽  
Diagnosis And Management

Tuberculous and fungal infections are two relatively uncommon but important causes of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The clinical features, diagnosis, and management of these two special forms of CAPD-related peritonitis are highlighted in this article.

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