scholarly journals Colistin Induced Neurotoxicity in a Patient with End Stage Kidney Disease and Recovery with Conventional Hemodialysis

2015 ◽  
Vol 8 (1) ◽  
pp. 53-55 ◽  
Author(s):  
Radhika Chemmangattu Radhakrishnan ◽  
Shibu Jacob ◽  
Harish Ratnakarrao Pathak ◽  
Veerasami Tamilarasi
Keyword(s):  
Bacterial Infections ◽  
Blood Stream Infection ◽  
Signs And Symptoms ◽  
Blood Stream ◽  
Multidrug Resistant ◽  
End Stage Kidney Disease ◽  
Neurotoxic Effects ◽  
Stage Renal Disease ◽  
End Stage ◽  
Conventional Hemodialysis

Colistin is widely used in the treatment of multidrug resistant bacterial infections. Nephrotoxicity and neurotoxicity are risks associated with colistin use. We report the case of a 50 year old lady with end stage renal disease, treated with colistin for catheter related blood stream infection and developed muscle weakness and parasthesia. Concomitant use of meropenem may have precipitated neurotoxicity of colistin. Conventional hemodialysis was effective in reversing her signs and symptoms. Clinicians should be aware of the risk of neurotoxicity while using colistin, especially after a loading dose in patients with renal impairment. According to our knowledge, this is the first report of conventional hemodialysis reversing the neurotoxic effects of colistin.

scholarly journals Intracardiac fistula: an unusual complication of catheter-related blood stream infection

JRSM Open ◽  
2017 ◽  
Vol 8 (9) ◽  
pp. 205427041772823 ◽  
Author(s):  
Abhilash Koratala ◽  
Hussain Aboud ◽  
Robert Gibson ◽  
Karen K Hamilton
Keyword(s):  
End Stage Renal Disease ◽  
Blood Stream Infection ◽  
Significant Risk ◽  
Blood Stream ◽  
Unusual Complication ◽  
Early Use ◽  
Venous Fistula ◽  
Stage Renal Disease ◽  
End Stage ◽  
High Index Of Suspicion

Lesson In end stage renal disease patients on dialysis, the use of catheter as a vascular access is associated with a significant risk of sepsis compared to an arterio-venous fistula. Our case emphasizes the importance of having high index of suspicion for unusual complications in patients presenting with possible catheter-related blood stream infection and early use of complementary tools such as trans-oesophageal echocardiography whenever applicable.

scholarly journals Single-Center Investigation of the Pharmacokinetics of WCK 4282 (Cefepime-Tazobactam Combination) in Renal Impairment

2019 ◽  
Vol 63 (10) ◽  
Author(s):  
Richard A. Preston ◽  
Grigor Mamikonyan ◽  
Mushtaque Mastim ◽  
Dyal Garg ◽  
Christopher J. Kemper ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Impairment ◽  
Bacterial Infections ◽  
Severe Renal Impairment ◽  
Multidrug Resistant ◽  
Time Curve ◽  
Healthy Control ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

ABSTRACT WCK 4282 is a combination product of cefepime (FEP) and tazobactam (TAZ) in a 1:1 ratio currently under development for the treatment of multidrug-resistant Gram-negative bacterial infections. We investigated the effect of renal impairment on the pharmacokinetics (PK) and safety of WCK 4282 in 48 subjects with various degrees of renal function. Subjects were categorized on the basis of their Cockcroft-Gault equation-estimated creatinine clearance (CLCR). We enrolled 6 subjects each into those with mild (CLCR, 60 to <90 ml/min), moderate (CLCR, 30 to <60 ml/min), or severe (CLCR, <30 ml/min) renal impairment and those with end-stage renal disease (ESRD) requiring hemodialysis and 24 healthy control subjects (CLCR, ≥90 ml/min). Healthy subjects and subjects with mild and moderate renal impairment received a single 90-min infusion of 4 g of WCK 4282 (2 g FEP and 2 g TAZ). Subjects with severe renal impairment and ESRD received 2 g of WCK 4282 (1 g FEP and 1 g TAZ) over 90 min. The plasma exposure of FEP-TAZ increased as renal function decreased. In subjects with mild, moderate, and severe renal impairment and ESRD, the mean exposure (area under the plasma concentration versus time curve from time zero extrapolated to infinity) of FEP and TAZ increased by 1.3- and 1.2-fold, 2.3- and 2.3-fold, 4.7- and 4.0-fold, and 8.5- and 11.6-fold, respectively. The urinary recovery of FEP and TAZ decreased with increasing renal impairment. There were no adverse events reported during the study. The findings suggest that dose adjustments for WCK 4282 will be required according to the degree of renal impairment. A single infusion of WCK 4282 was found to be safe and well tolerated in subjects with normal and impaired renal function. (This study has been registered at ClinicalTrials.gov under identifier NCT02709382.)

