1451
|
Garcia N, Sanyal AJ. Minimizing ascites. Complication of cirrhosis signals clinical deterioration. Postgrad Med 2001; 109:91-6, 101-3. [PMID: 11272697 DOI: 10.3810/pgm.2001.02.854] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ascites is the most common complication of cirrhosis. Its development is associated with a grave prognosis; 50% of patients die within 2 years of diagnosis. An understanding of the analysis of ascitic fluid is essential for the appropriate management of patients with liver disease and ascites. The management of patients with ascites involves a combination of dietary, medical, and surgical approaches. Furthermore, patients with ascites are at risk for ascitic fluid infections and neurohormonal dysregulation that can lead to hepatorenal syndrome. Early recognition of these complications allows therapeutic interventions that minimize further clinical deterioration in already chronically ill patients.
Collapse
|
1452
|
Korzets A, Weinberger M, Chagnac A, Goldschmied-Reouven A, Rinaldi MG, Sutton DA. Peritonitis due to Thermoascus taitungiacus (Anamorph Paecilomyces taitungiacus). J Clin Microbiol 2001; 39:720-4. [PMID: 11158134 PMCID: PMC87803 DOI: 10.1128/jcm.39.2.720-724.2001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The first case of human disease due to the thermophilic ascomycete Thermoascus taitungiacus (the teleomorph of Paecilomyces taitungiacus) is presented. T. taitungiacus was recovered from four dialysate fluid specimens of a 57-year-old patient undergoing chronic peritoneal dialysis. Identification was based upon cylindrical conidia, reddish orange nonostiolate ascomata, lack of growth at 20 degrees C, thermotolerance, and ascospores that appeared pale yellow, elliptical, thick walled, and predominately echinulate by light microscopy but irregularly verrucose by scanning electron microscopy.
Collapse
|
1453
|
Lush CW, Cepinskas G, Sibbald WJ, Kvietys PR. Endothelial E- and P-selectin expression in iNOS- deficient mice exposed to polymicrobial sepsis. Am J Physiol Gastrointest Liver Physiol 2001; 280:G291-7. [PMID: 11208553 DOI: 10.1152/ajpgi.2001.280.2.g291] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In vitro, nitric oxide (NO) decreases leukocyte adhesion to endothelium by attenuating endothelial adhesion molecule expression. In vivo, lipopolysaccharide-induced leukocyte rolling and adhesion was greater in inducible NO synthase (iNOS)-/- mice than in wild-type mice. The objective of this study was to assess E- and P-selectin expression in the microvasculature of iNOS-/- and wild-type mice subjected to acute peritonitis by cecal ligation and perforation (CLP). E- and P-selectin expression were increased in various organs within the peritoneum of wild-type animals after CLP. This CLP-induced upregulation of E- and P-selectin was substantially reduced in iNOS-/- mice. Tissue myeloperoxidase (MPO) activity was increased to a greater extent in the gut of wild-type than in iNOS-/- mice subjected to CLP. In the lung, the reduced expression of E-selectin in iNOS-/- mice was not associated with a decrease in MPO. Our findings indicate that NO derived from iNOS plays an important role in sepsis-induced increase in selectin expression in the systemic and pulmonary circulation. However, in iNOS-/- mice, sepsis-induced leukocyte accumulation is affected in the gut but not in the lungs.
