Serum vancomycin levels predict the short-term adverse outcomes of peritoneal dialysis–associated peritonitis

2022 ◽  
pp. 089686082110641
Author(s):  
Ying Ma ◽  
Yingzhou Geng ◽  
Li Jin ◽  
Xiaopei Wang ◽  
Changna Liang ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Individual Variability ◽  
Adverse Outcomes ◽  
Short Term ◽  
Gram Positive ◽  
Diagnostic Threshold ◽  
Trough Serum ◽  
Serum Vancomycin ◽  
Culture Negative ◽  
Gram Positive Cocci

Background: The role of monitoring serum vancomycin levels during treatment of peritoneal dialysis (PD)–associated peritonitis is controversial. Substantial inter-individual variability may result in suboptimal serum levels despite similar dosing of vancomycin. The published predictors of suboptimal serum vancomycin levels remain limited. Methods: Data were retrospectively collected from 541 patients on continuous ambulatory peritoneal dialysis between 1 January 2018 and 31 December 312019. For gram-positive cocci and culture-negative peritonitis, we adopted a vancomycin administration and monitoring protocol. Short-term adverse outcomes of PD-associated peritonitis, including transfer to haemodialysis, death, persistent infection beyond planned therapy duration and relapse, were observed. The association between trough serum vancomycin levels and short-term adverse outcomes was evaluated. Results: Intraperitoneal vancomycin was used in 61 gram-positive cocci or culture-negative peritonitis episodes in 56 patients. Fourteen episodes of short-term adverse outcomes occurred in 12 patients, whose average trough serum vancomycin levels on day 5 of treatment were significantly lower than those who didn’t experience any adverse outcomes (8.4 ± 1.7 vs 12.5 ± 4.3 mg/L, p = 0.003). In gram-positive cocci or culture-negative peritonitis patients, those with higher day 5 trough serum vancomycin levels had a lower risk of short-term adverse outcomes (odds ratio: 0.6, 95% confidence interval: 0.4 to 0.9, p = 0.011). Receiver operating charecteristic curve (ROC) analyses showed that the day 5 trough serum vancomycin levels diagnostic threshold value for short-term adverse outcomes was 10.1 mg/L. After adjustments for gender, exchange volume and residual kidney function (RKF), baseline higher peritoneal transport was associated with a suboptimal (<10.1 mg/L) day 5 serum vancomycin level. Conclusions: Serum vancomycin levels are correlated with short-term adverse outcomes of PD-associated peritonitis, and higher peritoneal solute transport status is associated with suboptimal trough serum vancomycin levels on day 5.

Trough serum vancomycin levels predict the relapse of gram-positive peritonitis in peritoneal dialysis patients

1995 ◽  
Vol 25 (4) ◽  
pp. 611-615 ◽  
Author(s):  
Jeffrey G. Mulhern ◽  
Gregory L. Braden ◽  
Michael H. O'Shea ◽  
Robert L. Madden ◽  
George S. Lipkowitz ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Gram Positive ◽  
Trough Serum ◽  
Serum Vancomycin

scholarly journals The Role of Monitoring Vancomycin Levels in Patients with Peritoneal Dialysis-Associated Peritonitis

2015 ◽  
Vol 35 (2) ◽  
pp. 222-228 ◽  
Author(s):  
Sarah Stevenson ◽  
Wen Tang ◽  
Yeoungjee Cho ◽  
David W. Mudge ◽  
Carmel M. Hawley ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Outcomes ◽  
Median Number ◽  
Gram Positive ◽  
Empiric Antibiotic ◽  
Serum Vancomycin ◽  
Cure Rates ◽  
Culture Negative ◽  
Vancomycin Level

BackgroundThere is limited available evidence regarding the role of monitoring serum vancomycin concentrations during treatment of peritoneal dialysis (PD)-associated peritonitis.MethodsA total of 150 PD patients experiencing 256 episodes of either gram-positive or culture-negative peritonitis were included to investigate the relationship between measured serum vancomycin within the first week and clinical outcomes of cure, relapse, repeat or recurrence of peritonitis, catheter removal, temporary or permanent transfer to hemodialysis, hospitalization and death.ResultsVancomycin was used as an initial empiric antibiotic in 54 gram-positive or culture-negative peritonitis episodes among 34 patients. The median number of serum vancomycin level measurements in the first week was 3 (interquartile range; IQR 1 - 4). The mean day-2 vancomycin level, measured in 34 (63%) episodes, was 17.5 ± 5.2 mg/L. Hospitalized patients were more likely to have serum vancomycin levels measured on day 2 and ≥ 3 measurements in the first week. The peritonitis cure rates were similar between patients with < 3 and ≥ 3 measurements in the first week (77% vs 57%, p = 0.12) and if day-2 vancomycin levels were measured or not (68% vs 65%, p = 0.84). The average day-2 (18.0 ± 5.9 vs 16.6 ± 3.2, p = 0.5), first-week average (18.6 ± 5.1 vs 18.6 ± 4.3, p = 0.9) and nadir (14.5 ± 4.1 vs 13.6 ± 4.2, p = 0.5) vancomycin levels were comparable in patients who did or did not achieve peritonitis cure. Similar results were observed for all other clinical outcomes.ConclusionThe clinical outcomes of gram-positive and culture-negative peritonitis episodes are not associated with either the frequency or levels of serum vancomycin measurements in the first week of treatment when vancomycin is dosed according to International Society for Peritoneal Dialysis (ISPD) Guidelines.

