Peritonitis in Continuous Ambulatory Peritoneal Dialysis (CAPD): Diagnostic Findings, Therapeutic Outcome and Complications

1989 ◽  
Vol 9 (3) ◽  
pp. 179-190 ◽  
Author(s):  
Anders Tranæus ◽  
Olof Heimbürger ◽  
Bengt Lindholm
Keyword(s):  
Membrane Filtration ◽  
Mononuclear Cells ◽  
Clinical Symptoms ◽  
White Cell Count ◽  
Positive Culture ◽  
Generation Cephalosporin ◽  
Drop Out ◽  
Coagulase Negative Staphylococci ◽  
In Vitro Susceptibility

The analysis of all episodes of peritonitis occurring in a uniformly treated continuous ambulatory peritoneal dial ysis (CAPD) population ( N = 128) at one centre during a six-year period showed the following major findings. The initial white cell count (WCC) of the dialysate was <100 .106/L in 10% of the episodes and showed a predominance of mononuclear cells in 15%. The Gram stain results were consistent with the findings of the culture in 28% of the episodes and influenced the initial therapy in only 7% of the cases. Between 9% and 31% of all episodes would not have been classified as peritonitis if positive culture, a WCC of >100 .106/L in the dialysate, or clinical symptoms had been required for the diagnosis. The proportion of negative dialysate cultures was 2% after the introduction of pre-culture membrane filtration. Tunnel infection as a cause of peritonitis was more frequent in episodes due to Staphylococcus aureus than in episodes due to coagulase-negative staphylococci (p = 0.009). Peritonitis caused by coagulase negative staphylococci were followed by a milder course than other organisms (p = 0.02). Of all episodes initially treated with cephradine only 62% were cured with this antibiotic (or cloxacillin) and 35% were followed by recurrency, protracted course or catheter loss, despite intermediate or full in vitro susceptibility. In only 53% of all episodes no complication was observed. Complications were more frequent in women and diabetics than in men (p = 0.01) and non-diabetics (p = 0.03), and were more common in episodes with clinical symptoms (p = 0.02). Peritonitis resulted in drop-out from CAPD in 6% of all episodes. Hospital care was needed in 68% of all episodes. We conclude that turbidity can be used as the sole criterion for the initial diagnosis of peritonitis, and that a first generation cephalosporin should not be used as a first line antibiotic in the treatment of CAPD peritonitis.

Evaluation of in vitro susceptibility of Gram-positive pathogens from a tertiary care hospital in Singapore to a novel oxazolidinone, tedizolid, by a gradient diffusion method and broth microdilution

2018 ◽  
Vol 72 (2) ◽  
pp. 181-184
Author(s):  
Saugata Choudhury ◽  
Lee Kar Mun ◽  
Esme Ng Chu Xuan ◽  
Lee Shin Jia ◽  
Shawn Vasoo ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Bloodstream Infections ◽  
Diffusion Method ◽  
Care Hospital ◽  
Broth Microdilution ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
In Vitro Susceptibility ◽  
Gradient Diffusion

We compared the in vitro antimicrobial activities of tedizolid and linezolid on the Sensititre broth microdilution system for Gram-positive cocci isolates (n=146) from skin and skin structure infections and bloodstream infections, bronchoalveolar lavage and sputum. These pathogens included 40 methicillin-resistant Staphylococcus aureus, 38 coagulase-negative staphylococci, 20 Enterococcus faecalis and 48 beta-haemolytic Streptococcus spp. Susceptibility was simultaneously determined for 48 vanA vancomycin-resistant enterococci isolates 2013–2016 from rectal swabs (23 E. faecalis and 25 E. faecium, of which 4 were linezolid-non-susceptible). MIC90s for tedizolid were fourfold to eightfold lower than linezolid on the Sensititre and ranged from 0.12 to 0.5 µg/mL for the different pathogen groups. All isolates were susceptible to tedizolid except two vanA E. faecium strains (MICs of 1 and 2 µg/mL, respectively). Categorical and essential agreement for tedizolid were 99.48% and 92%, respectively, between Liofilchem gradient diffusion and Sensititre methods. Overall, the drug exhibited excellent activity against the surveyed Gram-positive pathogens.