scholarly journals Pulmonary Embolization with Tunneled Hemodialysis Catheter-Associated Blood Stream Infection: The Perils of Systemic Anticoagulation

2012 ◽  
Vol 4 (2) ◽  
pp. 73-75 ◽  
Author(s):  
Kamel A. Gharaibeh ◽  
Éva Csongrádi ◽  
Michael Shoemaker-Moyle ◽  
Anna Lerant ◽  
Mihály Tapolyai ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Blood Stream Infection ◽  
Renal Dialysis ◽  
Blood Stream ◽  
Hemodialysis Catheter ◽  
Individualized Care ◽  
Pulmonary Embolization ◽  
Systemic Anticoagulation ◽  
Stage Renal Disease ◽  
End Stage

A 35-year old African-American male with end-stage renal disease on hemodialysis through a tunneled dialysis catheter (TDC) presented with fever, diffuse aches and generalized distress. Blood cultures (BC) were obtained and empirical broad-spectrum antibiotic therapy started. After urgent renal dialysis, TDC was pulled at the bedside. Chest computed tomography (CT) diagnosed pulmonary embolism and systemic i.v. heparin was initiated. BC grew Gram positive cocci (methicillin-sensitive S. aureus) and cardiac echocardiogram confirmed acute bacterial endocarditis. Due to declined mental status, CT imaging was obtained revealing massive intracranial hemorrhage leading to the patient's death. Further chest CT review revealed only hemodynamically non-significant pulmonary emboli in some segmental and subsegmental arteries. Pulmonary embolization may be an expected occurrence with removal of infected TDC; systemic anticoagulation may not be warranted in such cases and may lead to catastrophic intracranial hemorrhage. This case draws our attention to the perils of rigid adherence to protocol and the failure of considering the needs of special patient cohorts and individualized care.

scholarly journals Recurrent thrombosis of an arteriovenous fistula as a complication of COVID-19 in a chronic hemodialysis patient: A case report

2021 ◽  
pp. 112972982110008
Author(s):  
Joao Pedro Teixeira ◽  
Sara A Combs ◽  
Jonathan G Owen
Keyword(s):  
Arteriovenous Fistula ◽  
Hemodialysis Patient ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Chronic Hemodialysis ◽  
Risk Of Death ◽  
Catheter Directed Thrombolysis ◽  
Intravenous Heparin ◽  
Increased Risk ◽  
End Stage

Patients with end-stage kidney disease are at increased risk of death from coronavirus disease 2019 (COVID-19). In addition, severe COVID-19 has been associated with an increased risk of arterial and venous thromboses. In this report, we describe the case of a hemodialysis patient who developed an otherwise-unexplained thrombosis of an arteriovenous fistula during a symptomatic COVID-19 infection. Despite prompt treatment with three technically successful thrombectomies along with systemic intravenous heparin and two rounds of catheter-directed thrombolysis with tissue plasminogen activator, the fistula rapidly re-thrombosed each time and he required tunneled dialysis catheter placement. He subsequently required admission for hypoxemia from COVID-19 pneumonia and ultimately developed a catheter-related blood stream infection that likely contributed to his death. As the fistula had been previously well functioning and no angiographic explanation for the thrombosis was found, we speculate in this case the recurrent thromboses were related to the hypercoagulable state characteristic of severe COVID-19. Interventionalists performing hemodialysis access procedures should be aware of the prothrombotic state associated with COVID-19 and should consider it when deliberating how to best plan and approach access interventions in patients with symptomatic COVID-19.

