scholarly journals Cefoperazone and sulbactam-related eosinophilic peritonitis: a case report and literature review

2021 ◽  
Vol 49 (6) ◽  
pp. 030006052110253
Author(s):  
Zi Wang ◽  
Zhiying Li ◽  
Suping Luo ◽  
Zhikai Yang ◽  
Ying Xing ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Blood Cells ◽  
White Blood Cells ◽  
Antibiotic Use ◽  
Absolute Count ◽  
Peritoneal Dialysate ◽  
Refractory Peritonitis ◽  
Technique Failure ◽  
Peritoneal Dialysis Effluent ◽  
Pathogenic Infection

Eosinophilic peritonitis (EP) is a well-described complication of peritoneal dialysis that occurs because of an overreaction to constituents that are related to the catheter or tubing, peritoneal dialysate, pathogenic infection, or intraperitoneal drug use. EP caused by antibiotic use is rare. We present the case of a patient with cefoperazone and sulbactam-related EP. A 59-year-old woman who was undergoing peritoneal dialysis presented with peritonitis with abdominal pain and turbid peritoneal dialysis. Empiric intraperitoneal cefazolin in combination with cefoperazone and sulbactam was started after peritoneal dialysis effluent cultures were performed. Her peritonitis achieved remission in 2 days with the help of cephalosporin, but she developed EP 1 week later, when her dialysate eosinophil count peaked at 49% of the total dialysate white blood cells (absolute count, 110/mm3). We excluded other possible causes and speculated that cefoperazone and sulbactam was the probable cause of EP. The patient continued treatment with cefoperazone and sulbactam for 14 days. EP resolved within 48 hours after stopping cefoperazone and sulbactam. Thus, EP can be caused by cefoperazone and sulbactam use. Physicians should be able to distinguish antibiotic-related EP from refractory peritonitis to avoid technique failure.

The situation of antibiotic use for diarrhea treatment on pediatric inpatient at Pediatrics - Kien Giang General Hospital in 2019-2020

2020 ◽  
pp. 15-24
Author(s):  
Nhon Tran Van ◽  
Mai Do Van ◽  
Hien Ha Minh
Keyword(s):  
General Hospital ◽  
Blood Cells ◽  
Antibiotic Prescription ◽  
White Blood Cells ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Loose Stool ◽  
Cross Sectional ◽  
Watery Stool ◽  
Pediatric Inpatient

Background: To survey for evaluation the use of antibiotic for diarrhea treatment on pediatric inpatient in compliance with MOH, WHO or treatment regimen. Objectives: (1) To describe the situation of antibiotic use for diarrhea treatment and (2) to determine factors that affected on indication of antibiotic for pediatric inpatient under 15 years at Kien Giang General Hospital in 2019. Subjects and methods: A cross-sectional study on 251 medical records of pediatric inpatients who treated by one of any drug from 01/2019 to 12/2019. Results: one antibiotic was prescribed in 71.7% in comparison with 17.1% on two antibiotics. The antibiotic prescription was based on the results of blood test including examinations of white blood cells (WBC), the percentage of neutrophils (Neu%) and/or C-reactive protein (CRP) (59.4%), stool with white blood cells and/or red blood cells (1.6%), high fever without causes (27.9%), watery stool (86.3%), loose stool with blood (100%), loose stool (97.9%). The most used antibiotics are ceftriaxone (53.4%), ciprofloxacin (12.4%). Duration of antibiotic use is 5 days in median. Conclusion: The rate of antibiotic prescription that met MOH and WHO guidelines was 88.3% in comparison with 11.7% of non-conformance. The compliance prescriptions based on antibiogram were 77.8%, non-compliance were 22.5%. The compliance dosage refered to guideline was 86.4%, non-conpliance was 2.4%. The duration of hospitalization and neutrophil are factors that affected the use of antibiotics (p < 0.05). Keywords: diarrhea, pediatric inpatient, antibiotic, Pediatrics-Kien Giang General Hospital

scholarly journals Utility of Peritoneal Scintigraphy in Peritoneal Dialysis Patients: One Center Experience

