Plasmid Profile and Slime Analysis of Coagulase-Negative Staphylococci from Capd Patients with Peritonitis

1986 ◽  
Vol 6 (4) ◽  
pp. 195-198 ◽  
Author(s):  
Gregory B. Horsman ◽  
Leslie MacMillan Yuri ◽  
Amatnieks Oretta RifKin ◽  
Stephen I. Vas
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Normal Skin ◽  
Recurrent Infection ◽  
Plasmid Profile ◽  
Coagulase Negative Staphylococci ◽  
Plasmid Profiles ◽  
Skin Flora ◽  
Initial Episode ◽  
Multiple Episodes

Little is known about the epidemiology of infections causing peritonitis in continuous ambulatory peritoneal dialysis (CAPD). The commonest cause, coagulase-negative staphylococci (C-NS), are normal skin flora. The main source is thought to be organisms from the patient's own skin or environment. Using plasmid profiles as an epidemiological marker, the authors identified cases in which surveillance skin cultures taken just before an episode of peritonitis were identical to those isolated from the effluent. On comparing the plasmid profiles from the effluent of patients who had multiple episodes over eight weeks, they identified two patterns. One group had different plasmid profiles between episodes of infection. The second group (the majority of the cases) had identical plasmid profiles between the initial episode and the second which occurred between 10 days and four weeks after stopping antibiotics. This suggests that, in most cases of recurrent infection studied, the second episode represented a reinfection or recurrence with the same organism (as the initial episode). Slime production did not discriminate those patients who would develop recurring peritonitis.

scholarly journals Prevalence of peritonitis-associated coagulase-negative staphylococci on the skin of continuous ambulatory peritoneal dialysis patients

1989 ◽  
Vol 102 (3) ◽  
pp. 365-378 ◽  
Author(s):  
M. A. Beard-Pegler ◽  
C. L. Gabelish ◽  
E. Stubbs ◽  
C. Harbour ◽  
J. Robson ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Profile Analysis ◽  
Normal Skin ◽  
Plasmid Profile ◽  
Phage Typing ◽  
Body Site ◽  
Dialysis Fluid ◽  
Coagulase Negative Staphylococci ◽  
Skin Flora

SUMMARYThe predominance of coagulase-negative staphylococci as normal skin flora is thought to be a factor in their association with episodes of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. We investigated the prevalence of peritonitis-associated strains on the skin of 28 patients undergoing peritoneal dialysis. Coagulase-negative staphylococci were the most frequently isolated organisms. comprising 47% of peritoncal dialysis fluid isolates and 59% of body site isolates. A total of 142 coagulase-negative staphylococci were speciated. tested for their antimicrobial sensitivity and slime production. and identified by phage typing and plasmid-profile analysis.Staphylococcus epidermidiswas the most commonly identified species from both peritoncal dialysis fluid (73%) and body sites (53%). Multiple antibiotic resistance was common, and the greater proportion of isolates were resistant to methicillin: 63·6% of peritoncal dialysis fluid isolates and 61·7% of body-site isolates.isolates.S. haemolyticusisolates were significantly more resistant to methicillin than other species. By phage typing and plasmid-profile analysis it was shown that peritonitis was rarely caused by skincolonizing strains. In only 3 of 14 patients were peritonitis-associated strains isolated as skin colonizers, and no patients developed peritonitis due to organisms previously isolated as skin colonizers.

scholarly journals Aeromonas Sobria: a Rare Cause of Continuous Ambulatory Peritoneal Dialysis-Related Peritonitis

2017 ◽  
Vol 24 (2) ◽  
Author(s):  
Andreja Figurek ◽  
Vlastimir Vlatkovic ◽  
Dragan Vojvodic
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Pseudomembranous Colitis ◽  
Normal Skin ◽  
Aeromonas Species ◽  
Gram Negative Bacteria ◽  
Aeromonas Sobria ◽  
Skin Flora ◽  
Common Causes ◽  
Gram Positive Cocci

Peritonitis is a very common complication in patients treated with continuous ambulatory peritoneal dialysis. The most common causes are gram positive cocci (part of the normal skin flora), and then gram negative bacteria, while fungi are listed as a rare cause of peritonitis. Aeromonas species are identified as a rare cause of continuous ambulatory peritoneal dialysis-related peritonitis. Among them, Aeromonas hydrophila is somewhat more common, followed by Aeromonas caviae.Case presentation. We reported a case of continuous ambulatory peritoneal dialysis peritonitis caused by Aeromonas sobria that is extremely rare cause of this type of peritonitis. In our patient, pseudomembranous colitis occured as a complication and, reinfection – another episode of peritonitis with Klebsiella pneumoniae. Treatment with third-episode cephalosporins was successful and patient continued treatment with continuous ambulatory peritoneal dialysis. Conclusions. The rare causes of peritonitis should not be ignored, especially those which lead to increased morbidity and mortality of patients.

scholarly journals Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis.

