An experience with colistin applied in treatment of imunocompromised patients with peritonitis on peritoneal dialysis

Introduction. Immunocompromised patients, such as those with multiple myeloma on peritoneal dialysis, are particularly susceptible to the occurrence of peritonitis. Case report. We presented a 56-year-old female patient with a 10-year history of multiple myeloma. The patient was on peritoneal dialysis since 2010. During 2012 the patient had the first episode of peritonitis that was successfully managed, but in 2013 the second episode of peritonitis occured. Analysis of dialysate culture and exit site swab revealed the presence of multiresistant Acinetobacter spp., which was susceptible only to colistin. Prompt colistin therapy was administered at the doses of 100,000 units/day during six days, which resulted in complete recovery of the patient, as well as improvement of local abdominal findings. Gram-negative bacteria (genus Acinetobacter) are common causative agents in hospital-acquired infections. Studies confirmed susceptibility of Acinetobacter to colistin, which was also the case with the presented patient. Intravenous administration of colistin resulted in a complete remission of this severe, life-threatening peritonitis. Conclusion. Patients with multiple myeloma and renal failure are highly prone to severe life-threatening infections.

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Modification of the percutaneous approach to peritoneal dialysis catheter placement under peritoneoscopic visualization: clinical results in 78 patients.

Journal of the American Society of Nephrology ◽

10.1681/asn.v31103 ◽

1992 ◽

Vol 3 (1) ◽

pp. 103-107

Author(s):

N S Nahman ◽

D F Middendorf ◽

W H Bay ◽

R McElligott ◽

S Powell ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Catheter Placement ◽

Seldinger Technique ◽

First Episode ◽

Dialysis Access ◽

Peritoneal Dialysis Catheter ◽

Exit Site ◽

Exit Site Infection ◽

Percutaneous Approach ◽

Tunnel Infection

The placement of percutaneous peritoneal dialysis catheters under direct peritoneoscopic visualization is a relatively new technique for establishing peritoneal dialysis access. In this study, in which a modification of the Seldinger technique was used to facilitate the placement of the peritoneoscope, the experience with 82 consecutive catheterization procedures in 78 patients is reported. In 2 (2.4%) of 82 catheterization procedures, we were unable to enter the peritoneal cavity but experienced no other complications unique to the percutaneous approach. Of the 80 successful catheterization procedures, 76 represented first-time catheter placement and constituted a population subjected to life-table analysis examining catheter survival rates, the time to first cutaneous exit site or s.c. tunnel infection, and the time to first episode of peritonitis. After a follow-up period of 50.1 patient yr, 11 catheters were lost because of catheter dysfunction. Other clinical complications included peritoneal fluid leaks at the cutaneous exit site in 11 instances (0.22/patient yr), cutaneous exit site infection in 7 instances (0.14/patient yr), s.c. tunnel infection in 2 instances (0.04/patient yr), and 34 episodes of peritonitis (0.68/patient yr). The results of this study demonstrate that the suggested modification of the percutaneous placement of peritoneal dialysis catheters, under peritoneoscopic visualization, is a viable method for establishing peritoneal access.

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A RARE CASE OF NEONATE WITH SEVERE LUNG DISEASE SECONDARY TO COVID 19 DISEASE

10.36106/ijar/9202874 ◽

2021 ◽

pp. 4-5

Author(s):

Vishal Dnyaneshwar Sawant ◽

Murtuja Shaikh ◽

Sushma Malik ◽

Poonam Wade ◽

Santosh Kondekar

Keyword(s):

Age Groups ◽

Severe Infection ◽

Complete Recovery ◽

Nasopharyngeal Swab ◽

Global Pandemic ◽

Similar Disease ◽

Life Threatening ◽

History Of ◽

Polymerase Chain ◽

Protective Strategies

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome Corona virus 2 (SARS-CoV-2), has caused a global pandemic affecting many countries. The disease is affecting all age groups but data so far has shown that infants and children seem to be at a lower risk of severe infection. This case emphasis that neonates too can have life threatening pulmonary disease that mimics a similar disease course to that described in adults with COVID-19 infection. We report a 21-day-old neonate who presented with fever and signicant positive history of COVID 19 infection in family and developed acute respiratory distress syndrome (ARDS). The SARSCoV-2 polymerase chain reaction (PCR) of nasopharyngeal swab was positive and chest computed tomography had classical changes of COVID 19 infection. Good hydration, lung protective strategies, intravenous immunoglobulin and supportive care led to complete recovery in the patient.