Kidney360 ◽  
2020 ◽  
Vol 1 (5) ◽  
pp. 354-358
Author(s):  
R. Haridian Sosa Barrios ◽  
María Eugenia Rioja Martín ◽  
Víctor Burguera Vion ◽  
Astrid Lucía Santos Carreño ◽  
Milagros Fernández Lucas ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Membrane ◽  
Polycystic Kidney ◽  
Dialysis Patients ◽  
First Line ◽  
Peritoneal Dialysate ◽  
Other Substances ◽  
Line Imaging ◽  
Technique Failure ◽  
Peritoneal Scintigraphy

BackgroundPeritoneal dialysis (PD) is the RRT of choice in 15% of patients with CKD and has multiple advantages over hemodialysis. PD leaks can prompt technique failure and dropout. Use of peritoneal scintigraphy (PS) for diagnosis of PD leaks has declined in favor of more complex and expensive tests. We analyzed the utility of PS for PD leak diagnosis in our center.MethodsWe retrospectively analyzed all PS done in our center from January 2000 until December 2018, inclusive, in all patients on PD with a suspected dialysate leak.ResultsA total of 39 PS procedures were done in 36 patients on PD in the study period. Of those, 81% were male and 11% had CKD due to polycystic kidney disease. During this period, 23 leaks were diagnosed, showing an incidence of 6% (three episodes per patient per year). In all cases with negative PS, other tests did not confirm a peritoneal dialysate leak.ConclusionsPS is a safe, inexpensive, reproducible, and highly effective diagnostic tool for peritoneal dialysate leaks that allows nephrologists to tailor or stop PD therapy if required. In our opinion, it should be the first-line imaging test to diagnose PD leaks with minimum exposure to radiation, contrast, or other substances that could irritate the peritoneal membrane. We believe PS should be considered as the initial test of choice to diagnose this PD complication as soon as possible, minimizing technique failure and dropout due to leaks.

scholarly journals Surgical Intervention after Catheter Removal in a Case of Refractory Peritoneal Dialysis-Related Peritonitis

2015 ◽  
Vol 5 (1) ◽  
pp. 66-70
Author(s):  
Hao Yan ◽  
Zhengqian Bian ◽  
Weiming Zhang ◽  
Yan Fang ◽  
Miaolin Che ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Surgical Intervention ◽  
Exploratory Laparotomy ◽  
Catheter Removal ◽  
Pelvic Cavity ◽  
Peritoneal Infection ◽  
Refractory Peritonitis ◽  
Technique Failure ◽  
Common Infection ◽  
Improve Patient

Peritonitis is the most common infection in peritoneal dialysis (PD) and has been noted to be not only a cause of mortality but also the leading cause of technique failure in patients maintained on PD. Appropriate management of peritonitis to improve patient outcome has been the focus of clinical practice. We report a case of refractory PD-related peritonitis with surgical intervention intending to control ongoing peritoneal infection despite aggressive antibiotics and timely catheter removal. Exploratory laparotomy was performed in this case, and an encapsulated abscess in the peritoneal and pelvic cavity was obliterated. Adhesiolysis was done simultaneously. Continuous postoperative peritoneal lavage and drainage were implemented. Symptoms dramatically improved after operation, and indwelling tubes were removed several days later. Finally, the patient recovered and switched to permanent hemodialysis without intra-abdominal complications. Our case suggested that appropriate and timely surgical intervention in refractory peritonitis is necessary for saving lives in certain subgroups of patients. Clearly, well-designed studies with large samples are warranted to explore this issue in more detail.