Collapse
|
1454
|
Amato D, Miranda G, Leaños B, Alcántara G, Hurtado ME, Paniagua R. Staphylococcal peritonitis in continuous ambulatory peritoneal dialysis: colonization with identical strains at exit site, nose, and hands. Am J Kidney Dis 2001; 37:43-48. [PMID: 11136166 DOI: 10.1053/ajkd.2001.20576] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To evaluate the relationship of nasal or skin Staphylococcus carrier status with identical strains and the development of staphylococcal peritonitis, 59 consecutive peritonitis episodes in patients using a twin-bag system for continuous ambulatory peritoneal dialysis from a single dialysis center were prospectively studied. Dialysate samples and exit-site, nose, and nail swabs from patients and their dialysis partners were obtained on the same day for culture. When bacteria belonging to the same species of the Staphylococcus genus were isolated from dialysate and at least one extraperitoneal anatomic site, pulsed-field gel electrophoresis typing was performed. The bacterial strains isolated from catheter exit site, nose, or nails of each patient and his or her dialysis partner were classified as identical or different. Twenty-seven of the 59 peritonitis episodes (46%) were caused by staphylococci. Nineteen of these 27 patients carried the same Staphylococcus species causing the peritonitis episode at the exit site, nose, or nails, but only 17 patients (63%) carried an identical strain. Four of 5 dialysis partners carried the same Staphylococcus species causing the peritonitis episode at nose or nails, but the strain was identical for only 3 dialysis partners (60%). Four patients and 1 dialysis partner carried unrelated strains of the Staphylococcus species causing the peritonitis episode. The most frequently colonized site with strains identical to that causing the peritonitis episode was the catheter exit site, followed by nose and nails. This finding may be clinically relevant because eradication of Staphylococcus aureus colonizing the catheter exit site may be more important and have a greater likelihood of success than maneuvers directed to more distant locations.
Collapse
|
1455
|
Buijk SL, Gyssens IC, Mouton JW, Verbrugh HA, Touw DJ, Bruining HA. Pharmacokinetics of sequential intravenous and enteral fluconazole in critically ill surgical patients with invasive mycoses and compromised gastro-intestinal function. Intensive Care Med 2001; 27:115-21. [PMID: 11280621 DOI: 10.1007/s001340000771] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES (1) To determine the pharmacokinetics of sequential intravenous and enteral fluconazole in the serum of surgical intensive care unit (ICU) patients with deep mycoses. (2) To determine the concentrations of fluconazole reached at the site of infection. (3) To determine if enteral administration of fluconazole, which has an important pharmaco-economic advantage, is justified in this specific patient group. DESIGN Descriptive, sequential study as a part of a therapeutic drug monitoring programme. SETTING Eighteen-bed surgical ICU in a referral centre. PATIENTS Fourteen critically ill surgical patients with recent gastro-intestinal (GI) surgery and deep mycosis caused by a fluconazole-susceptible fungus and a calculated creatinine clearance of more than 40 ml/min. INTERVENTIONS Fluconazole dosage regimen: 400 mg i. v. every 24 h with an extra dose of 400 mg i.v. after 12 h on day 1. If the clinical condition allowed enteral administration on day 4, the content of two capsules of 200 mg was given via the feeding tube with concomitant enteral feeds. MEASUREMENTS AND MAIN RESULTS Serum, exudate from the site of infection and urine samples collected at assumed steady state ( after > or = 5 doses). Fluconazole concentrations were determined by high-performance liquid chromatography (HPLC). The mean area under the concentration curve (AUC0-24 h) in serum after enteral administration did not significantly differ from the AUC0-24 h during intravenous treatment. The elimination half-life was longer compared to healthy volunteers. The mean (95% CI) estimated bioavailability was 124 (90-158)%. The mean (95% CI) area under the concentration time curves (AUCs) achieved in the exudate from the site of infection were 67 (55-79)% of the AUCs reached in serum for both regimens. CONCLUSIONS In critically ill patients with recent GI surgery and/or peritonitis the bioavailability of enteral fluconazole was adequate. The concentrations of fluconazole reached in exudate were lower than those in serum for both regimens, but adequate to treat most cases of deep mycoses in this specific patient group.
