Longitudinal Study of Peritoneal Defence Mechanisms in Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD)

1989 ◽  
Vol 9 (2) ◽  
pp. 115-119 ◽  
Author(s):  
Sheila J. McGregor ◽  
Jeremy H. Brock ◽  
J. Douglas Briggs ◽  
Brian J.R. Junor
Keyword(s):  
Peritoneal Dialysis ◽  
Longitudinal Study ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Staphylococcus Epidermidis ◽  
In Vitro Growth ◽  
Defence Mechanisms ◽  
Opsonic Activity ◽  
Immunological Protection ◽  
Peritoneal Dialysis Effluent

Peritoneal cellular and humoral defence mechanisms have been examined in a group of 16 patients over a nine-month period from the day of commencement of continuous ambulatory peritoneal dialysis (CAPD). Significant decreases in the levels of IgG, C3, and opsonic activity occurred with the passage of time in the overnight peritoneal dialysis effluent (PDE). The ability of PDE to inhibit in vitro growth of Staphylococcus epidermidis also decreased. The number ot cells in the PDE and their ability to kill S. epidermidis decreased, although there was no significant change in their ability to ingest this organism. These results suggest that the immunological protection of the peritoneal cavity decreases with time, and this may account for the increase in the incidence of peritonitis with length of time on CAPD that some workers have reported.

Scanning Electron Microscopy of Staphylococcus Epidermidis Adherence to Continuous Ambulatory Peritoneal Dialysis Catheters

1985 ◽  
Vol 43 ◽  
pp. 520-521
Author(s):  
William J. Lamoreaux ◽  
David L. Smalley ◽  
Larry M. Baddour ◽  
Alfred P. Kraus
Keyword(s):  
Electron Microscopy ◽  
Scanning Electron Microscopy ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Staphylococcus Epidermidis ◽  
Sterile Saline ◽  
Intravascular Devices ◽  
Capd Patient ◽  
Scanning Electron

Infections associated with the use of intravascular devices have been documented and have been reported to be related to duration of catheter usage. Recently, Eaton et al. reported that Staphylococcus epidermidis may attach to silastic catheters used in continuous ambulatory peritoneal dialysis (CAPD) treatment. The following study presents findings using scanning electron microscopy (SEM) of S. epidermidis adherence to silastic catheters in an in vitro model. In addition, sections of polyvinyl chloride (PVC) dialysis bags were also evaluated by SEM.The S. epidermidis strain RP62A which had been obtained in a previous outbreak of coagulase-negative staphylococcal sepsis at local hospitals was used in these experiments. The strain produced surface slime on exposure to glucose, whereas a nonadherent variant RP62A-NA, which was also used in these studies, failed to produce slime. Strains were grown overnight on blood agar plates at 37°C, harvested from the surface and resuspended in sterile saline (0.85%), centrifuged (3,000 rpm for 10 minutes) and then washed twice in 0.1 M phosphate-buffered saline at pH 7.0. Organisms were resuspended at a concentration of ca. 106 CFU/ml in: a) sterile unused dianeal at 4.25% dextrose, b) sterile unused dianeal at 1.5% dextrose, c) sterile used dialysate previously containing 4.25% dextrose taken from a CAPD patient, and d) sterile used dialysate previously containing 1.5% dextrose taken from a CAPD patient.

Peritoneal Defence Mechanisms and Staphylococcus Aureus in Patients Treated with Continuous Ambulatory Peritoneal Dialysis (CAPD)

1990 ◽  
Vol 10 (2) ◽  
pp. 135-140 ◽  
Author(s):  
Simon J. Davies ◽  
Virginia M. A. Yewdall ◽  
Chisholm S. Ogg ◽  
J. Stewart Cameron
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Peritoneal Macrophages ◽  
Significant Activity ◽  
Adverse Clinical Outcome ◽  
Defence Mechanisms ◽  
Opsonic Activity ◽  
Blood Neutrophils ◽  
And Staphylococcus Aureus ◽  
Related Increase

Peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients due to S. aureus is associated with an adverse clinical outcome, suggesting impaired clearance of this organism by the host. The ability of peritoneal macrophages (PMO) derived from CAPD patients to take up S. aureus and mount a respiratory burst was investigated. Whilst significant activity was observed in the absence of opsonin, both parameters of phagocytosis were augmented by addition of 20% pooled human serum (PHS), complement-depleted PHS, and fibronectin. When used as sole opsonin, fibronectin resulted in a dose-related increase in chemiluminescent response by both blood neutrophils and PMO. The opsonic activity of dialysis effluent, as judged by neutrophil chemiluminescence, correlated with IgG and fibronectin content, but not with complement as assessed by C3 levels. The addition of urokinase to dialysate improved its opsonic properties whilst having no effect on the activity of PHS-20%; this would suggest that the formation of fibrin in dialysate, promoted by S. aureus, interferes with phagocytosis. This and the low IgG, complement and fibronectin levels in dialysate may explain in part the relatively poor clearance of this organism from the peritoneum.

Specific Opsonic Activity for Staphylococci in Peritoneal Dialysis Effluent During Continuous Ambulatory Peritoneal Dialysis

1992 ◽  
Vol 20 (4) ◽  
pp. 372-375 ◽  
Author(s):  
Henrik Nielsen ◽  
Frank Espersen ◽  
Arsalan Kharazmi ◽  
Steen Antonsen ◽  
Ellen Ejlersen, ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Opsonic Activity ◽  
Peritoneal Dialysis Effluent

Defective Opsonic Activity of Peritoneal Effluent during Continuous Ambulatory Peritoneal Dialysis (CAPD): Importance and Prevention

1986 ◽  
Vol 6 (2) ◽  
pp. 87-93 ◽  
Author(s):  
Silvano Lamperi ◽  
Silvia Carozzi
Keyword(s):  
Peritoneal Dialysis ◽  
Staphylococcus Epidermidis ◽  
Phagocytic Activity ◽  
Peritoneal Macrophages ◽  
Phagocytic Capacity ◽  
Opsonic Activity ◽  
Control Serum ◽  
Normal Women ◽  
Micro Organisms ◽  
Peritoneal Dialysis Effluent

To evaluate peritoneal immunological defenses and to find a way to prevent peritonitis we have studied the capacity of peritoneal dialysis effluent (PDE) to opsonize bacteria, and the phagocytic activity of peritoneal macrophages (PM). The subjects were 40 uremic patients followed for a mean period of 36 months and 40 normal women who underwent laparoscopy (controls). Opsonic capacity for Staphylococcus epidermidis of undiluted PDE from CAPD patients with low peritonitis incidence (LPI) proved to be similar to that of 10% control serum. However, the capacity of effluent from patients with a high peritonitis incidence (HPI) was noticeably inferior. In these cases, IgG concentration in PDE was lower than in LPI patients. There was a significant correlation between opsonization capacity for bacteria and IgG concentration values in PDE. We found inverse correlations between opsonic capacity of PDE and number of episodes of peritonitis. Phagocytic capacity of PM from CAPD patients was similar to that of control PM when micro-organisms were preopsonized by control serum. Treatment with intraperitoneal intmunoglobulin raised PDE opsonization capacity and lowered the incidence in those with previous HPI, thus demonstrating the importance of abnormal opsonization in CAPD peritonitis and the possibility of preventing infection by prophylaxis with intraperitoneal immunoglobulin. Intravenous immunoglobulin does not reduce the incidence of infection.

Strain Differences in the Opsonisation of Staphylococcus Epidermidis

1989 ◽  
Vol 9 (4) ◽  
pp. 333-339 ◽  
Author(s):  
David N. Bennett-Jones ◽  
Virginia M. A. Yewdall ◽  
Cecilia M. E. Gillespie ◽  
Chisholm S. Ogg ◽  
J. Stewart Cameron
Keyword(s):  
Peritoneal Dialysis ◽  
Salt Solution ◽  
Host Resistance ◽  
Staphylococcus Epidermidis ◽  
Strain Differences ◽  
In Vitro Study ◽  
Coagulase Negative Staphylococci ◽  
Opsonic Activity ◽  
Heat Treated