ID: 49: STUDY OF MINIMUM INHIBITORY CONCENTRATION OF CEFAZOLIN FOR METHICILLIN SENSITIVE STAPHYLOCOCCUS AUREUS AND CORRELATION WITH OXACILLIN SUSCEPTIBILITY

2016 ◽  
Vol 64 (4) ◽  
pp. 954.2-954
Author(s):  
C Quarshie ◽  
J Koirala ◽  
V Sundareshan
Keyword(s):  
Staphylococcus Aureus ◽  
Standard Deviation ◽  
Minimum Inhibitory Concentration ◽  
Inhibitory Concentration ◽  
Medical Center ◽  
Generation Cephalosporin ◽  
In Vitro Susceptibility ◽  
Suitable Alternative ◽  
High Level

BackgroundCefazolin, a first generation cephalosporin, has been used for the treatment of Methicillin Sensitive Staphylococcus aureus (MSSA) infections since the 1970s. There have now been reported cases of failed therapy with cefazolin. High-level β-lactamase producing strains of S. aureus can inactivate the susceptible β-lactam (cefazolin) at a rate high enough to overcome its antibacterial effect. These strains typically have a high Minimum Inhibitory Concentration (MIC) for cefazolin when a large inoculum is used. About 20% of MSSA isolates have been shown to have a substantial inoculum effect suggesting that cefazolin treatment might be associated with clinical failure in serious MSSA infections. The minimum inhibition concentration (MIC) for cefazolin is not provided on all standard sensitivity panels and susceptibility is extrapolated from the report on oxacillin. The goal of this study was to analyze the MIC of cefazolin for MSSA isolates to determine the correlation of cefazolin susceptibility and in vitro susceptibility of oxacillin. We also evaluated the MIC of alternative antibiotics as part of this study for use in patients that might be allergic to penicillin.MethodThirty two isolates of MSSA were randomly selected from repositories of isolates at Memorial Medical Center hospital's microbiology department from 2015. The isolates were from patients with a wide variety of diagnoses, including bacteremia, osteomyelitis and wound infections. S. aureus ATCC 29213 was used as controls. MICs were determined by a Kirby Bauer method for cefazolin and Epsilometer test for other antibiotics that were studied. Inocula were standardized using optical density measurements, with determinations of CFU/ml to determine the inoculum concentrations. IN addition to cefazolin, we obtained the MIC for daptomycin, oxacillin, ceftaroline and telavancin as well.ResultsOf the thirty two MSSA isolates tested, 100% were susceptible to cefazolin. The mean zone of inhibition (ZOI) was 29.18 with standard deviation of 3.67 for cefazolin (29–35 mm ZOI with ATCC strains of MSSA) . All the isolates were susceptible to Oxacillin with mean MIC of 0.7735 with standard deviation of 0.30. Daptomycin, ceftaroline and telavancin were 100% susceptible with mean MIC of 0.27, 0.25, and 0.07, respectively. All isolates were studied for the alternate antibiotics and no resistance was noted.ConclusionThe MIC of cefazolin for MSSA determined by in vitro susceptibility to oxacillin was entirely in the susceptible range with 100% correlation. Daptomycin, ceftaroline and telavancin are suitable alternative antibiotics for treatment of patients with infections due to MSSA in whom anti-staphylococcal penicillins cannot be used due to penicillin allergic, intolerance, and/or non-availability since there is not much resistance to these antibiotics in MSSA.

scholarly journals Effect of Vitamin D3 On the Expression of Antimicrobial Peptide Gene in Experimental Pneumonia in Calf

2021 ◽  
Author(s):  
Parisa Asgharpour ◽  
Zohre Eftekhari ◽  
Mohammad Goli Nadealian ◽  
Gholam Reza Nikbakht Borojeni ◽  
Mohammad Reza Mokhber Dezfouli
Keyword(s):  
Vitamin D ◽  
Treatment Group ◽  
Vitamin D3 ◽  
Pasteurella Multocida ◽  
Mononuclear Cells ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Cell Content ◽  
Peripheral Blood Mononuclear