Characteristics of Peripheral and Peritoneal White Blood Cells in Children with Chronic Renal Failure, Dialyzed or Not

2000 ◽  
Vol 20 (6) ◽  
pp. 748-756 ◽  
Author(s):  
Antonia H.M. Bouts ◽  
Theo A. Out ◽  
Cornelis H. Schröder ◽  
Leo A.H. Monnens ◽  
Jeroen Nauta ◽  
...  
Keyword(s):  
Renal Failure ◽  
T Cells ◽  
Peritoneal Dialysis ◽  
Chronic Renal Failure ◽  
Natural Killer Cells ◽  
Natural Killer ◽  
Blood Cells ◽  
White Blood Cells ◽  
Healthy Children ◽  
Killer Cells

Objective To explore further the mechanisms leading to immune deficiency in chronic renal failure and the role of dialysis treatment in these mechanisms. Design Cross-sectional and longitudinal analysis. Patients We studied 39 children treated with peritoneal dialysis (PD), 23 children treated with hemodialysis (HD), 33 children not yet dialyzed [chronic renal failure (CRF)], and 27 healthy children. Peritoneal cells were also obtained from PD children for analysis. Methods White blood cells (WBCs) were isolated from blood and peritoneal dialysis effluent by centrifugation. The number of CD2+, CD4+, and CD8+ T cells, B cells, and natural killer cells were measured by flow cytometry. Results The total peripheral blood lymphocyte count was lower in PD children (2.6 x 109/L), HD children (2.1 x 109/L), and CRF children (2.0 x 109/L) compared with healthy children (3.1 x 109/L, p < 0.05). The B lymphocyte count was also lower in PD children (0.34x109/L), HD children (0.22 x 109/L), and CRF children (0.33 x 109/L) compared with healthy children (0.52 x 109/L, p < 0.01). Numbers of CD4+ T cells were not different, but numbers of CD8+ T cells were lower in PD children (0.56 x 109/L), HD children (0.63 x 109/L), and CRF children (0.53 x 109/L) compared with healthy children (0.77 x 109/L, p < 0.05). The count of natural killer cells was lower in PD children (0.21 x 109/L), HD children (0.17 x 109/L), and CRF children (0.18 x 109/L) compared with healthy children (0.50 x 109/L, p < 0.0001). The CD4/CD8 ratio of lymphocytes in peritoneal effluent was 0.8 versus 1.9 in peripheral blood ( p < 0.001). The CD2/CD19 ratio was not different. The cell subsets remained stable during the first year of PD treatment. The CD2/CD19 ratio in peritoneal effluent was higher in children with a peritonitis incidence ≥ 1 per year. Conclusions The reduced numbers of B lymphocytes, CD8+ T cells, and natural killer cells found in CRF children, dialyzed or not, may favor the frequent occurrence of infections.

Lipopolysaccharide Evaluation in Peritoneal Dialysis Patients with Peritonitis

2020 ◽  
Vol 49 (4) ◽  
pp. 434-439 ◽  
Author(s):  
Sabrina Milan Manani ◽  
Grazia Maria Virzì ◽  
Anna Giuliani ◽  
Michele Baretta ◽  
Valentina Corradi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Blood Cells ◽  
White Blood Cells ◽  
Enzyme Linked Immunosorbent Assay ◽  
Dialysis Patients ◽  
Cell Wall Component ◽  
Gram Staining ◽  
Median Level ◽  
Wbc Count