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Subcutaneous Cuff Migrates after Initiation of Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.3747/pdi.2017.00196 ◽

2018 ◽

Vol 38 (3) ◽

pp. 229-231

Author(s):

Tsutomu Sakurada ◽

Hitoshi Kotake ◽

Kenichiro Koitabashi ◽

Yugo Shibagaki

Keyword(s):

Diabetes Mellitus ◽

Peritoneal Dialysis ◽

Retrospective Study ◽

Site Infection ◽

Background Characteristics ◽

Single Center ◽

Exit Site ◽

Exit Site Infection ◽

Factors Affecting ◽

History Of

The aim of this study was to determine whether subcutaneous cuffs migrate toward the exit site after initiation of peritoneal dialysis (PD) and to clarify the factors affecting such migration. Subcutaneous cuff migration was defined as extension of the length of the external catheter. In this single-center, retrospective study, the external catheter lengths at initiation and 1 year later were compared in 33 PD patients (median age 62 years; 64% men; 49% with diabetes mellitus). The correlations between patient background characteristics at initiation and extension of catheter length were also examined. The external catheter length was significantly extended at 1 year later (13.5 vs 15.0 cm, p < 0.001). There was no relationship between a history of exit-site infection and extension of catheter length ( p = 0.250). Hemoglobin (r = -0.447, p = 0.009), serum albumin (r = -0.377, p = 0.031), and external catheter length at initiation (r = -0.350, p = 0.046) showed negative correlations with extension. In conclusion, subcutaneous cuff migration was observed in just 1 year and may be associated with malnutrition, anemia, and short external catheter length at initiation of PD.

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Paralysis from an ear infection: a severe case of otitis externa leading to acute complete cervical cord syndrome

BMJ Case Reports ◽

10.1136/bcr-2021-245594 ◽

2021 ◽

Vol 14 (12) ◽

pp. e245594

Author(s):

Rachael Collins ◽

George Lafford ◽

Laura Parry

Keyword(s):

Otitis Externa ◽

Severe Case ◽

Complete Recovery ◽

Cervical Cord ◽

Team Approach ◽

Neck Stiffness ◽

Threatening Condition ◽

Life Threatening ◽

History Of ◽

Red Flag

We report a case of a generally fit and well 54-year-old man who presented with a 2-day history of worsening left-sided otorrhea, headache, neck stiffness, vomiting and fever on the background of a 7-week history of otitis externa (OE). His condition progressed dramatically as he developed symptoms consistent with acute complete cervical cord syndrome with radiological evidence of skull base osteomyelitis, parapharyngeal, retropharyngeal and paravertebral abscesses and sigmoid sinus thrombus. Ultimately, he made a significant, although not complete, recovery. This case is unique in demonstrating how OE can develop into a potentially life threatening condition. It emphasises the importance of early diagnosis and treatment of OE, the recognition of ‘red flag’ symptoms and highlights the importance of a multidisciplinary team approach when managing complex complications of OE.

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Comparison of Peritonitis Rates during Long Term Use of Standard Spike versus Ultraset in Continuous Ambulatory Peritoneal Dialysis (CAPD)

Peritoneal Dialysis International ◽

10.1177/089686089001000111 ◽

1990 ◽

Vol 10 (1) ◽

pp. 41-43 ◽

Cited By ~ 42

Author(s):

John M. Burkart ◽

Britta Hylander ◽

Theresa Durnell-Figel ◽

Denise Roberts

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

First Episode ◽

Site Infection ◽

Exit Site ◽

Exit Site Infection ◽

Significant Difference ◽

Stage Renal Disease ◽

The Impact

Continuous ambulatory peritoneal dialysis (CAPD) is an increasingly popular means of end-stage renal disease replacement therapy. Unfortunately, peritonitis continues to be a major source of both morbidity and mortality. The Ultraset incorporates a “flush-before-fill” concept which should theoretically decrease peritonitis rates when compared to the standard spike procedure, while allowing patients the convenience of disconnect. To investigate the impact of long-term use of the Ultraset on peritonitis rates, we conducted the following study. We prospectively compared 21 new CAPD patients using the standard spike to 20 new CAPD patients using the Ultraset. Peritonitis episodes, episodes of exit -site infection, and the association of peritonitis with exit-site infection were monitored. Peritonitis rates were 7.57 months/episode for the group using the standard spike vs. 27.79 months/episode in the group using the Ultraset. Exit-site infection rates were 22.21 months/infection with the standard spike vs. 37.05 months/infection with the Ultraset. Using Kaplan-Meier plots, there was a statistically significant difference in the estimated time to the first episode of peritonitis, but there was no statistically significant difference regarding the risk of exit-site infections.