Abstract Background Vitamin D3 has been identified as an immunomodulatory agent that confronts the pathogens via stimulating antimicrobial peptides (AMPs). Objective The effects of vitamin D3 on the expression of AMPs was assessed in experimental pasteurellosis in calves. Methods 10 Holstein crossbred male calves (2–4 months) were chosen and randomly divided into the two groups. Pasteurella multocida was prepared (3×109 CFU/mL) and inoculated in the trachea. Vitamin D3 was injected to the treatment group after confirming the pneumonia. Blood samples were obtained from both groups at different time intervals and the peripheral blood mononuclear cells (PBMCs) were isolated. Clinical symptoms were recorded. Broncho-alveolar lavage was performed to evaluate the lung cell content. On the other hand, 10− 6, 10− 7, and 10 − 8 molar (M) of vitamin D3, was used to evaluate the expression of CD4, BMAP34, and BNBD4 genes using PBMCs under the in vitro conditions. Results The prescription of vitamin D3 to the treatment group caused a decline in clinical signs. Following the vitamin D3 injections the treatment groups under the in vivo conditions, significant increase was observed in the expression level of Defensin (BNBD4), and CD4. Evaluation of bronchoalveolar lavage fluid (BALF) revealed that the amount of neutrophils decreased after vitamin D injection. In vitro, increased expression of Catalicidin (BMAP34), Defensin (BNBD4), and CD4 was observed at a concentration of 10− 6 M of vitamin D3. Conclusion The present study indicated that vitamin D3, exerts immunomodulatory effects on many infectious diseases via activation of VDR pathways and stimulation of AMP production.

Treatment of Peritoneal Dialysis-Related Peritonitis with Ciprofloxacin Monotherapy: Clinical Outcomes and Bacterial Susceptibility over Two Decades

2009 ◽  
Vol 29 (3) ◽  
pp. 310-318 ◽  
Author(s):  
Miguel Pérez Fontán ◽  
Helena Díaz Cambre ◽  
Ana Rodríguez-Carmona ◽  
Andrés López Muñiz ◽  
Teresa García Falcón
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Outcome ◽  
Time Course ◽  
Initial Therapy ◽  
Coagulase Negative Staphylococci ◽  
In Vitro Susceptibility ◽  
Historical Cohort ◽  
Early Results

Background There is controversy about the preferred initial antibiotic therapy for peritoneal dialysis (PD)-related peritonitis. Quinolones have been used extensively in this setting, yet their long-term effectiveness is unknown. Aim To analyze the results of a protocol of treatment of PD-related peritonitis with ciprofloxacin, maintained over two decades. Method We analyzed the clinical outcome of 682 episodes of bacterial peritonitis treated with intraperitoneal ciprofloxacin monotherapy, and the time course of bacterial susceptibility to this antimicrobial, in a historical cohort of 641 PD patients (1988-2007). Main outcome variables included changes to initial therapy and rates of hospital admission, catheter removal, relapse, reinfection, PD dropout, and mortality. For comparisons we divided the study period into phases A (1988-1994), B (1995-2000), and C (2001-2007). Results The incidence of Staphylococcus aureus peritonitis decreased, while the incidences of polymicrobial and negative-culture peritonitis increased after phase A. In vitro susceptibility to ciprofloxacin decreased significantly only among coagulase-negative staphylococci (87.0% susceptible strains in phase A vs 70.0% in B and 70.1% in C, p = 0.006). Overall success rates (catheter not removed and ongoing PD after the episode) remained stable, at over 85%. However, the proportion of patients treated solely with ciprofloxacin declined from 75.7% (A) to 47.3% (B) to 32.4% (C) ( p < 0.0005) and admission rates increased from 12.7% to 16.8% to 24.9% respectively ( p = 0.001). These changes affected all the etiologic groups except culture-negative peritonitis. In vitro resistance to ciprofloxacin was a marker of multiresistance and correlated strongly with clinical outcome of peritonitis. Among isolates susceptible to ciprofloxacin, changing initial therapy for any reason also predicted a poor outcome. Conclusions Following satisfactory early results, the effectiveness of ciprofloxacin as monotherapy for PD-related peritonitis has declined markedly in the long term. This decline cannot be explained solely by a decrease of in vitro susceptibility to this antimicrobial, which was significant only among coagulase-negative staphylococci. Resistance to ciprofloxacin is a strong marker of in vitro multiresistance and poor clinical outcome of peritonitis.

scholarly journals Susceptibility of bacterial endophthalmitis isolates to vancomycin, ceftazidime, and amikacin

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kuan-Jen Chen ◽  
Ming-Hui Sun ◽  
Chiun-Ho Hou ◽  
Hung-Chi Chen ◽  
Yen-Po Chen ◽  
...  
Keyword(s):  
Vision Loss ◽  
Multidrug Resistant ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
In Vitro Susceptibility ◽  
Gram Negative ◽  
Tertiary Referral Center ◽  
Bacterial Endophthalmitis ◽  
Severe Vision Loss