Collapse
|
1456
|
Chang CS, Yang SS, Kao CH, Yeh HZ, Chen GH. Small intestinal bacterial overgrowth versus antimicrobial capacity in patients with spontaneous bacterial peritonitis. Scand J Gastroenterol 2001; 36:92-6. [PMID: 11218245 DOI: 10.1080/00365520150218110] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Spontaneous bacterial peritonitis (SBP) is a serious infection in cirrhotic patients with ascites. Both defects in the host defense mechanisms and the enhancement of the offensive factor (small intestinal bacterial overgrowth (SIBO)) may contribute to the development of SBP. Therefore, the aim of this study was to evaluate the role of SIBO versus various antimicrobial capacities in the pathogenesis of SBP in cirrhotic patients. METHODS Forty-five cirrhotic patients were enrolled in this study. Bacterial overgrowth was evaluated by breath hydrogen test (BH2T). The hepatic reticuloendothelial system phagocytic index (HRESPI) was measured by intravenously injected colloid suspensions. RESULTS The Child-Pugh scores in the SBP group were higher than in the non-SBP group (10.5 +/- 2.0 versus 8.0 +/- 1.8, P < 0.01). The ascitic protein concentration was significantly lower in the SBP group than in the non-SBP group (897 +/- 425 mg/l versus 1,325 +/- 453 mg/l, P < 0.01). Furthermore, the serum C3 concentration was lower in the SBP group than in the non-SBP group (43.1 +/- 13.6 ng/dl versus 73.2 +/- 26.4 ng/dl, P < 0.01). The serum C4 concentration was also lower in the SBP group than in the non-SBP group (12.4 +/- 4.0 ng/dl versus 16.9 +/- 6.6 ng/dl, P < 0.05). The incidence of SIBO was higher in the SBP group than in the non-SBP group (68.2% versus 17.4%, P < 0.01). HRESPI values were significantly higher in the two groups of cirrhotic patients than in the normal reference. However, there were no statistical differences in HRESPI between the two groups (8.4 +/- 2.8 min in the SBP group versus 7.9 +/- 2.8 min in the non-SBP group). CONCLUSIONS The results of this study showed that the hepatic reticuloendothelial function is impaired in cirrhotic patients, but the degree of impairment does not differ between patients with and without previous history of SBP. Lower ascitic total protein, lower serum C3 and C4 concentrations, and presence of SIBO are all risk factors for SBP. Based on the results of our study, defects in the host defense mechanisms and the enhancement of the offensive factor (SIBO) may act in concert for the development of SBP.
Collapse
|
1457
|
Peng H, Cheung AK, Reimer LG, Kamerath CD, Leypoldt JK. Effect of indomethacin on peritoneal protein loss in a rabbit model of peritonitis. Kidney Int 2001; 59:44-51. [PMID: 11135056 DOI: 10.1046/j.1523-1755.2001.00464.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although various inflammatory mediators have been previously shown to be released into the peritoneal cavity during peritonitis in peritoneal dialysis patients, those that are involved in governing changes in peritoneal permeability to small solutes and protein remain incompletely defined. METHODS We determined the importance of prostanoid production in the enhanced protein loss observed during acute peritonitis by inhibition experiments using indomethacin, an inhibitor of cyclooxygenase activity. The association between changes in peritoneal permeability and the generation of inflammatory mediators after adding Escherichia coli to peritoneal dialysate was first examined in series 1 experiments. Series 2 experiments then determined the effect of intraperitoneal administration of indomethacin (75 microg/mL) on changes in peritoneal permeability after adding E. coli to peritoneal dialysate. All experiments were performed in male New Zealand White rabbits (2.6 to 3.4 kg body weight) using an eight-hour dwell of dialysate containing 2.5% glucose. Peritoneal permeability to creatinine and protein was assessed by time-dependent changes in the dialysate to plasma concentration ratios of these solutes. RESULTS Series 1 experiments showed enhanced leukocyte migration into the peritoneal cavity and increased peritoneal permeability to protein during bacterial challenge that was accompanied by an increase in the dialysate concentrations of prostaglandin E2 (PGE2), 6-keto-PGF1alpha, and interleukin-8, but not nitrate + nitrite (a measure of local nitric oxide production). Inhibition of prostanoid production by intraperitoneal administration of indomethacin in series 2 experiments resulted in lower dialysate concentrations of PGE2 and 6-keto-PGF1alpha and in lower peritoneal permeability to protein, both to control levels. No effect of indomethacin on transperitoneal migration of leukocytes or the generation of interleukin-8 was observed. CONCLUSIONS Enhanced production of prostanoids likely plays an important role in governing the increase in peritoneal permeability to protein during acute, bacterial peritonitis in the rabbit.
