Outcome of Gram-Positive and Gram-Negative Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis: A Single-Center Experience

2003 ◽  
Vol 23 (2_suppl) ◽  
pp. 144-147 ◽  
Author(s):  
Narayan Prasad ◽  
Amit Gupta ◽  
Raj K. Sharma ◽  
Kashi N. Prasad ◽  
Sanjeev Gulati ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Total Duration ◽  
Educational Status ◽  
Developed Countries ◽  
Outcome Analysis ◽  
Gram Positive ◽  
Fungal Peritonitis ◽  
Gram Negative ◽  
Single Center Experience

Background The spectrum of bacterial peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) in India may be different from that seen in developed countries because of differences in culture and in social, environmental, financial, and educational status. We analyzed our data regarding the incidence and outcome of monomicrobial peritonitis in our CAPD patients. Patients and Methods We reviewed the records of 225 patients on CAPD to retrieve data concerning demographics, peritonitis rate, organism isolated, and outcome. Polymicrobial and fungal peritonitis were excluded from the outcome analysis because of their different outcomes. Results We identified 168 episodes of peritonitis (range: 1 – 6 episodes per patient). Of the 168 episodes, 106 (63.1%) episodes were culture-positive. Total duration of CAPD was 264.16 patient–years. The overall peritonitis rate was 0.63 episodes per patient–CAPD year. The rates of gram-negative, gram-positive, polymicrobial, and fungal peritonitis were 0.17, 0.11, 0.04, 0.09 episodes per patient–year, respectively. Among the 75 episodes of monomicrobial peritonitis, gram-negative episodes [ n = 45 (60%)] were significantly more frequent than gram-positive episodes [ n = 30 (40%), p = 0.03]. Escherichia coli was the most commonly seen organism. Organisms of fecal origin (40/75) were significantly more frequent than those of skin origin (21/75, p = 0.0016). Catheter loss (17/45 vs 5/20, p = 0.04), hospitalization (31/ 45 vs 13/30, p = 0.03), death [9/45 vs 3/30, p = nonsignificant (NS)], switch to hemodialysis (8.9% vs 3.3%, p = NS), and reimplantation of the catheter (6.6% vs 3.3%, p = NS) were all more frequent in gram-negative episodes than in gram-positive episodes. Conclusions Gram-negative peritonitis is more frequent than gram-positive peritonitis in our CAPD population in India and is associated with worse outcome.

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.

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.

Peritonitis following Colonoscopy in a Peritoneal Dialysis Patient

1990 ◽  
Vol 10 (1) ◽  
pp. 97-98 ◽  
Author(s):  
Susan M. Ray ◽  
Beth Piraino ◽  
Jean Holley
Keyword(s):  
Peritoneal Dialysis ◽  
Antibiotic Prophylaxis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Dialysis Patient ◽  
Aminoglycoside Antibiotic ◽  
Peritoneal Dialysis Patient ◽  
Colonoscopic Polypectomy ◽  
Gram Positive ◽  
Gram Negative ◽  
Bacterial Peritonitis

A 65-year-old woman on continuous ambulatory peritoneal dialysis (CAPD) developed blood-tinged dialysate and bacterial peritonitis following a colonoscopic polypectomy. She grew multiple anaerobic organisms in her dialysate despite antibiotic prophylaxis with vancomycin and gentamicin prior to the procedure. This case confirms the need for broad spectum antibiotic prophylaxis prior to colonoscopic procedures, especially if polypectomy is planned. The antibiotic chosen should cover anaerobes as well as gram-positive and gram-negative enteric organisms. We suggest the use of ampicillin, clindamycin, and an aminoglycoside antibiotic for this prophylaxis.

scholarly journals The Effects of Biocompatible Compared with Standard Peritoneal Dialysis Solutions on Peritonitis Microbiology, Treatment, and Outcomes: TheBalanz Trial

2012 ◽  
Vol 32 (5) ◽  
pp. 497-506 ◽  
Author(s):  
◽  
David W. Johnson ◽  
Fiona G. Brown ◽  
Margaret Clarke ◽  
Neil Boudville ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Controlled Trial ◽  
Statistical Significance ◽  
Geometric Mean ◽  
Secondary Outcome ◽  
Outcome Analysis ◽  
Control Group ◽  
Gram Positive ◽  
Gram Negative ◽  
Culture Negative