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Natural History of Exit-Site Infection (ESI) in Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD)

Peritoneal Dialysis International ◽

10.1177/089686088800800308 ◽

1988 ◽

Vol 8 (3) ◽

pp. 211-216 ◽

Cited By ~ 69

Author(s):

Georgi Abraham ◽

Evgeije Savin ◽

Anthony Ayiomamitis ◽

Sharron Izatt ◽

Stephen I. Vas ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Site Infection ◽

Exit Site ◽

Exit Site Infection ◽

Staph Aureus ◽

Serous Discharge ◽

History Of ◽

One Year ◽

Esi Group

One hundred and thirty-one patients were started on continuous ambulatory peritoneal dialysis (CAPD) between January 1984 and June 1987. They ranged in age from 14 to 82 years (mean 52.8). Sixty patients (1914 patient months) developed 133 episodes of exit-site infection (ESI), an incidence of one episode per 14.4 patient months. Sixty-six episodes were purulent and 67 were nonpurulent (redness, crust, or serous discharge). In diminishing order of frequency, the bacteria isolated were Staph. aureus, Staph. epidermidis, Pseudomonas, and diphtheroids. The probability for remaining free of ESI was 54% at one year and 22% at three years. Factors like single or double-cuff catheters, diabetes, and sex did not influence the development of ESI. Recurrence was common especially in purulent ESI, and medical or surgical treatment did not eradicate the infection. Patients with purulent ESI had a higher incidence of peritonitis than those with no ESI-one episode per 8.1 patient months vs. one episode per 20.9 patient months. In the ESI group, of the 154 catheters implanted, 24 (15.6%) were removed; five were lost without ESI (3%). The main cause leading to catheter removal in the ESI group were Staph. aureus and Pseudomonas infections. Peritonitis following ESI was not necessarily due to the organisms isolated from the ESI.

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Pseudomonas exit site infections in continuous ambulatory peritoneal dialysis patients.

Journal of the American Society of Nephrology ◽

10.1681/asn.v2101498 ◽

1992 ◽

Vol 2 (10) ◽

pp. 1498-1501

Author(s):

H R Kazmi ◽

F D Raffone ◽

A S Kliger ◽

F O Finkelstein

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Catheter Removal ◽

Site Infection ◽

Dialysis Patients ◽

Exit Site ◽

Exit Site Infection ◽

Retrospective View ◽

History Of ◽

Oral Ciprofloxacin

The purpose of this study is to examine the natural history of Pseudomonas aeruginosa exit site infections in continuous ambulatory peritoneal dialysis (CAPD) patients treated with oral ciprofloxacin and local exit site care. A retrospective view was undertaken of 18 episodes of P. aeruginosa exit site infections developing in 17 patients maintained on CAPD during 1989 and 1990. Standardized therapy for the exit site infection consisted of oral ciprofloxacin (500 mg twice daily) and local exit site care with antiseptic agents. Fifteen (83%) of 18 of the pseudomonas exit site infections resolved with therapy. Three episodes (17%) required catheter removal to successfully eradicate the infection. Four of the 15 patients whose exit site infections resolved developed P. aeruginosa peritonitis 2 to 9 months after the clinical resolution of the exit site infection. The majority of pseudomonas exit site infections in CAPD patients can be successfully treated with oral ciprofloxacin and local care. Approximately 17% of the patients in this study required catheter removal to successfully eradicate the infection and an additional 22% of the patients developed pseudomonas peritonitis several months after the resolution of the exit site infection.

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CRISPR-cas system in the acquisition of virulence genes in dental-root canal and hospital-acquired isolates of Enterococcus faecalis

10.21203/rs.2.13402/v3 ◽

2019 ◽

Author(s):

Pourya Gholizadeh ◽

Mohammad Aghazadeh ◽

Reza Ghotaslou ◽

Mohammad Ahangarzadeh Rezaee ◽

Tahereh Pirzadeh ◽

...