scholarly journals Evaluation of Specific Risk Factors and Outcomes of Colistin-Resistant Klebsiella pneumoniae Infections in a Tertiary Care Centre - An Observational Study

2021 ◽  
Vol 4 (2) ◽  
pp. 1-6
Author(s):  
Prakash Shastri ◽  
Shamanth A Shankarnarayan
Keyword(s):  
Risk Factors ◽  
Blood Stream Infection ◽  
Tertiary Care ◽  
Venous Catheter ◽  
Blood Stream ◽  
Central Line ◽  
Multidrug Resistant ◽  
Automated System ◽  
Tertiary Care Centre ◽  
Broth Microdilution Method

Background: Incidence of multidrug resistant Klebsiella pnumoniae infections are increasing globally especially in ICUs. Aim: We evaluated the burden of colistin resistant K. pneumoniae (ColR KP) and the risk factors associated with the outcome of these patients. Methods: Consecutive patients developing K. pneumoniae infections were included. K. pneumoniae from endotracheal tube and catheterized urine sample, having cell count <105 cfu/ml, and which did not necessitate a change in antibiotics as per the treating physicians was considered as colonizer. Demographic and clinical details were collected and samples were processed as per standard protocol. Any growth was identified and its antimicrobial susceptibility was carried out by using Vitek 2 automated system. Minimum inhibitory concentration of >4 μg/ml for Colistin was considered as resistant. The resistant isolates were confirmed with Broth microdilution method. Risk factor associated with the outcome of ColR KP was analyzed. Findings: Burden of K. pneumoniae infection was 50.02 per 1000 admissions. K. pneumonie (n=155) was isolated from patients with ventilator associated pneumonia (84, 54.2%), followed by blood stream infection (49, 31.6%) and urinary tract infection (22, 14.2%). ColR KP and intermediate (ColI KP) isolates were 58 (37.41%) and 97 (62.6%) respectively. Among ColR KP infected patients 32 (55.1%) died whereas 26 (44.8%) patients were discharged. Higher mortality was witnessed in ColI KP cases (75, 77.3%) compared to ColR-KP cases (32, 55.1%) (p=0.004; OR=2.77; 95% CI=1.37 to 5.59). Colistin resistance and presence of central line were independently associated with mortality. Conclusion: Colistin resistant K. pneumoniae infections among ICU patients are on rise. Presence of central venous catheter and resistance to colistin were independent predictors of mortality.

scholarly journals Catheter-Related ESBL-Producing Leclercia adecarboxylata Septicemia in Hemodialysis Patient: An Emerging Pathogen?

2020 ◽  
Vol 2020 ◽  
pp. 1-3 ◽  
Author(s):  
Roaa Sultan Alosaimi ◽  
Mai Muhmmed kaaki
Keyword(s):  
End Stage Renal Disease ◽  
Hemodialysis Patient ◽  
Multidrug Resistant ◽  
Beta Lactamase ◽  
Emerging Pathogen ◽  
First Case ◽  
Stage Renal Disease ◽  
End Stage ◽  
Multidrug Resistant Strain ◽  
Producer Strains

We report a multidrug-resistant strain of Leclercia adecarboxylata which was responsible for a catheter-related bacteremia, in a 50-year-old female with an end-stage renal disease on hemodialysis. The isolated strain was an extended beta-lactamase producer. Based on a literature review of L. adecarboxylata, there have been only two reports of extended beta-lactamase producer strains. To our knowledge, this is the first case reported in Saudi Arabia.

scholarly journals Sociodemographic and Clinical Risk Factors Associated With Tuberculosis Mortality in the United States, 2009-2013

