The culture from peritoneal dialysis catheter enhances yield of microorganism identification in peritoneal dialysis-related peritonitis

An additional yield of culture from the removed peritoneal dialysis (PD) catheter in diagnosis of pathogen causing refractory peritonitis was assessed in 118 eligible patients from 7 PD centers. Peritoneal dialysis fluid (PDF) culture identified organisms in 86 (72.9%) patients, while the catheter culture identified organisms in 55 (46.6%) patients. PD catheter culture could additionally identify organisms in 19 patients whose PDF culture were negative, increasing the positive culture rate to 89%, in other word 16.1% reducing the culture-negative rate. PD catheter culture provided additional yield, especially in fungal and enterococcal infections.

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Management of Refractory Peritonitis to Maintain the Peritoneum for Subsequent Dialysis

Peritoneal Dialysis International ◽

10.1177/089686089201200205 ◽

1992 ◽

Vol 12 (2) ◽

pp. 211-213 ◽

Cited By ~ 1

Author(s):

Neil H. Shusterman ◽

Joseph Jacobs

Keyword(s):

Peritoneal Dialysis ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Dialysis Fluid ◽

Abdominal Adhesions ◽

Blood Cell Count ◽

Tenckhoff Catheter ◽

The Past ◽

Refractory Peritonitis ◽

Clinical Problems

Peritonitis and its sequelae remain major clinical problems in treating peritoneal dialysis (PD) patients. One of these sequelae is the formation of intra-abdominal adhesions, preventing a patient from returning to peritoneal dialysis after a Tenckhoff catheter is removed for refractory peritonitis. We have recently applied a technique that appears to reduce the incidence of this severe complication. When it is determined that a catheter will be removed for refractory peritonitis, hourly peritoneal dialysis exchanges are performed for 12 hr prior to surgery. Postoperatively, the abdomen is rested for 48 hr, after which a temporary peritoneal dialysis catheter is placed at the bedside and hourly exchanges (with antibiotics) are performed for 2–3 days or until the dialysis fluid white blood cell count improves. Then the temporary catheter is removed and the abdomen is rested until the Tenckhoff catheter is replaced in 10–14 days. We treated 5 consecutive patients with refractory peritonitis (2 Pseudomonas, 1 Proteus, 1 Candida, 1 S. aureus) with this technique. All 5 patients were able to return successfully to peritoneal dialysis. At our institution over the past five years, 9 patients with refractory peritonitis due to the same organisms have had their catheters removed. Only 5 (56%) were able to return to PD. Although preliminary, our technique holds promise for those patients wishing to return to peritoneal dialysis after having a catheter removed for refractory peritonitis.

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Non-touch Aseptic technique Maintains Sterility of Antibiotic-Admixed peritoneal Dialysis Fluid

Peritoneal Dialysis International ◽

10.3747/pdi.2017.00106 ◽

2018 ◽

Vol 38 (1) ◽

pp. 65-67

Author(s):

Louis L. Huang ◽

Ellen Ramas ◽

Priti Prasad ◽

Jenny Catania ◽

Pauline Meade ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Room Temperature ◽

Positive Culture ◽

Coagulase Negative Staphylococcus ◽

Dialysis Fluid ◽

Aseptic Technique ◽

Sterile Technique ◽

Peritoneal Dialysis Fluid ◽

Culture Positive ◽

Positive Controls

There is a paucity of data on the sterility of peritoneal dialysis fluid (PDF) after drug admixture. International Society for Peritoneal Dialysis (ISPD) guidelines suggest using sterile technique when admixing antibiotics; however, the degree of sterility remains unclear. This issue is most pertinent when preparing take-home PDF for outpatient treatment of peritonitis. This study compares the sterility of PDF admixed with antibiotics using a non-touch aseptic technique (NTAT) versus sterile technique. Groups of 8 PDF mixtures (1.5% Dianeal or Icodextrin [Baxter International Inc., Spring Grove, IL, USA]) were admixed with 1 g/L ceftazidime and vancomycin, or 20 mL saline, either by a pharmacist using sterile technique in a sterile suite, or a nurse in a clinical room using NTAT. Dianeal inoculated with 1 x 106 colony-forming units (CFU)/L of coagulase-negative Staphylococcus (CNS), with and without antibiotics, served as positive controls. Admixed PDFs were left at room temperature for 72 hours, then cultured using the BacT/ALERT system. A positive culture by day 5 constituted a contamination. Differences in proportion of contamination between groups were assessed using the Chi-squared test. Eighty PDF bags underwent microbiological testing. Sterility was maintained in all bags, independent of technique (NTAT versus sterile technique), type of PDF (Dianeal versus Icodextrin), or whether antibiotics were admixed. Of the positive controls, CNS-inoculated PDFs without antibiotics were all culture positive; however, when inoculated into antibiotic-admixed PDFs, only S. haemolyticus remained culture-positive ( p < 0.0001). In conclusion, PDF sterility can be maintained using NTAT for up to 3 days at room temperature. Currently, there is insufficient evidence to adopt sterile technique in sterile suites when admixing take-home PDF.