Keyword(s):

Enterococcus Faecalis ◽

Root Canal ◽

Biofilm Formation ◽

Virulence Genes ◽

Virulence Determinants ◽

Root Canals ◽

Causative Agents ◽

Life Threatening ◽

Selective Forces ◽

Hospital Acquired

Abstract Introduction Enterococcus faecalis is one of the important causative agents of nosocomial and life-threatening infections in human. Several studies have demonstrated that the presence of CRISPR- cas is associated with antibiotic susceptibility and lack of virulence traits. In this study, we aimed to assess the phenotypic and genotypic virulence determinants in relation to CRISPR elements from the dental-root canals and hospital-acquired isolates of E. faecalis .Methods and materials Eighty-eight hospital-acquired and 73 dental-root canal isolates of E. faecalis were assessed in this study. Phenotypic screening of the isolates included biofilm formation, and gelatinase and hemolysis activities. Genotypical screening using PCR was further used to evaluate the presence of CRISPR elements and different virulence-associated genes such as efaA , esp , cylA , hyl , gelE , ace , ebpR , and asa1 .Results Biofilm formation, and gelatinase and hemolysis activity were detected in 93.8%, 29.2% and 19.2% of the isolates, respectively. The most prevalent virulence-associated gene was ace , which was followed by efaA , whereas cylA was the least identified. The presence of CRISPR1- cas , orphan CRISPR2 and CRISPR3- cas was determined in 13%, 55.3% and 17.4% of the isolates, respectively. CRISPR elements were significantly more prevalent in the dental-root canals isolates. An inverse significant correlation was found between CRISPR- cas loci, esp and gelE , while direct correlations were observed in the case of cylA , hyl , gelE (among CRISPR-loci 1 and 3), asa1 , ace , biofilm formation, and hemolysis activity.Conclusion Findings, therefore, indicate that CRISPR- cas might prevent the acquisition of some respective pathogenicity factors in some isolates, though not all; so selective forces could not influence pathogenic traits.

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A Case of Relapsing Peritoneal Dialysis-Associated Peritonitis byDokdonella koreensis

Case Reports in Infectious Diseases ◽

10.1155/2018/3820513 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Jamie Bee Xian Tan ◽

Alvin Ren Kwang Tng ◽

Htay Htay

Keyword(s):

Renal Failure ◽

Abdominal Pain ◽

Peritoneal Dialysis ◽

Tract Infection ◽

Patient Management ◽

Significant Morbidity ◽

Exit Site ◽

First Case ◽

Rrna Sequencing ◽

History Of

Peritonitis is a common and serious complication of peritoneal dialysis (PD) with significant morbidity. We report the first case of relapsingDokdonella koreensisperitonitis in a patient on peritoneal dialysis. A 63-year-old Chinese man, with history of renal failure on continuous ambulatory peritoneal dialysis, presented with cloudy peritoneal effluent and abdominal pain. There was no sign or symptom suggestive of exit-site/tunnel tract infection. Peritoneal effluent cultures yieldedDokdonella koreensiswhich was initially misidentified asWeeksella virosaandBrevundimonasspecies by the API® 20 NE and VITEK® 2 GN ID card, respectively. He was treated with intraperitoneal amikacin, but the infection relapsed within a few days upon completing each antibiotic course. He eventually required removal of catheter and was transferred to hemodialysis. Infections due to unusual organisms may pose a diagnostic issue as currently available commercial tests will not be able to identify them. There is a role for using 16S rRNA sequencing to help identify these organisms and guide patient management.

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Exercise-Induced Anaphylaxis: A Case Report and Review of the Diagnosis and Treatment of a Rare but Potentially Life-Threatening Syndrome

Case Reports in Medicine ◽

10.1155/2013/610726 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 5

Author(s):

Nathan T. Jaqua ◽

Matthew R. Peterson ◽

Karla L. Davis

Keyword(s):

Anaphylactic Shock ◽

Clinical History ◽

First Episode ◽

Intravenous Fluids ◽

Allergy Clinic ◽

Intravenous Methylprednisolone ◽

Daily Exercise ◽

Life Threatening ◽

History Of ◽

Exercise Induced

A 24-year-old male Marine with an uncomplicated medical history and a long history of strenuous, daily exercise presented to the emergency department after experiencing anaphylactic shock while running. Symptoms resolved following administration of intramuscular diphenhydramine, ranitidine, intravenous methylprednisolone, and intravenous fluids. On followup in the allergy clinic, a meticulous clinical history was obtained which elucidated a picture consistent with exercise-induced anaphylaxis. He had experienced diffuse pruritus and urticaria while exercising on multiple occasions over the last three years. His symptoms would usually increase as exercise continued. Prior to the first episode, he regularly exercised without symptoms. Exercise-induced anaphylaxis is a rare but potentially life-threatening syndrome that requires a careful clinical history and is a diagnosis of exclusion. Treatment is primarily exercise avoidance. Prophylactic mediations are inconsistently effective but are empirically used. Successful treatment with omalizumab was recently reported in a case of refractory exercise-induced anaphylaxis.

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