Multicentre registry data analysis comparing outcomes of culture-negative peritonitis and different subtypes of culture-positive peritonitis in peritoneal dialysis patients

2020 ◽  
Vol 40 (1) ◽  
pp. 47-56 ◽  
Author(s):  
Htay Htay ◽  
Yeoungjee Cho ◽  
Elaine M Pascoe ◽  
Carmel Hawley ◽  
Philip A Clayton ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Primary Outcome ◽  
Catheter Removal ◽  
Dialysis Patients ◽  
Gram Positive ◽  
Pseudomonas Species ◽  
Gram Negative Organisms ◽  
Culture Positive ◽  
Culture Negative ◽  
Related Mortality

Background: The outcomes of culture-negative peritonitis in peritoneal dialysis (PD) patients have been reported to be superior to those of culture-positive peritonitis. The current study aimed to examine whether this observation also applied to different subtypes of culture-positive peritonitis. Methods: This multicentre registry study included all episodes of peritonitis in adult PD patients in Australia between 2004 and 2014. The primary outcome was medical cure. Secondary outcomes were catheter removal, hemodialysis transfer, relapsing/recurrent peritonitis and peritonitis-related death. These outcomes were analyzed using mixed effects logistic regression. Results: Overall, 11,122 episodes of peritonitis occurring in 5367 patients were included. A total of 1760 (16%) episodes were culture-negative, of which 77% were medically cured. Compared with culture-negative peritonitis, the odds of medical cure were lower in peritonitis caused by Staphylococcus aureus (adjusted odds ratio (OR) 0.62, 95% confidence interval (CI) 0.52–0.73), Pseudomonas species (OR 0.20, 95% CI 0.16–0.26), other gram-negative organisms (OR 0.48, 95% CI 0.41–0.56), polymicrobial organisms (OR 0.30, 95% CI 0.25–0.35), fungi (OR 0.02, 95% CI 0.01–0.03), and other organisms (OR 0.61, 95% CI 0.49–0.76), while the odds were similar in other (non-staphylococcal) gram-positive organisms (OR 1.11, 95% CI 0.97–1.28). Similar results were observed for catheter removal and hemodialysis transfer. Compared with culture-negative peritonitis, peritonitis-related mortality was significantly higher in culture-positive peritonitis except that due to other gram-positive organisms. There was no difference in the odds of relapsing/recurrent peritonitis between culture-negative and culture-positive peritonitis. Conclusion: Culture-negative peritonitis had superior outcomes compared to culture-positive peritonitis except for non-staphylococcal gram-positive peritonitis.

Case 23

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.

scholarly journals Retrospective single-center analysis of the reasons and serious complications of peritoneal-related peritonitis in patients with end-stage renal disease undergoing peritoneal dialysis treatment

2018 ◽  
Vol 128 (3) ◽  
pp. 103-106
Author(s):  
Agnieszka M. Grzebalska ◽  
Anna Steć ◽  
Izabela Ławnicka ◽  
Anna Bednarek-Skublewska ◽  
Andrzej Książek
Keyword(s):  
Peritoneal Dialysis ◽  
Medical Center ◽  
Gram Positive ◽  
Dialysis Treatment ◽  
Gram Negative ◽  
Antibiotics Use ◽  
Stage Renal Disease ◽  
End Stage ◽  
Culture Negative ◽  
Dialysis Discontinuation

Abstract Introduction. Peritonitis is still a serious complication of peritoneal dialysis (PD). Consequences of peritonitis can be severe. The most severe are peritoneal dialysis discontinuation and patient’s death. In majority, peritonitis is bacterial in the origin. Mainly there is a gram-positive infection, less commonly gram-negative one. Some peritonitis are culture-negative, because of former antibiotics use. In minority, fungal, tuberculous or even viral peritonitis are observed. Aim. The aim of the present study is to analyze the number, origin and serious complications of peritoneal-related peritonitis cases found in our PD center. Material and methods. We performed a retrospective five-years evaluation of medical records. The total number of peritonitis episodes was 56 cases, underwent by 30 adult patients on chronic peritoneal dialysis. Peritonitis was diagnosed according to ISPD recommendations. Causes and serious complications of peritoneal-related peritonitis were analyzed in every single year. Etiology of peritonitis was classified on the basis of the result of effluent dialysate culture as: gram-positive, gram-negative and culture negative. Peritoneal dialysis discontinuation or patient’s death were defined as serious complications. Results. Among 56 cases of peritoneal-related peritonitis 44.6% were gram-positive, 26.8% gram-negative and 28.6% culture-negative. No fungal or tuberculosis peritonitis were found. Because of the peritonitis complications in the evaluated period, six patients discontinued peritoneal dialysis and were switched to hemodialysis (20%), two others died (6.7%). Conclusion. The further improvement in peritonitis’ causes identification and treatment is needed in order to reduce number of serious complications in our medical center.