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Morphological analysis of biofilm of peritoneal dialysis catheter in refractory peritonitis patient

CEN Case Reports ◽

10.1007/s13730-012-0012-7 ◽

2012 ◽

Vol 1 (1) ◽

pp. 50-54 ◽

Cited By ~ 1

Author(s):

Tetsuro Kusaba ◽

Yuhei Kirita ◽

Ryo Ishida ◽

Eiko Matsuoka ◽

Mayuka Nakayama ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Morphological Analysis ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Refractory Peritonitis

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Case 23

Oxford Case Histories in Infectious Diseases and Microbiology ◽

10.1093/med/9780198846482.003.0023 ◽

2020 ◽

pp. 151-157

Author(s):

Hilary Humphreys

Keyword(s):

Peritoneal Dialysis ◽

Recurrent Infection ◽

Positive Culture ◽

Personal Hygiene ◽

Peritoneal Dialysis Catheter ◽

Coagulase Negative Staphylococci ◽

Gram Positive ◽

Fungal Peritonitis ◽

Gram Positive Bacteria ◽

Culture Negative

Infection is one of the commonest complications of continuous ambulatory peritoneal dialysis (CAPD) which often presents with a cloudy bag and sometimes abdominal pain. Gram-positive bacteria, such as coagulase negative staphylococci, are the commonest cause. The diagnosis is confirmed by markedly elevated white cells in the CAPD fluid and a positive culture. Empiric antibiotics should cover Gram-positive and Gram-negative bacteria—e.g intra-peritoneal vancomycin and gentamicin—which are modified when culture and antibiotic susceptibility results are available. Removal of the peritoneal dialysis catheter is indicated in pseudomonal and fungal peritonitis and when there is recurrent infection. Culture-negative CAPD infection may be due to tuberculosis. Minimizing infection is largely achieved through good standards of personal hygiene, patient training and education, and home visits.

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After peritoneal dialysis discontinuation: When will we remove peritoneal dialysis catheter?

The Journal of Vascular Access ◽

10.1177/1129729817751620 ◽

2018 ◽

Vol 20 (1_suppl) ◽

pp. 31-34

Author(s):

Hirotake Kasuga

Keyword(s):

Peritoneal Dialysis ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Dialysis Patients ◽

Peritoneal Equilibration Test ◽

Ultrafiltration Failure ◽

Refractory Peritonitis ◽

End Stage ◽

Peritoneal Function ◽

Dialysis Discontinuation

Most of the peritoneal dialysis patients stop their peritoneal dialysis therapy and transfer to hemodialysis or kidney transplantation. In Japan, most end-stage kidney disease patients select hemodialysis after peritoneal dialysis discontinuation. Peritoneal dialysis catheter will be removed after stopping peritoneal dialysis. If peritoneal dialysis patients suffer from refractory peritonitis or severe tunnel infection, we remove the peritoneal dialysis catheter immediately. However, the causes of peritoneal dialysis discontinuation are ultrafiltration failure or peritoneal membrane dysfunction, and we have to consider the timing of peritoneal dialysis catheter removal. Encapsulating peritoneal sclerosis is the most important adverse event of peritoneal dialysis. And encapsulating peritoneal sclerosis often develops after stopping peritoneal dialysis. Risk factors associated with encapsulating peritoneal sclerosis are high peritoneal equilibration test values, longer peritoneal dialysis period, frequent peritonitis, and so on. There is no evidence to prevent encapsulating peritoneal sclerosis completely. Therefore, we can preserve the peritoneal dialysis catheter and assess the changes of peritoneal function after peritoneal dialysis discontinuation, if patient is suspected to have high risk of encapsulating peritoneal sclerosis.

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Paramedian Insertion of Tenckhoff Catheters with Three Purse-String Sutures Reduces the Risk of Leakage

Peritoneal Dialysis International ◽

10.1177/089686089301302s33 ◽

1993 ◽

Vol 13 (2_suppl) ◽

pp. 124-126 ◽

Cited By ~ 18

Author(s):

Bernd G. Stegmayr

Keyword(s):

Peritoneal Dialysis ◽

Rectus Muscle ◽

Bed Rest ◽

Outer Side ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Peritoneal Membrane ◽

Linea Alba ◽

Peritoneal Dialysis Fluid ◽

The Right

Starting peritoneal dialysis (PD) Immediately after insertion of a peritoneal dialysis catheter is essential in some patients. However, due to a poor insertion technique, leakage may occur in up to 20% of patients after insertion of a peritoneal dialysis catheter, for example, in the midline. PD was started in 50 consecutive patients (age range 7–81 years). Under local anesthesia the Tenckhoff catheter was inserted about 3 cm lateral to the linea alba (mostly to the right) near the navel. The ventral and dorsal fasciae of the rectus muscle were split sagitally before entering the peritoneal membrane by a small incision. One pursestring suture fixed the peritoneal membrane around the Inner cuff, while the second suture fixed the dorsal fascia of the rectus muscle around the outer side of the cuff. A third suture was placed around the catheter in the ventral fascia. Dialysis in all our patients was started peroperatively, Initially by the use of 1 L of peritoneal dialysis fluid (Dlaneal, Baxter Medical AB, Sweden). Bed rest for 2 or 3 days was requested of and performed by most patients. Only one early and no late leakages occurred. At reoperation of the patient with the leak, the second suture was found to have been loosened. The technique is easy to handle and enables immediate dialysis. The risk for leakage Is very low.

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