Background: Lipopolysaccharide (LPS), also known as endotoxin, is cell wall component of Gram-negative (GN) bacteria, which may contribute to the progression of a local infection to sepsis. Previous studies demonstrate that LBP is detectable in peritoneal effluents of peritoneal dialysis (PD) patients and it is significantly elevated in PD patients with peritonitis caused by both GN and Gram-positive (GP) bacteria. Aim: The aim of this study was to evaluate LPS levels in PD patients; in particular, we investigated different LPS levels in the context of GP and GN peritonitis. Material and Methods: We enrolled 49PD (61% Continuous Ambulatory PD and 39% Automated PD) patients: 37 with peritonitis and 12 without. Quantitative determination of LPS was performed by Enzyme-linked Immunosorbent Assay Kitin peritoneal and plasma samples. Results: Quantitative analysis of peritoneal and plasma LPS showed significantly higher levels in PD patients with peritonitis compared to patients without (p = 0.001). Furthermore, we divided patients with peritonitis in 2 groups on the basis of Gram staining (GP 27; GN 12). Peritoneal and plasma LPS levels showed significantly lower levels in PD patients with GP peritonitis than in patients with GN (p = 0.001). The median level of LPS showed no significant differences between patients without peritonitis and with GP peritonitis (p = 0.195). On the contrary, LPS levels showed significantly higher levels in PD patients with GN peritonitis compared to patients without peritonitis (p = 0.001). A significant positive correlation was observed between peritoneal white blood cells count (pWBC) and peritoneal LPS (Spearman’s rho = 0,412, p = 0.013). However, no statistically significant correlation was observed between plasma LPS and WBC count. Conclusion: We observed LPS presence in all PD patients. In particular, our results demonstrated that LPS is significantly elevated in PD patients with GN peritonitis. Furthermore, pWBC and LPS levels increased proportionally in PD patients with peritonitis. Peritoneal and plasma LPS levels could be a useful marker for diagnosis and management of GN peritonitis in PD patients.

Ultrastructural changes in murine lymphoma cells exposed to ultraviolet-A radiation

1991 ◽  
Vol 49 ◽  
pp. 104-105
Author(s):  
Delma P. Thomas ◽  
Dianne E. Godar
Keyword(s):  
Medical Devices ◽  
Blood Cells ◽  
White Blood Cells ◽  
Consumer Products ◽  
Ultrastructural Changes ◽  
Ultraviolet A ◽  
Uv Spectrum ◽  
Lymphoma Cells ◽  
Murine Lymphoma ◽  
Transmission Electron

Ultraviolet radiation (UVR) from all three waveband regions of the UV spectrum, UVA (320-400 nm), UVB (290-320 nm), and UVC (200-290 nm), can be emitted by some medical devices and consumer products. Sunlamps can expose the blood to a considerable amount of UVR, particularly UVA and/or UVB. The percent transmission of each waveband through the epidermis to the dermis, which contains blood, increases in the order of increasing wavelength: UVC (10%) < UVB (20%) < UVA (30%). To investigate the effects of UVR on white blood cells, we chose transmission electron microscopy to examine the ultrastructure changes in L5178Y-R murine lymphoma cells.

The Effect of Red Blood Cells on the ADP-induced Aggregation of Human Platelets in Flow Through Tubes

1990 ◽  
Vol 63 (01) ◽  
pp. 112-121 ◽  
Author(s):  
David N Bell ◽  
Samira Spain ◽  
Harry L Goldsmith
Keyword(s):  
Platelet Aggregation ◽  
Shear Rate ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Platelet Rich Plasma ◽  
Mean Transit Time ◽  
White Blood Cells ◽  
Aggregate Size ◽  
Human Platelets ◽  
Induced Aggregation

SummaryThe effect of red blood cells, rbc, and shear rate on the ADPinduced aggregation of platelets in whole blood, WB, flowing through polyethylene tubing was studied using a previously described technique (1). Effluent WB was collected into 0.5% glutaraldehyde and the red blood cells removed by centrifugation through Percoll. At 23°C the rate of single platelet aggregtion was upt to 9× greater in WB than previously found in platelet-rich plasma (2) at mean tube shear rates Ḡ = 41.9,335, and 1,920 s−1, and at both 0.2 and 1.0 µM ADP. At 0.2 pM ADP, the rate of aggregation was greatest at Ḡ = 41.9 s−1 over the first 1.7 s mean transit time through the flow tube, t, but decreased steadily with time. At Ḡ ≥335 s−1 the rate of aggregation increased between t = 1.7 and 8.6 s; however, aggregate size decreased with increasing shear rate. At 1.0 µM ADP, the initial rate of single platelet aggregation was still highest at Ḡ = 41.9 s1 where large aggregates up to several millimeters in diameter containing rbc formed by t = 43 s. At this ADP concentration, aggregate size was still limited at Ḡ ≥335 s−1 but the rate of single platelet aggregation was markedly greater than at 0.2 pM ADP. By t = 43 s, no single platelets remained and rbc were not incorporated into aggregates. Although aggregate size increased slowly, large aggregates eventually formed. White blood cells were not significantly incorporated into aggregates at any shear rate or ADP concentration. Since the present technique did not induce platelet thromboxane A2 formation or cause cell lysis, these experiments provide evidence for a purely mechanical effect of rbc in augmenting platelet aggregation in WB.

