Pharmacokinetics of Intraperitoneal Vancomycin and Amikacin in Automated Peritoneal Dialysis Patients With Peritonitis

Objective: The study aimed to evaluate the vancomycin and amikacin concentrations in serum and dialysate for automatic peritoneal dialysis (APD) patients.Methods: A total of 558 serum and dialysate samples of 12 episodes of gram-positive and 18 episodes of gram-negative peritonitis were included to investigate the relationship between vancomycin and amikacin concentrations in serum and dialysate on the first and third days of treatment. Samples were analysed 30, 120 min, and 48 h after intraperitoneal administration of vancomycin in peritonitis caused by gram-positive agents and 30, 120 min, and 24 h after intraperitoneal administration of amikacin in peritonitis caused by gram-negative agents. Vancomycin was administered every 72 h and amikacin once a day. The target therapeutic concentration of amikacin was 25–35 mg/l at the peak moment and 4–8 mg/l at the trough moment; and after 48 h for vancomycin, 15–20 mg/l at the trough moment.Results: For peritonitis caused by gram-negative agents, at the peak moment, therapeutic levels of amikacin were reached in dialysate in 80.7% of patients with evolution to cure and in 50% of patients evaluated as non-cure (p = 0.05). At the trough moment, only 38% were in therapeutic concentrations in the dialysate in the cure group and 42.8% in the non-cure group (p = 1). Peak plasma concentrations were subtherapeutic in 98.4% of the samples in the cure group and in 100% of the non-cure group. At the trough moment, therapeutic concentrations were present in 74.4% of the cure group and 71.4% of the non-cure group (p = 1). Regarding vancomycin and among gram-positive agents, therapeutic levels were reached at the peak moment in 94% of the cure group and 6% of the non-cure group (p = 0.007). After 48 h, 56.8% of the cure group had a therapeutic serum concentration whereas for the non-cure group it was only 33.3% (p = 0.39).Conclusion: Despite a small sample size, we demonstrated peak dialysate amikacin level and peak serum vancomycin level correlates well with Gram-negative and Gram positve peritonitis cure, respectively. It is suggested to study the antibiotics pharmacodynamics for a better understanding of therapeutic success in a larger sample.

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P1173PERITONEAL DIALYSIS INFECTIONS IN MALTA - TRENDS OVER ELEVEN YEARS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1173 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Angela Borg Cauchi ◽

Maria Angela Gauci ◽

Theresia Dalli ◽

James Gauci ◽

James Farrugia ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Coagulase Negative Staphylococcus ◽