2017 ◽  
Vol 132 (3) ◽  
pp. 366-375 ◽  
Author(s):  
Haylea A. Hannah ◽  
Roque Miramontes ◽  
Neel R. Gandhi
Keyword(s):  
United States ◽  
Risk Factors ◽  
Multinomial Logistic Regression ◽  
The United States ◽  
Multidrug Resistant ◽  
Multinomial Logistic Regression Analysis ◽  
Factors Associated ◽  
Specific Mortality ◽  
Stage Renal Disease ◽  
End Stage

Objectives: The objectives of our study were (1) to determine risk factors associated with tuberculosis (TB)–specific and non–TB-specific mortality among patients with TB and (2) to examine whether risk factors for TB-specific mortality differed from those for non–TB-specific mortality. Methods: We obtained data from the National Tuberculosis Surveillance System and included all patients who had TB between 2009 and 2013 in the United States and its territories. We used multinomial logistic regression analysis to determine the adjusted odds ratio (aOR) of each risk factor for TB-specific and non–TB-specific mortality. Results: Of 52 175 eligible patients with TB, 1404 died from TB, and 2413 died from other causes. Some of the risk factors associated with the highest odds of TB-specific mortality were multidrug-resistant TB diagnosis (aOR = 3.42; 95% CI, 1.95-5.99), end-stage renal disease (aOR = 3.02; 95% CI, 2.23-4.08), human immunodeficiency virus infection (aOR = 2.63; 95% CI, 2.02-3.42), age 45-64 years (aOR = 2.57; 95% CI, 2.01-3.30) or age ≥65 years (aOR = 5.76; 95% CI, 4.37-7.61), and immunosuppression (aOR = 2.20; 95% CI, 1.71-2.83). All of these risk factors except multidrug-resistant TB were also associated with increased odds of non–TB-specific mortality. Conclusion: TB patients with certain risk factors have an elevated risk of TB-specific mortality and should be monitored before, during, and after treatment. Identifying the predictors of TB-specific mortality may help public health authorities determine which subpopulations to target and where to allocate resources.

The influence of hemodialysis membrane permeability on serum procalcitonin values in patients on maintenance hemodialysis

2017 ◽  
Vol 41 (2) ◽  
pp. 124-128 ◽  
Author(s):  
Taoufiq Aatif ◽  
Yassir Zajjari ◽  
Anas Jeaidi
Keyword(s):  
Membrane Permeability ◽  
Bacterial Infections ◽  
Serum Levels ◽  
Maintenance Hemodialysis ◽  
Specific Reference ◽  
Reference Ranges ◽  
High Flux ◽  
Before And After ◽  
Stage Renal Disease ◽  
End Stage

Background: Procalcitonin (PCT) has emerged as a marker of infection and it could be useful for detection of systemic bacterial infections in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). The aim of this study was to assess the influence of HD membrane permeability to PCT serum levels in noninfected HD patients on maintenance HD. Methods: In a prospective comparative study, we measured PCT serum levels and C reactive protein (CRP) before and after HD in 36 sessions (18 sessions of HD with low-flux = Group L; and 18 sessions with high flux membranes = Group H), in 18 chronic HD patients without history of infection. Results: Sessions of HD by high-flux membranes (Group H) displayed median PCT values that were significantly decreased after dialysis (0.21 ng/mL [0.13-0.41] vs. 0.18 ng/mL [0.10-0.24], p <0.001) but median PCT significantly increased after HD sessions by low-flux membranes (Group L) (0.21 ng/mL [0.14-0.33] vs. 0.25 ng/mL [0.14-0.36]; p = 0.008). CRP values were significantly increased after HD in both groups. CRP correlated with PCT values only in group H before HD (r = 0.49; p = 0.36). Conclusions: PCT represents a useful diagnostic marker for systemic bacterial infection. However, there is a need for specific reference ranges to be developed in patients with renal failure undergoing HD; also, PCT serum levels must be interpreted according to the HD membrane permeability.

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