BackgroundA multicenter, multi-country randomized controlled trial (the balANZ study) recently reported that peritonitis rates significantly improved with the use of neutral-pH peritoneal dialysis (PD) solutions low in glucose degradation products (“biocompatible”) compared with standard solutions. The present paper reports a secondary outcome analysis of the balANZ trial with respect to peritonitis microbiology, treatment, and outcomes.MethodsAdult incident PD patients with residual renal function were randomized to receive either biocompatible or conventional (control) PD solutions for 2 years.ResultsThe safety population analysis for peritonitis included 91 patients in each group. The unadjusted geometric mean peritonitis rates in those groups were 0.30 [95% confidence interval (CI): 0.22 to 0.41] episodes per patient–year for the biocompatible group and 0.49 (95% CI: 0.39 to 0.62) episodes per patient–year for the control group [incidence rate ratio (IRR): 0.61; 95% CI: 0.41 to 0.90; p = 0.01]. When specific causative organisms were examined, the rates of culture-negative, gram-positive, gram-negative, and polymicrobial peritonitis episodes were not significantly different between the biocompatible and control groups, although the biocompatible group did experience a significantly lower rate of non-pseudomonal gram-negative peritonitis (IRR: 0.41; 95% CI: 0.18 to 0.92; p = 0.03). Initial empiric antibiotic regimens were comparable between the groups. Biocompatible fluid use did not significantly reduce the risk of peritonitis-associated hospitalization (adjusted odds ratio: 0.80; 95% CI: 0.48 to 1.34), but did result in a shorter median duration of peritonitis-associated hospitalization (6 days vs 11 days, p = 0.05). Peritonitis severity was more likely to be rated as mild in the biocompatible group (37% vs 10%, p = 0.001). Overall peritonitis-associated technique failures and peritonitis-related deaths were comparable in the two groups.ConclusionsBiocompatible PD fluid use was associated with a broad reduction in gram-positive, gram-negative, and culture-negative peritonitis that reached statistical significance for non-pseudomonal gram-negative organisms. Peritonitis hospitalization duration was shorter, and peritonitis severity was more commonly rated as mild in patients receiving biocompatible PD fluids, although other peritonitis outcomes were comparable between the groups.

scholarly journals THE RISK FACTORS AND OUTCOME OF FUNGAL PERITONITIS IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS

2009 ◽  
Vol 27 (1) ◽  
pp. 59-61
Author(s):  
E Indhumathi ◽  
V Chandrasekaran ◽  
D Jagadeswaran ◽  
M Varadarajan ◽  
G Abraham ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Fungal Peritonitis

Newer Quinolones in the Treatment of Continuous Ambulatory Peritoneal Dialysis (CAPD) Related Infections

1990 ◽  
Vol 10 (2) ◽  
pp. 127-133 ◽  
Author(s):  
Paul Nikolaidis
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Adverse Reactions ◽  
Antimicrobial Agents ◽  
Hospital Staff ◽  
Gram Negative Bacteria ◽  
Promising Alternative ◽  
Gram Negative ◽  
Dosing Intervals ◽  
Good Oral Bioavailability

Newer fluoroquinolones such as ciprofloxacin, pefloxacin, ofloxacin, enoxacin, and fleroxacin are potent antimicrobial agents against many gram-negative bacteria, including Pseudomonas aeruginosa species and staphylococci-sensitive or resistant to methicillin. They are almost completely absorbed when given orally, reaching therapeutic plasma and dialysate concentrations, and their long half lives permit infrequent dosing intervals. Clinical studies on fluoroquinolones efficacy in continuous ambulatory peritoneal dialysis (CAPD) infections, although not extensive, demonstrate good results. They are well tolerated and the adverse reactions, consisting mainly of gastrointestinal disturbance, were uncommon, mild, and reversible. The fluoroquinolones offer a promising alternative to standard parenteral treatments in CAPD patients, while their good oral bioavailability makes them attractive and convenient for both patients and hospital staff. However, they must be used with caution until we have more information and gain further experience.