Distributed Data ◽

Dialysis Modality ◽

Gram Positive ◽

Gram Negative ◽

Male Predominance ◽

E Coli ◽

Number Of Patients ◽

Gram Negative Organisms

Abstract Background and Aims Infections related to peritoneal dialysis (PD) are still a cause of morbidity and mortality. We describe an overview of PD peritonitis and catheter-related infections (CRI) in Malta over a period of eleven years. We also describe trends in dialysis modality over the years. Method All patients undergoing PD in Malta during 2008 and 2018 were analysed. Data from 2008-2012 was retrospective, shown as mean, that from 2013-2018 prospective. International Society for Peritoneal Dialysis (ISPD) definitions were used. Results for categorical responses were summarized using absolute numbers and percentages. Medians (range) were used to describe continuous non-normally distributed data. Results The total number of patients undergoing PD from 2008 till 2018 were 137 (2008-2012), 91, 80, 126, 117, 102, 103 respectively. There was an overall male predominance of 63.5% (61-67). Patient years at risk were 85.80, 85.25, 89.71, 83.70, 79.69, 72.88 since 2013 respectively. The overall incidence of diabetes mellitus was 45.3% (41.8-50), cardiovascular disease 34.2% (33.8-35), hypertension 79.3% (73.8-84.6). PD was used in 50% of dialysis modality prior to 2012, 39% in 2018. Initially 51% used Automated PD (APD), with 21% assisted PD, in 2018 39% used APD, with 6% assisted PD. PD peritonitis rates from 2008 were 0.38, 0.31, 0.35, 0.46, 0.43, 0.57, 0.54, 0.43, 0.39, 0.40, 0.46 episodes/patient year respectively There was marked dominance of Gram-positive peritonitis, mainly Staphylococcal, with a reduction of coagulase-negative-Staphylococcus from 0.26 episodes/patient in 2013 to 0.03 in 2017, 0.11 in 2018. Methicillin-resistant S. aureus (MRSA) peritonitis decreased from 0.03 episodes/patient to nil in 2016, 2017, 0.01 episodes/patient in 2018. Amongst Gram-negative peritonitis, Pseudomonas rates decreased from 0.06 to 0.03 episodes/patient in 2018, nil in 2016. Escherichia coli rates decreased from 0.02 episodes/patient to nil in the last three years. Fungal rates from 0.03 to 0.01 episodes/patient/year, with nil in 2016, 2017. Catheter-related infection rates were 0.39 (2008-2012), 0.35, 0.91, 0.37, 0.38, 0.25, 0.50 episodes/patient/year respectively. There was a higher incidence of recurrent infections in 2014, none in 2015 and 2016. Gram-negative organisms accounted for 57% of all CRI, predominantly Pseudomonas at 0.12 (2008-2012), 0.06, 0.09, 0.09, 0.14, 0.03, 017 episodes/patient/year respectively. Gram-positive CRI were mostly Staphylococcus aureus, peaking in 2014 at 0.38 episodes/patient/year. MRSA rates declined from 0.15 to 0.01 episodes/patient/year in 2018. Conclusion PD peritonitis rates in Malta between 2008 and 2018 were below the ISPD recommended threshold. There were no episodes of MRSA in 2016, 2017, no Pseudomonas in 2016, no E coli in the last three years and no fungal PD peritonitis in 2016, 2017. CRI rates also declined, with an overall predominance of Gram-negative infections.

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A Prospective Study of the Efficacy of Local Application of Gentamicin versus Mupirocin in the Prevention of Peritoneal Dialysis Catheter-Related Infections

Peritoneal Dialysis International ◽

10.1177/089686080802800514 ◽

2008 ◽

Vol 28 (5) ◽

pp. 505-508 ◽

Cited By ~ 39

Author(s):

Kwok Hong Chu ◽

Wai Yee Choy ◽

Chi Chung William Cheung ◽

Ka Shun Fung ◽

Hon Lok Tang ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Prospective Study ◽

Hospital Admissions ◽

Local Application ◽

Peritoneal Dialysis Catheter ◽

Exit Site ◽

Gram Positive ◽

Gram Negative ◽

A Prospective Study

Background Peritoneal dialysis (PD)-related infections are the major cause of technique failure. Exit-site infections (ESI) can be prevented by local application of antibiotics. Mupirocin (M) is the most extensively studied drug for this application. Long-term use can result in the development of resistance. Gentamicin (G) is an attractive alternative, with both gram-positive and gram-negative activities. We studied the comparative efficacy of G cream versus M ointment in the prevention of PD-related infections in a Chinese cohort. Methods This was a prospective study of adult PD patients of the Princess Margaret Hospital, Hong Kong. Patients were excluded if they had active infection, recent ESI or peritonitis, history of allergy to either drug, or were unable to apply the drug or give consent. Patients were taught to apply the drug daily to the exit site after routine exit-site care. Records were tracked prospectively during hospital admissions and clinic follow-ups. Results 95 patients were recruited; 14 discontinued the study. The ESI rates were 0.38 and 0.20 episodes/patient-year for the G group and the M group respectively ( p = 0.36). Gram-positive ESI rates were 0.18 and 0 episodes/patient-year for the G group and the M group respectively. Gram-negative ESI rates were 0.20 episodes/patient-year for both groups ( p = 0.62). The overall peritonitis rates were similar in the two groups ( p = 0.91). Discussion In addition to good perioperative care and strict exit-site care, local antibiotic application can prevent ESI. Mupirocin has been extensively studied and shown to be effective. Similar if not superior effects of G cream have been demonstrated. In this study, neither antibiotic gave significantly better results in the prevention of either ESI or peritonitis. Conclusions Both gentamicin and mupirocin were effective as prophylaxis for ESI. Longer study is required to determine the long-term efficacy and the potential beneficial effect on the prevention of peritonitis.