Ten isolates of coagulase-negative staphylococci, collected from patients receiving treatment with continuous ambulatory peritoneal dialysis (CAPD), exhibited marked differences in the degree of opsonisation when incubated in 10% and 1% pooled human serum, 10% and 1% heat-treated serum, Hanks’ Balanced Salt Solution, and timed peritoneal dialysis (PD) effluent. The addition of exogenous IgG to PD effluent results in a greater increase in opsonisation in those fluids with the weakest inherent opsonic activity, but is ineffective against the majority of isolates in the absence of heat-Iabile opsonic activity. The results of this in vitro study suggest that host resistance to CAPD peritonitis due to coagulasenegative staphylococci may be determined as much by the characteristics of the contaminating strain, as by the opsonising activity of PD effluent.

Pharmacokinetics and Pharmacodynamics of Antistaphylococcal Antibiotics in Continuous Ambulatory Peritoneal Dialysis Patients

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 367-371 ◽  
Author(s):  
Erich Keller
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Inhibitory Concentration ◽  
Pharmacokinetic Data ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Antistaphylococcal Activity ◽  
Cure Rates ◽  
Vitro Data ◽  
In Vitro Data

Staphylococci are the leading pathogens In continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis. Vancomycin appears to be an outstanding antistaphylococcal drug because resistance to It Is nearly absent. The pharmacokinetics of vancomycin and clinical cure rates of peritonitis with different dosing guidelines have been studied extensively. Different dosing guidelines with IP or IV loading doses followed or not followed by IP maintenance doses are used successfully, despite the fact that some of the dosing schemes produce apparently suboptimal drug levels referring to In vitro data like the MIC value (minimum Inhibitory concentration). Alternatively, amlnoglycosldes, cephalosporlns, Isoxazolyl penicillins, and broad-spectrum penicillins combined with betalactamase Inhibitors may be used for the treatment of gram-positive peritonitis. For the above panicillins pharmacokinetic data are scarce, and clinical experience is limited. Rifampin has excellent Intracellular antistaphylococcal activity and should be used In combination with other antibiotics. Although pharmacokinetic data are lacking, rifampin dosages do not require adaptation to renal function or replacement therapy.

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.

Cancer Antigen 1251S Locally Produced in the Peritoneal Cavity during Continuous Ambulatory Peritoneal Dialysis

1994 ◽  
Vol 14 (2) ◽  
pp. 132-136 ◽  
Author(s):  
Ger C.M. Koomen ◽  
Michiel G.H. Betjes ◽  
Oésirée Zemel ◽  
Raymond T. Krediet ◽  
Frans J. Hoek
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Mesothelial Cell ◽  
Linear Increase ◽  
Mesothelial Cells ◽  
Ca 125 ◽  
Cancer Antigen ◽  
The Relationship

The local production of cancer antigen (CA) 125 in the peritoneal cavity of 14 continuous ambulatory peritoneal dialysis patients was studied. In addition, the relationship between the concentration of mesothelial cells and CA 125 in the peritoneal dialysate effluent was examined. The median results and ranges were as follows: plasma CA 125 14 U/mL (range 10 23), dialysate CA 125 18 U/mL (range 5.2 76), dialysate/plasma ratio 1. 9 (range 0.61 -5.4), and number of mesothelial cells 400/mL (range 10 5000). Peritoneal concentrations of mesothelial cellsand CA 125 were positively correlated (r = 0.50, p < 0.01). Using a monoclonal antibody, CA 125-positive cells were found in the cytospin preparations of the cells of dialysis effluents. All these CA 125 positive cells were also positive for cytokeratin used as a mesothelial cell marker. In vitro experiments using mesothelial cells in monolayers showed a linear increase in CA 125 concentration both in time and in relation to the number of mesothelial cells. From these experiments a production rate of 24 U/hour/1 06 cells could be calculated. It is therefore concluded that CA 125 is locally produced in the peritoneal cavity during CAPD and that the mesothelial cells are the major source of this CA 125.

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