1992 ◽  
Vol 5 (1) ◽  
pp. 36-48 ◽  
Author(s):  
A von Graevenitz ◽  
D Amsterdam
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Antimicrobial Agents ◽  
Positive Culture ◽  
Bloodstream Infections ◽  
Peritoneal Macrophages ◽  
Gram Stain ◽  
Coagulase Negative Staphylococci ◽  
Safe Alternative ◽  
Skin Flora

The process of continuous ambulatory peritoneal dialysis has provided a useful, relatively inexpensive, and safe alternative for patients with end-stage renal disease. Infectious peritonitis, however, has limited a more widespread acceptance of this technique. The definition of peritonitis in this patient population is not universally accepted and does not always include the laboratory support of a positive culture (or Gram stain). In part, the omission of clinical microbiological findings stems from the lack of sensitivity of earlier microbiological efforts. Peritonitis results from decreased host phagocytic efficiency with depressed phagocytosis and bactericidal capacity of peritoneal macrophages. During episodes of peritonitis, fluid movement is reversed, away from the lymphatics and peritoneal membrane and toward the cavity. As a result, bloodstream infections are rare. Most peritonitis episodes are caused by bacteria. Coagulase-negative staphylococci are the most frequently isolated organisms, usually originating from the skin flora, but a wide array of microbial species have been documented as agents of peritonitis. Clinical microbiology laboratories need to be cognizant of the diverse agents so that appropriate primary media can be used. The quantity of dialysate fluid that is prepared for culture is critical and should constitute at least 10 ml. The sensitivity of the cultural approach depends on the volume of dialysate, its pretreatment (lysis or centrifugation), the media used, and the mode of incubation. The low concentration of microorganisms in dialysate fluids accounts for negative Gram stain results. Prevention of infection in continuous ambulatory peritoneal dialysis patients is associated with the socioeconomic status of the patient, advances in equipment (catheter) technology, and, probably least important, the application of prophylactic antimicrobial agents.

scholarly journals Peritonitis Associated with Vancomycin-ResistantLactobacillus rhamnosus in a Continuous Ambulatory Peritoneal Dialysis Patient: Organism Identification, Antibiotic Therapy, and Case Report

1998 ◽  
Vol 36 (6) ◽  
pp. 1781-1783 ◽  
Author(s):  
Günter Klein ◽  
Edith Zill ◽  
Ralf Schindler ◽  
Jacobus Louwers
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Dialysis Patient ◽  
Susceptibility Testing ◽  
Lactobacillus Rhamnosus ◽  
Peritoneal Dialysis Patient ◽  
Antibiotic Susceptibility Testing ◽  
Coagulase Negative Staphylococci ◽  
Pure Cultures ◽  
Organism Identification

A case of Lactobacillus rhamnosus-associated peritonitis in a patient undergoing continuous ambulatory peritoneal dialysis is reported. The patient was treated with vancomycin after isolation of glycopeptide-susceptible coagulase-negative staphylococci. After a skin rash developed, vancomycin was discontinued and replaced with teicoplanin. Seven weeks after the glycopeptide therapy was discontinued, a Lactobacillus strain was isolated in pure cultures. The isolate was identified first incorrectly as L. acidophilus but later correctly as L. rhamnosus. Antibiotic susceptibility testing showed that the isolate was resistant to glycopeptides but susceptible to several other antibiotics. The antibiotic treatment was then switched to imipenem and was successful.

Comparison of the in Vitro Activity of Daptomycin and four other Antimicrobial Agents against Staphylococci Associated with CAPD Peritonitis

1988 ◽  
Vol 8 (4) ◽  
pp. 277-279
Author(s):  
Wendy L. Vaudry ◽  
Claudia Gratton ◽  
Kinga Kowalewska ◽  
Wanda M. Wenman
Keyword(s):  
Peritoneal Dialysis ◽  
Minimum Inhibitory Concentration ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Antimicrobial Agents ◽  
Inhibitory Concentration ◽  
Vitro Activity ◽  
In Vitro Activity ◽  
Coagulase Negative Staphylococci ◽  
Vancomycin Resistant

The minimum inhibitory concentration (MIC) of daptomycin was compared with that of four other antimicrobial agents against clinically relevant staphylococci. Sixtyfive isolates were obtained from patients on continuous ambulatory peritoneal dialysis (CAPD) who contracted peritonitis. These isolates comprised 29 S. Sureus strains (all sensitive to oxacillin); 25 S. epidermidis strains (14 sensitive and 9 resistant to oxacillin); and 11 unspeciated coagulase-negative staphylococci (2 sensitive and 11 resistant to oxacillin). All of the oxacillin susceptible strains were inhibited by ≤2 mg/L of the five antibiotics tested. The oxacillin resistant staphylococci were also resistant to cefuroxime and variably resistant to cefamandole, but were uniformly susceptible to both vancomycin and daptomycin. Daptomycin possesses equivalent in vitro activity to vancomycin against strains of S. Sureus and coagulase negative staphylococci associated with CAPD peritonitis. If vancomycin resistance becomes a significant problem in these patients, and daptomycin is shown to be active against vancomycin resistant organisms, then it would have potential usefulness as an alternative to vancomycin in the treatment of peritonitis caused by multiply -resistant staphylococci.

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.

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