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The Impact of Peritonitis on Peritoneal and Systemic Acid-Base Status of Patients on Continuous Ambulatory Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686089401400112 ◽

1994 ◽

Vol 14 (1) ◽

pp. 61-65 ◽

Cited By ~ 4

Author(s):

Jacques J. Sennesael ◽

Godelieve C. De Smedt ◽

Patricia Van der Niepen ◽

Dierik L. Verbeelen

Keyword(s):

Staphylococcus Aureus ◽

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Acid Base ◽

Gram Positive ◽

Gram Negative ◽

Arterial Blood ◽

Blood Ph ◽

Acid Base Status ◽

And Staphylococcus Aureus

Objective To assess the possible effects of peritonitis on peritoneal and systemic acid-base status. Design pH, pCO2, lactate, and total leukocyte and differential count were simultaneously determined in the overnight dwell peritoneal dialysis effluent (PDE) and arterial blood in noninfected patients (controls) and on days 1, 3, and 5 from the onset of peritonitis. Setting University multidisciplinary dialysis program. Patients Prospective analysis of 63 peritonitis episodes occurring in 30 adult CAPD patients in a single center. Results In controls, mean (±SD) acid-base parameters were pH 7.41 ±0.05, pCO2 43.5±2.6 mm Hg, lactate 2.5±1.5 mmol/L in the PDE, and pH 7.43±0.04, PaCO2 36.8±3.8 mm Hg, lactate 1.4±0.7 mmol/L in the blood. In sterile (n=6), gram-positive (n=34), and Staphylococcus aureus (n=9) peritonitis PDE pH's on day 1 were, respectively, 7. 29±0.07, 7. 32±0.07, and 7.30±0.08 (p<0.05 vs control). In gram -negative peritonitis (n=14) PDE pH was 7.21 ±0.08 (p<0.05 vs all other groups). A two-to-threefold increase in PDE lactate was observed in all peritonitis groups, but a rise in pCO2 was only seen in gram -negative peritonitis. Acid-base profile of PDE had returned to control values by day 3 in sterile, gram -positive and Staphylococcus aureus peritonitis and by day 5 in gramnegative peritonitis. Despite a slight increase in plasma lactate on the first day of peritonitis, arterial blood pH was not affected by peritonitis. Conclusion PDE pH is decreased in continuous ambulatory peritoneal dialysis (CAPD) peritonitis, even in the absence of bacterial growth. In gram-negative peritonitis, PDE acidosis is more pronounced and prolonged, and pCO2 is markedly increased. Arterial blood pH is not affected by peritonitis.

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Frequency and Antimicrobial Susceptibility of Bacterial Agents Causing Peritoneal Dialysis-Related Peritonitis: A Two-Center Experience

International Journal of Infection ◽

10.5812/iji.104037 ◽

2020 ◽

Vol 7 (4) ◽

Author(s):

Fariba Shirvani ◽

Nakysa Hooman ◽

Abdollah Karimi ◽

Shahnaz Armin ◽

Alireza Fahimzad ◽

...

Keyword(s):

Abdominal Pain ◽

Peritoneal Dialysis ◽

Therapeutic Option ◽

Intraperitoneal Administration ◽

Clinical Manifestations ◽

Empiric Therapy ◽

Fungal Peritonitis ◽

Gram Negative ◽

Oxacillin Resistance ◽

Gram Negative Organisms

Background: Peritonitis remains a significant complication of peritoneal dialysis (PD) in children. Objectives: The current study aimed to evaluate the causative agents of PD-related peritonitis in pediatric patients treated by continuous ambulatory peritoneal dialysis (CAPD) in order to provide evidence for improving the empirical treatment of PD-related peritonitis and avoid antimicrobial resistance. Methods: The medical records of children diagnosed with PD-related peritonitis hospitalized at Mofid and Ali-Asghar Children’s Hospitals from January 2018 to December 2019 were retrospectively reviewed. Cases of relapsing peritonitis and fungal peritonitis were excluded. Data on demographics, clinical manifestations, para-clinical evaluations, peritoneal fluid culture and antibiogram, and antibiotic regimen were analyzed. Results: A total of 23 CAPD children aged 1 - 17 years were hospitalized with a confirmed diagnosis of PD-related peritonitis, accounting for a total of 27 peritonitis cases. The most frequent manifestation of peritonitis was cloudy dialysate (85.2%), followed by abdominal pain (59.3%). Gram-negative organisms were isolated in 48.1% of cases, and 4 cases had negative cultures. The frequency of antibiotic prescription within 14 days of admission was significantly higher in culture-negative cases (P = 0.002), and abdominal pain was more prevalent in Gram-negative peritonitis (P = 0.004). All Gram-negative organisms were sensitive to ceftazidime and imipenem; while 61.6% of them were sensitive to gentamycin. All Gram-positive organisms were sensitive to cefazolin, and vancomycin was effective against all Staphylococcus strains. Oxacillin resistance was reported in 50% of Staphylococcus strains. Conclusions: PD-related peritonitis should be suspected even in cases with clear dialysis effluent who present with other manifestations of peritonitis such as fever or abdominal pain. Moreover, intraperitoneal administration of a first-generation cephalosporin (cefazolin) combined with ceftazidime was an appropriate therapeutic option for empiric therapy.