AbstractBacterial endophthalmitis is a rare intraocular infection, and prompt administration of intravitreal antibiotics is crucial for preventing severe vision loss. The retrospective study is to investigate the in vitro susceptibility to the antibiotics vancomycin, amikacin, and ceftazidime of bacterial endophthalmitis isolates in specimens at a tertiary referral center from January 1996 to April 2019 in Taiwan. Overall, 450 (49.9%) isolates were Gram positive, 447 (49.6%) were Gram negative, and 4 (0.4%) were Gram variable. In Gram-positive isolates, coagulase-negative staphylococci were the most commonly cultured bacteria (158, 35.1%), followed by Streptococci (100, 22.2%), Enterococci (75, 16.7%), and Staphylococcus aureus (70, 15.6%). In Gram-negative isolates, they were Klebsiella pneumoniae (166, 37.1%) and Pseudomonas aeruginosa (131, 29.3%). All Gram-positive organisms were susceptible to vancomycin, with the exception of one Enterococcus faecium isolate (1/450, 0.2%). Of the Gram-negative isolates, 96.9% and 93.7% were susceptible to ceftazidime and amikacin, respectively. Nine isolates (9/447, 2.0%) were multidrug-resistant Gram-negative bacteria, comprising K. pneumoniae (4/164, 2.4%), Acinetobacter baumannii (2/3, 67%), and Stenotrophomonas maltophilia (3/18, 17%). In conclusion, in vitro susceptibility testing revealed that vancomycin remains the suitable antibiotic treatment for Gram-positive endophthalmitis. Ceftazidime and amikacin provide approximately the same degree of Gram-negative coverage. Multidrug-resistant bacterial endophthalmitis was uncommon.

Effect of bovine lactoferrin on the internalization of coagulase-negative staphylococci into bovine mammary epithelial cells under in-vitro conditions

2009 ◽  
Vol 76 (2) ◽  
pp. 144-151 ◽  
Author(s):  
Paula Hyvönen ◽  
Sari Käyhkö ◽  
Suvi Taponen ◽  
Atte von Wright ◽  
Satu Pyörälä
Keyword(s):  
Cell Model ◽  
Bovine Mastitis ◽  
Mammary Epithelial ◽  
Bovine Lactoferrin ◽  
Intracellular Replication ◽  
Coagulase Negative Staphylococci ◽  
In Vitro Susceptibility ◽  
Intramammary Infection ◽  
Mastitis Pathogens

Coagulase-negative staphylococci (CNS) have emerged as bovine mastitis pathogens in many countries. CNS mastitis is generally mild but can persist in the udder for long periods. Pathogenesis of CNS intramammary infection is not well understood. In the present study, adhesion, invasion and intracellular replication of twenty-two CNS strains isolated from bovine mastitis and the effect of bovine lactoferrin (bLf) on the internalization were studied in vitro in a bovine mammary epithelial (BME) cell model. The CNS strains were ofStaphylococcus chromogenes, Staph. simulans, Staph. epidermidis, Staph. haemolyticusandStaph. cohnii urealyticus; two strains ofStaph. aureuswere used as controls. Seven of the CNS strains originated from persistent and five from transient mastitis infections. The in-vitro susceptibility of the strains to bLf was also investigated. All CNS species examined had an adhesive ability equal to that ofStaph. aureus, but internalization varied among staphylococcal strains. The antagonistic effect of bLf on the adhesion and invasion of CNS strains was weak, but bLf significantly decreased intracellular replication and replication rates of CNS. No correlation between the in-vitro susceptibility of the strain to bLf or internalization among clinical signs of mastitis was established. No difference between the persistent and transient CNS strains in adhesion, invasion or replication rate was recorded. This in-vitro BME cell model can be used to study the virulence potential of mastitis pathogens, although the severity and persistence of eventual infections shall be further investigated in vivo. The role of bLf in intramammary infection caused by CNS may be limited.

scholarly journals Applications of Transcriptomics and Proteomics for Understanding Dormancy and Resuscitation in Mycobacterium tuberculosis