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.

Infections due to Gram-Positive Cocci

2009 ◽  
Author(s):  
Dennis L. Stevens
Keyword(s):  
Rheumatic Fever ◽  
Antibiotic Treatment ◽  
Acute Rheumatic Fever ◽  
Clinical Manifestations ◽  
Underlying Disease ◽  
Adverse Outcomes ◽  
Group A Streptococci ◽  
Gram Positive ◽  
Group A ◽  
Gram Positive Cocci

The gram-positive cocci that produce infection include pneumococci, group A streptococci, non?group A streptococci (including groups B, C, D, G, and nongroupable streptococci), anaerobic streptococci, enterococci, and staphylococci. This chapter discusses the pathogenesis, diagnosis, and treatment of infections associated with each of these gram-positive cocci, including methicillin-resistant Staphylococcus aureus (MRSA). The clinical infections caused by each of these organisms are reviewed. Tables describe the incidence of pneumococcal disease according to age and underlying disease, factors associated with adverse outcomes in pneumococcal pneumonia; medically important streptococci and enterococci; antibiotic treatment for penicillin-resistant Streptococcus pneumoniae, enterococcal infections, and staphylococcal infections; laboratory tests for streptococcal pharyngitis; clinical manifestations and antibiotic treatment for staphylococcal toxic-shock syndrome (TSS); revised Jones criteria for the diagnosis of acute rheumatic fever, and drug treatment of acute rheumatic fever. This review contains 105 references.

scholarly journals Pharmacokinetics of Intraperitoneal Vancomycin and Amikacin in Automated Peritoneal Dialysis Patients With Peritonitis

2021 ◽  
Vol 12 ◽  
Author(s):  
Pâmela Falbo dos Reis ◽  
Pasqual Barretti ◽  
Laudilene Marinho ◽  
Andre Luís Balbi ◽  
Linda Awdishu ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Peak Plasma ◽  
Small Sample Size ◽  
Plasma Concentrations ◽  
Intraperitoneal Administration ◽  
Small Sample ◽  
Gram Positive ◽  
Therapeutic Success ◽  
Gram Negative ◽  
Serum Vancomycin

Objective: The study aimed to evaluate the vancomycin and amikacin concentrations in serum and dialysate for automatic peritoneal dialysis (APD) patients.Methods: A total of 558 serum and dialysate samples of 12 episodes of gram-positive and 18 episodes of gram-negative peritonitis were included to investigate the relationship between vancomycin and amikacin concentrations in serum and dialysate on the first and third days of treatment. Samples were analysed 30, 120 min, and 48 h after intraperitoneal administration of vancomycin in peritonitis caused by gram-positive agents and 30, 120 min, and 24 h after intraperitoneal administration of amikacin in peritonitis caused by gram-negative agents. Vancomycin was administered every 72 h and amikacin once a day. The target therapeutic concentration of amikacin was 25–35 mg/l at the peak moment and 4–8 mg/l at the trough moment; and after 48 h for vancomycin, 15–20 mg/l at the trough moment.Results: For peritonitis caused by gram-negative agents, at the peak moment, therapeutic levels of amikacin were reached in dialysate in 80.7% of patients with evolution to cure and in 50% of patients evaluated as non-cure (p = 0.05). At the trough moment, only 38% were in therapeutic concentrations in the dialysate in the cure group and 42.8% in the non-cure group (p = 1). Peak plasma concentrations were subtherapeutic in 98.4% of the samples in the cure group and in 100% of the non-cure group. At the trough moment, therapeutic concentrations were present in 74.4% of the cure group and 71.4% of the non-cure group (p = 1). Regarding vancomycin and among gram-positive agents, therapeutic levels were reached at the peak moment in 94% of the cure group and 6% of the non-cure group (p = 0.007). After 48 h, 56.8% of the cure group had a therapeutic serum concentration whereas for the non-cure group it was only 33.3% (p = 0.39).Conclusion: Despite a small sample size, we demonstrated peak dialysate amikacin level and peak serum vancomycin level correlates well with Gram-negative and Gram positve peritonitis cure, respectively. It is suggested to study the antibiotics pharmacodynamics for a better understanding of therapeutic success in a larger sample.

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