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Anti-PF4/Heparin Antibody Levels in Bacteremia, Fungemia and Sepsis

Blood ◽

10.1182/blood-2018-99-117917 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 3752-3752

Author(s):

Satish Maharaj ◽

Simone Chang ◽

Karan Seegobin ◽

Fauzia Rana ◽

Marwan Shaikh

Keyword(s):

Immune Response ◽

Statistical Significance ◽

Small Sample ◽

Primary Immune Response ◽

Control Group ◽

Gram Positive ◽

Platelet Factor ◽

Gram Negative ◽

Significant Difference ◽

Antibody Levels

Abstract Heparin-induced thrombocytopenia (HIT) is caused by antibodies targeting platelet factor 4 (PF4)/heparin complexes. The immune response leading to HIT remains perplexing with many paradoxes. Unlike other drug induced reactions, anti-PF4/heparin antibody generation does not follow the classic immunologic response. As Greinacher and colleagues have shown, the primary immune response lacks IgM precedence and class switching, and heparin-induced antibodies can induce HIT by day 5 in heparin-naïve patients.Continued exposure to heparin also is puzzling with a weak or declining secondary immune response. Research by Krauel and colleagues suggests that that there is close interplay among infection, PF4 and the immune system. In 2010 they demonstrated that human and murine PF4 bind to Gram positive (S.aureus, S.pneumoniae, L.monocytogenes) and Gram negative (E.coli, N.meningitidis) bacteria in vitro, with bacterial surfaces acting as polyanions. High dose heparin inhibited this binding and anti-PF4/heparin antibodies from patients with HIT reacted with these PF4/bacterial complexes (S. aureus and E. coli). Using a murine model, they went on to show that polymicrobial sepsis in the absence of heparin led to antibody generation. In a separate study, Krauel and colleagues also showed that PF4 binds specifically to the lipid A component of Gram negative bacteria. In this analysis, we report on anti-PF4/heparin antibody levels in groups of patients hospitalized for sepsis, as compared to a control group without sepsis. We examined 200 patients with sepsis, retrospectively identified, from a hospital database of anti-PF4/heparin testing done in medical inpatients with thrombocytopenia but low pretest probability of HIT. This included patients with bacteremia (57), fungemia (7) and sepsis without septicemia (136). For comparison, data from 50 patients without sepsis during the same time period was used. Inclusion criteria for all groups were age 18 years and older and antibody testing within 4 days of admission. Exclusion criteria were diagnosis of HIT or heparin allergy, prior hospitalization or heparin exposure within 90 days of admission, cardiopulmonary bypass or orthopedic surgery within 6 months, hemodialysis, active or past malignancy, antiphospholipid syndrome, autoimmune disease or immunosuppressive therapy. All patients studied were on subcutaneous heparin at prophylactic doses only (i.e. no intravenous use, no therapeutic anticoagulation). UFH use predominated with prevalence of >85% in all groups. Testing was done using a commercially available standardized solid phase enzyme-linked immunoassay (EIA) to detect antibodies (IgG/IgA/IgM) directed against PF4 complexed with polyvinylsulfonate (Genetic Testing Institute, Wisconsin). All assays were performed in the central hospital laboratory according to manufacturer's specifications and measured in optical density (OD) units. The data sets demonstrated continuous unimodal distribution with high OD outliers, indicative of varying immune responses along a continuum. Statistical significance was calculated using independent t-testing with p-value set at 0.05 for significance. Results showed that patients hospitalized with sepsis have higher anti-PF4/heparin antibody levels. Both patients with bacteremia, and sepsis without bacteremia, had significantly higher OD than patients without sepsis (p<0.05). There was no significant difference between Gram negative and Gram positive bacteremia and antibody levels. This suggests that bacterial cell wall components of both classes have similar antigenicity. Interestingly, patients with fungemia had much lower antibody levels compared to bacteremia and sepsis. Despite the small sample size for fungemia, this difference trended strongly towards statistical significance (p=0.05). The threshold for a positive EIA is currently established at OD>0.400, a value based on sensitivity and set by the manufacturer. When the prevalence of a positive EIA was assessed, 16% patients with sepsis and bacteremia tested positive compared to 4% in the control group. In summary, there is an increased prevalence of anti-PF4/heparin antibodies in patients hospitalized with bacterial but not fungal sepsis. These results support the theory that bacterial infection has a role to play in preimmunization leading to anti-PF4/heparin antibody generation. Disclosures No relevant conflicts of interest to declare.