2021 ◽  
Vol 12 ◽  
Author(s):  
Manikuntala Kundu ◽  
Joyoti Basu
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Fatty Acid ◽  
Cell Division ◽  
Drug Targets ◽  
Mononuclear Cells ◽  
Clinical Symptoms ◽  
Transcriptional Regulator ◽  
Peripheral Blood Mononuclear ◽  
Latently Infected

Mycobacterium tuberculosis can survive within its host for extended periods of time without any clinical symptoms of disease and reactivate when the immune system is weakened. A detailed understanding of how M. tuberculosis enters into and exits out of dormancy, is necessary in order to develop new strategies for tackling tuberculosis. Omics methodologies are unsupervised and unbiased to any hypothesis, making them useful tools for the discovery of new drug targets. This review summarizes the findings of transcriptomic and proteomic approaches toward understanding dormancy and reactivation of M. tuberculosis. Within the granuloma of latently infected individuals, the bacteria are dormant, with a marked slowdown of growth, division and metabolism. In vitro models have attempted to simulate these features by subjecting the bacterium to hypoxia, nutrient starvation, potassium depletion, growth in the presence of vitamin C, or growth in the presence of long-chain fatty acids. The striking feature of all the models is the upregulation of the DosR regulon, which includes the transcriptional regulator Rv0081, one of the central hubs of dormancy. Also upregulated are chaperone proteins, fatty acid and cholesterol degrading enzymes, the sigma factors SigE and SigB, enzymes of the glyoxylate and the methylcitrate cycle, the Clp proteases and the transcriptional regulator ClgR. Further, there is increased expression of genes involved in mycobactin synthesis, fatty acid degradation, the glyoxylate shunt and gluconeogenesis, in granulomas formed in vitro from peripheral blood mononuclear cells from latently infected individuals compared to naïve individuals. Genes linked to aerobic respiration, replication, transcription, translation and cell division, are downregulated during dormancy in vitro, but upregulated during reactivation. Resuscitation in vitro is associated with upregulation of genes linked to the synthesis of mycolic acids, phthiocerol mycocerosate (PDIM) and sulfolipids; ribosome biosynthesis, replication, transcription and translation, cell division, and genes encoding the five resuscitation promoting factors (Rpfs). The expression of proteases, transposases and insertion sequences, suggests genome reorganization during reactivation.

scholarly journals Leishmania spp Epitopes in Humans Naturally Resistant to the Disease: Working Toward a Synthetic Vaccine

2021 ◽  
Vol 11 ◽  
Author(s):  
Magda Melissa Flórez ◽  
Rocío Rodríguez ◽  
José Antonio Cabrera ◽  
Sara M. Robledo ◽  
Gabriela Delgado
Keyword(s):  
Immune Response ◽  
In Silico ◽  
Large Scale ◽  
Mononuclear Cells ◽  
Clinical Symptoms ◽  
Epitope Prediction ◽  
Effective Vaccine ◽  
Peripheral Blood Mononuclear

Vaccines are one of the most effective strategies to fight infectious diseases. Reverse vaccinology strategies provide tools to perform in silico screening and a rational selection of potential candidates on a large scale before reaching in vitro and in vivo evaluations. Leishmania infection in humans produces clinical symptoms in some individuals, while another part of the population is naturally resistant (asymptomatic course) to the disease, and therefore their immune response controls parasite replication. By the identification of epitopes directly in humans, especially in those resistant to the disease, the probabilities of designing an effective vaccine are higher. The aim of this work was the identification of Leishmania epitopes in resistant humans. To achieve that, 11 peptide sequences (from Leishmania antigenic proteins) were selected using epitope prediction tools, and then, peripheral blood mononuclear cells (PBMCs) were isolated from human volunteers who were previously divided into four clinical groups: susceptible, resistant, exposed and not exposed to the parasite. The induction of inflammatory cytokines and lymphoproliferation was assessed using monocyte-derived dendritic cells (moDCs) as antigen-presenting cells (APCs). The response was evaluated after exposing volunteers’ cells to each peptide. As a result, we learned that STI41 and STI46 peptides induced IL-8 and IL-12 in moDCs and lymphoproliferation and low levels of IL-10 in lymphocytes differentially in resistant volunteers, similar behavior to that observed in those individuals to L. panamensis lysate antigens. We conclude that, in silico analysis allowed for the identification of natural Leishmania epitopes in humans, and also STI41 and STI46 peptides could be epitopes that lead to a cellular immune response directed at parasite control.

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