White blood cells levels and PCOS: direct and indirect relationship with insulin resistance, but not with hyperandogenemia

2013 ◽  
Author(s):  
Olga Papalou ◽  
Sarantis Livadas ◽  
Athanasios Karachalios ◽  
Nektarios Benetatos ◽  
George Boutzios ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Blood Cells ◽  
White Blood Cells ◽  
Indirect Relationship

Endogenous Heparinoids Detected by anti-Xa Activity are Present in Blood during Acute Variceal Bleeding in Cirrhosis. A Prospective Study

2014 ◽  
Vol 23 (2) ◽  
pp. 187-194 ◽  
Author(s):  
Christos Triantos ◽  
Emmanuel Louvros ◽  
Maria Kalafateli ◽  
Anne Riddell ◽  
Ulrich Thalheimer ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Variceal Bleeding ◽  
Blood Cells ◽  
Venous Pressure ◽  
White Blood Cells ◽  
International Normalized Ratio ◽  
Ulcer Bleeding ◽  
Factor X ◽  
Packed Red Blood Cells ◽  
Bacterial Peritonitis

Background & Aims: Endogenous heparinoids have been detected by thromboelastography and quantified by clotting based anti-Xa activity assays in patients with cirrhosis, but their presence in variceal bleeding has not been established yet.Methods: Clotting based anti-Xa activity was measured in A) 30 cirrhotics with variceal bleeding, B) 15 noncirrhotics with peptic ulcer bleeding, C) 10 cirrhotics without infection or bleeding, and D) 10 cirrhotics with hepatocellular carcinoma (HCC).Results: Anti-Xa activity was not detected in ulcer bleeders or in cirrhotics without infection or bleedingbut was present in seven (23%) variceal bleeders (median levels: 0.03 u/mL (0.01-0.07)) and was quantifiable for 3 days in six of seven patients. Four of seven variceal bleeders with anti-Xa activity present had HCC (p=0.023). Age, creatinine, platelet count and total infections the second day from admission were significantly correlated with the presence of measureable anti-Xa levels (p=0.014, 0.032, 0.004 and 0.019, respectively). In the HCC group, anti-Xa activity was present in three patients (30%) [median levels: 0.05 u/mL (0.01-0.06)].Conclusions: In this study, variceal bleeders and 30% of the patients with HCC had endogenous heparinoids that were detected by a clotting based anti-Xa activity assay, whereas there was no anti Xa activity present in patients with cirrhosis without infection, or bleeding or HCC, nor in those with ulcer bleeding. Thus, the anti-Xa activity is likely to be a response to bacterial infection and/or presence of HCC in cirrhosis.List of abbreviations: AFP, alpha-fetoprotein; aPTT, activated partial thromboplastin time; CP, Child-Pugh; FXa, activated factor X; GAGS, glycosaminoglycans; Hb, hemoglobin; HCC, hepatocellular carcinoma; HVPG, hepatic venous pressure gradient; INR, International normalized ratio; LMWHs, low molecular weight heparins; MELD, Model for End-stage Liver Disease; PPP, platelet-poor plasma; PRBC, packed red blood cells; PT, prothrombin time; SBP, sponataneous bacterial peritonitis; TEG, thromboelastography; WBC, white blood cells.

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