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Reversal of Rocuronium-induced Meeting Abstracts with Sugammadex in Pediatric and Adult Surgical Patients

Anesthesiology ◽

10.1097/aln.0b013e318194caaa ◽

2009 ◽

Vol 110 (2) ◽

pp. 284-294 ◽

Cited By ~ 27

Author(s):

Benoît Plaud ◽

Olli Meretoja ◽

Rainer Hofmockel ◽

Julien Raft ◽

Peter A. Stoddart ◽

...

Keyword(s):

Neuromuscular Blockade ◽

Small Sample Size ◽

Dose Range ◽

Plasma Concentrations ◽

Age Groups ◽

Small Sample ◽

Reversal Agent ◽

Adult Age ◽

Class 1 ◽

Train Of Four

Background Sugammadex reverses neuromuscular blockade by chemical encapsulation of rocuronium. This phase IIIA study explored efficacy and safety of sugammadex in infants (28 days to 23 months), children (2-11 yr), adolescents (12-17 yr), and adults (18-65 yr). Methods Anesthetized patients (American Society of Anesthesiologists class 1-2) received 0.6 mg/kg rocuronium and were randomized to receive sugammadex (0.5, 1.0, 2.0, or 4.0 mg/kg) or placebo at reappearance of T2. Neuromuscular monitoring was performed using acceleromyography. Primary endpoint was time from sugammadex/placebo administration to recovery of the train-of-four ratio to 0.9. Adverse events and electrocardiograms were recorded, and blood samples were collected for safety and determination of sugammadex and rocuronium plasma concentrations. Results A dose-response relation was demonstrated in children (n = 22), adolescents (n = 28), and adults (n = 26), but not infants because of the small sample size (n = 8). After placebo, median recovery time of train-of-four to 0.9 was 21.0, 19.0, 23.4, and 28.5 min in infants, children, adolescents, and adults, respectively. After 2.0 mg/kg sugammadex train-of-four 0.9 was attained in 0.6, 1.2, 1.1, and 1.2 min, respectively. The sugammadex plasma concentrations were similar for the children, adolescent, and adult age groups across the dose range. Sugammadex was well tolerated: No reoccurrence of blockade, inadequate reversal, significant QT prolongation, or other abnormalities were observed. Conclusions Sugammadex is a new reversal agent that rapidly, effectively, safely, and with similar recovery times reverses rocuronium-induced neuromuscular blockade in children, adolescents, adults, and the small number of infants studied.

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Effects of Hypoxia on the Behaviour, Mortality and Plasma Electrolyte Concentrations of Goldlined Seabream, Rhabdosargus sarba

Journal of Agricultural and Marine Sciences [JAMS] ◽

10.24200/jams.vol13iss0pp73-83 ◽

2008 ◽

Vol 13 ◽

pp. 73

Author(s):

Hamed M. Al-Gheilani ◽

Colin Waring ◽

Abdulaziz Al-Kindi ◽

Shehla Amer

Keyword(s):