Rectal Stenosis Associated with Fungal Peritonitis: A Complication of Continuous Ambulatory Peritoneal Dialysis

Nephron ◽  
1989 ◽  
Vol 53 (3) ◽  
pp. 288-289 ◽  
Author(s):  
Masako Uchida ◽  
Takanobu Sakemi ◽  
Yoshiro Nagano ◽  
Masanobu Mizuguchi
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Rectal Stenosis ◽  
Fungal Peritonitis

P1173PERITONEAL DIALYSIS INFECTIONS IN MALTA - TRENDS OVER ELEVEN YEARS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Angela Borg Cauchi ◽  
Maria Angela Gauci ◽  
Theresia Dalli ◽  
James Gauci ◽  
James Farrugia ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Coagulase Negative Staphylococcus ◽  
Distributed Data ◽  
Dialysis Modality ◽  
Gram Positive ◽  
Gram Negative ◽  
Male Predominance ◽  
E Coli ◽  
Number Of Patients ◽  
Gram Negative Organisms

Abstract Background and Aims Infections related to peritoneal dialysis (PD) are still a cause of morbidity and mortality. We describe an overview of PD peritonitis and catheter-related infections (CRI) in Malta over a period of eleven years. We also describe trends in dialysis modality over the years. Method All patients undergoing PD in Malta during 2008 and 2018 were analysed. Data from 2008-2012 was retrospective, shown as mean, that from 2013-2018 prospective. International Society for Peritoneal Dialysis (ISPD) definitions were used. Results for categorical responses were summarized using absolute numbers and percentages. Medians (range) were used to describe continuous non-normally distributed data. Results The total number of patients undergoing PD from 2008 till 2018 were 137 (2008-2012), 91, 80, 126, 117, 102, 103 respectively. There was an overall male predominance of 63.5% (61-67). Patient years at risk were 85.80, 85.25, 89.71, 83.70, 79.69, 72.88 since 2013 respectively. The overall incidence of diabetes mellitus was 45.3% (41.8-50), cardiovascular disease 34.2% (33.8-35), hypertension 79.3% (73.8-84.6). PD was used in 50% of dialysis modality prior to 2012, 39% in 2018. Initially 51% used Automated PD (APD), with 21% assisted PD, in 2018 39% used APD, with 6% assisted PD. PD peritonitis rates from 2008 were 0.38, 0.31, 0.35, 0.46, 0.43, 0.57, 0.54, 0.43, 0.39, 0.40, 0.46 episodes/patient year respectively There was marked dominance of Gram-positive peritonitis, mainly Staphylococcal, with a reduction of coagulase-negative-Staphylococcus from 0.26 episodes/patient in 2013 to 0.03 in 2017, 0.11 in 2018. Methicillin-resistant S. aureus (MRSA) peritonitis decreased from 0.03 episodes/patient to nil in 2016, 2017, 0.01 episodes/patient in 2018. Amongst Gram-negative peritonitis, Pseudomonas rates decreased from 0.06 to 0.03 episodes/patient in 2018, nil in 2016. Escherichia coli rates decreased from 0.02 episodes/patient to nil in the last three years. Fungal rates from 0.03 to 0.01 episodes/patient/year, with nil in 2016, 2017. Catheter-related infection rates were 0.39 (2008-2012), 0.35, 0.91, 0.37, 0.38, 0.25, 0.50 episodes/patient/year respectively. There was a higher incidence of recurrent infections in 2014, none in 2015 and 2016. Gram-negative organisms accounted for 57% of all CRI, predominantly Pseudomonas at 0.12 (2008-2012), 0.06, 0.09, 0.09, 0.14, 0.03, 017 episodes/patient/year respectively. Gram-positive CRI were mostly Staphylococcus aureus, peaking in 2014 at 0.38 episodes/patient/year. MRSA rates declined from 0.15 to 0.01 episodes/patient/year in 2018. Conclusion PD peritonitis rates in Malta between 2008 and 2018 were below the ISPD recommended threshold. There were no episodes of MRSA in 2016, 2017, no Pseudomonas in 2016, no E coli in the last three years and no fungal PD peritonitis in 2016, 2017. CRI rates also declined, with an overall predominance of Gram-negative infections.

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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