Treatment Time ◽

Small Sample Size ◽

Plasma Concentrations ◽

Small Sample ◽

Low Oxygen ◽

Hypoxic Conditions ◽

Plasma Electrolyte ◽

Mean Size ◽

And Gender ◽

Ventilation Rates

The behaviour, mortality rates and plasma electrolyte concentrations of goldlined seabream Rhabdosargus sarba challenged with low dissolved oxygen (DO) conditions was studied in an experimental setup, comprising a control (7.9 ml/l DO) and two hypoxic (2 ml/l and 1 ml/l DO) treatments. Increased ventilation rates and decreased swimming activity were observed in hypoxic treatments, but some fish exhibited strenuous avoidance actions. No mortalities were observed after 3 h, 6 h, or 24 h, but 50% of males and 18% of females died in the 48 h treatment at 1 ml/l DO. The mean size of surviving fish (305± 32.1 g total weight) was significantly smaller than those that died (425 ± 33.1 g). The plasma concentrations of Na+, Cl- and Mg2+ did not vary significantly relative to treatment, exposure time, fish size and gender, or interactions among treatment, time and gender. Ca2+ concentrations increased significantly after 48 h at 1 ml/l, but this result may be artificial because of the small sample size. The results suggest that R. sarba is comparatively tolerant of the low oxygen or hypoxic conditions that often occur in the coastal waters of Oman, where seasonal upwellings and high primary productivity have in the past caused mass mortalities of demersal fishes.

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Outcome of Gram-Positive and Gram-Negative Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis: A Single-Center Experience

Peritoneal Dialysis International ◽

10.1177/089686080302302s30 ◽

2003 ◽

Vol 23 (2_suppl) ◽

pp. 144-147 ◽

Cited By ~ 24

Author(s):

Narayan Prasad ◽

Amit Gupta ◽

Raj K. Sharma ◽

Kashi N. Prasad ◽

Sanjeev Gulati ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Total Duration ◽

Educational Status ◽

Developed Countries ◽

Outcome Analysis ◽

Gram Positive ◽

Fungal Peritonitis ◽

Gram Negative ◽

Single Center Experience

Background The spectrum of bacterial peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) in India may be different from that seen in developed countries because of differences in culture and in social, environmental, financial, and educational status. We analyzed our data regarding the incidence and outcome of monomicrobial peritonitis in our CAPD patients. Patients and Methods We reviewed the records of 225 patients on CAPD to retrieve data concerning demographics, peritonitis rate, organism isolated, and outcome. Polymicrobial and fungal peritonitis were excluded from the outcome analysis because of their different outcomes. Results We identified 168 episodes of peritonitis (range: 1 – 6 episodes per patient). Of the 168 episodes, 106 (63.1%) episodes were culture-positive. Total duration of CAPD was 264.16 patient–years. The overall peritonitis rate was 0.63 episodes per patient–CAPD year. The rates of gram-negative, gram-positive, polymicrobial, and fungal peritonitis were 0.17, 0.11, 0.04, 0.09 episodes per patient–year, respectively. Among the 75 episodes of monomicrobial peritonitis, gram-negative episodes [ n = 45 (60%)] were significantly more frequent than gram-positive episodes [ n = 30 (40%), p = 0.03]. Escherichia coli was the most commonly seen organism. Organisms of fecal origin (40/75) were significantly more frequent than those of skin origin (21/75, p = 0.0016). Catheter loss (17/45 vs 5/20, p = 0.04), hospitalization (31/ 45 vs 13/30, p = 0.03), death [9/45 vs 3/30, p = nonsignificant (NS)], switch to hemodialysis (8.9% vs 3.3%, p = NS), and reimplantation of the catheter (6.6% vs 3.3%, p = NS) were all more frequent in gram-negative episodes than in gram-positive episodes. Conclusions Gram-negative peritonitis is more frequent than gram-positive peritonitis in our CAPD population in India and is associated with worse outcome.

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Predictors of Outcome following Bacterial Peritonitis in Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686080202200508 ◽

2002 ◽

Vol 22 (5) ◽

pp. 573-581 ◽

Cited By ~ 84

Author(s):

Murali Krishnan ◽

Elias Thodis ◽

Dimitrios Ikonomopoulos ◽

Ed Vidgen ◽

Maggie Chu ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Cell Count ◽

Univariate Analysis ◽

Albumin Level ◽

Successful Outcome ◽

Exit Site ◽

Gram Positive ◽

Gram Negative ◽

Bacterial Peritonitis ◽

Fluid Cell

Objective No studies have been done to examine factors that predict the outcome of bacterial peritonitis during peritoneal dialysis (PD), beyond the contribution of the organism causing the peritonitis, concurrent exit-site or tunnel infection, and abdominal catastrophes. Design In this study we examined several clinical and laboratory parameters that might predict the outcome of an episode of bacterial peritonitis. Between March 1995 and July 2000, we identified 399 episodes of bacterial peritonitis in 191 patients on dialysis. Results There were 260 episodes of gram-positive peritonitis, 99 episodes of gram-negative peritonitis, and 40 episodes of polymicrobial peritonitis. Gram-positive peritonitis had a significantly higher resolution rate than either polymicrobial peritonitis or gram-negative peritonitis. Staphylococcus aureus episodes had poorer resolution than other gram-positive infections. Nonpseudomonal peritonitis had a better outcome than Pseudomonas aeruginosa episodes. Among all the gram-negative infections, Serratia marcescens had the worst outcome. Episodes associated with a purulent exit site had poor outcome only on univariate analysis. For those peritonitis episodes in which the PD fluid cell count was > 100/μL for more than 5 days, the nonresolution rate was 45.6%, compared to a 4.2% nonresolution rate when the cell count returned to 100/μL or less in less than 5 days. Those patients that had a successful outcome had been on continuous ambulatory PD for a significantly shorter period of time than those patients that had nonresolution. The nonresolution rate for those patients that had been on PD for more than 2.4 years was 24.4%, compared to 16.5% for those that had been on PD for less than 2.4 years ( p = 0.05). Conclusion The duration of PD and the number of days the PD effluent cell count remained > 100/μL were the only factors that independently predicted the outcome of an episode of peritonitis. Caucasians seem to have a higher nonresolution (failure) rate compared to Blacks. Other variables, such as the number of peritonitis episodes before the episode in question, vancomycin-based initial empiric treatment, serum albumin level, total lymphocyte count and initial dialysate white blood cell count, age, sex, diabetes, previous renal transplantation, and the use of steroids did not affect the outcome of peritonitis.

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Effectiveness of Single Daily Intraperitoneal Administration of Aztreonam and Cefuroxime in the Treatment of Peritonitis in Continuous Ambulatory Peritoneal Dialysis (CAPD)

Peritoneal Dialysis International ◽

10.1177/089686088900900408 ◽

1989 ◽

Vol 9 (4) ◽

pp. 273-275 ◽

Cited By ~ 6

Author(s):

G. Fuiano ◽

V. Sepe ◽

M. Viscione ◽

E. Nani ◽

G. Conte

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Therapeutic Range ◽

Dwell Time ◽

Intraperitoneal Administration ◽

Positive Culture ◽

Treatment Procedure ◽

Streptococcus Faecalis ◽

Gram Negative ◽

Observation Period

To discover if the management of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) may be effectively simplified by single daily i.p. administration of aztreonam (A) and cefuroxime (C), 10 adult CAPD patients (pts) with peritonitis were trained to start the following treatment procedure: a) sterile collection of dialysate effluent for cultures; b) 4 rapid in-and-out exchanges with antibiotic free dialysate; c) addition of 2 g C and 2 g A to a 2-L exchange for 6-h dwell time (the same dosage was repeated once a day in the overnight exchange); d) routine CAPD exchanges. Concentrations of C and A were measured in dialysate and serum of the patients 2, 12, 18, and 21–23 h after the i.p. administration: C remained within therapeutic range in all samples, while serum and dialysate A levels fell below such range 16 h after the i.p. administration. Seventeen peritonitis episodes occurred during the observation period (12 months): initial dialysate cultures grew Staph. aureus in 6 episodes, Staph epidermidis in 6, Pseudomonas aer. in 2, Streptococcus faecalis in 1, Citrobacter in 1, and Candida in 1. All patients but 1 (with Candida-positive culture) responded to this treatment with no relapse in 2 months. We conclude that once a day i.p. administration of 2 g aztreonam plus 2 g of cefuroxime is an effective and simple way of treating CAPD pts with gram-positive and gram-negative peritonitis.

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