Collapse
|
1458
|
Goldberg L, Clemenger M, Azadian B, Brown EA. Initial treatment of peritoneal dialysis peritonitis without vancomycin with a once-daily cefazolin-based regimen. Am J Kidney Dis 2001; 37:49-55. [PMID: 11136167 DOI: 10.1053/ajkd.2001.20581] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
To reduce the use of vancomycin, the current recommendations of the International Society of Peritoneal Dialysis (PD) for the initial treatment of peritonitis complicating PD are to administer intraperitoneal (IP) cefazolin or cephalothin in every PD fluid bag, together with once-daily gentamicin. In view of the inherent impracticalities of this regimen, we studied the efficacy of once-daily cefazolin (1.5 g) IP with gentamicin IP as initial treatment for primary (nonrecurrent) PD peritonitis. This regimen has been used in all episodes of peritonitis not associated with tunnel or exit-site infections or fluid leaks. Sixty-nine episodes in 61 patients were analyzed (44 patients, continuous ambulatory PD; 22 patients, automated PD; and 3 patients, hospital-based intermittent PD), of which 38 episodes (55%) were gram-positive infections, 6 episodes (9%) were gram-negative infections, and 18 episodes (26%) had negative culture results. Four patients died within 4 weeks of infection (none considered attributable to inadequate treatment of their peritonitis). Ten catheters (14.5%) required removal to clear the infection; 7 catheters were in patients with gram-negative infections. The relapse rate within 4 weeks of ceasing antibiotic therapy was 8.9%. Compared with the results of 40 episodes of peritonitis treated initially with our previous IP vancomycin and gentamicin regimen, successful treatment (no death, catheter removal, or recurrence) was achieved in 52 of 69 episodes in the cefazolin group (75.4%) versus 23 of 40 episodes in the vancomycin group (57.5%; P: = 0.058). In conclusion, once-daily IP cefazolin and gentamicin for the initial treatment of PD peritonitis is at least as effective as a vancomycin-based regimen and is well tolerated.
Collapse
|
1459
|
Navasa M, Casafont F, Clemente G, Guarner C, de la Mata M, Planas R, Solà R, Suh J. [Consensus on spontaneous bacterial peritonitis in liver cirrhosis: diagnosis, treatment, and prophylaxis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2001; 24:37-46. [PMID: 11219138 DOI: 10.1016/s0210-5705(01)70131-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
1460
|
Vlassopoulos D, Kouppari G, Arvanitis D, Papaefstathiou K, Dounavis A, Velegraki A, Hadjiconstantinou V. Wangiella dermatitidis peritonitis in a CAPD patient. Perit Dial Int 2001; 21:96-7. [PMID: 11280509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
|
1461
|
Konner P, Watschinger B, Apfalter P, Hörl WH, Vychytil A. A case of continuous ambulatory peritoneal dialysis peritonitis with an uncommon organism and an atypical clinical course. Am J Kidney Dis 2001; 37:E10. [PMID: 11136199 DOI: 10.1016/s0272-6386(01)90007-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This report describes a 46-year-old patient who experienced an atypical course of peritonitis while undergoing continuous ambulatory peritoneal dialysis (CAPD). The first sign of peritonitis was progressive impairment of ultrafiltration with increasing fluid absorption. The patient came to the center after 5 days with leg edemas and 645 leukocytes/microL in the first dialysate outflow. On the same day, the dialysate cell count decreased to 208/microL. During the following days, ultrafiltration failure persisted despite spontaneous normalization of PD-fluid leukocytes. No other clinical symptoms were observed, and the serum C-reactive protein (CRP) level remained normal. Magnetic resonance peritoneography and abdominal radiograph did not show dislocation of the catheter, a dialysate leak, or other causes of ultrafiltration failure. At day 14, fever, diarrhea, and an elevated serum CRP level occurred. Dialysate cultures taken on days 8, 11, and 14 showed growth of NEISSERIA: sicca. After initiation of antibiotic therapy with levofloxacine on day 14 ultrafiltration, clinical symptoms and serum CRP normalized within 3 days. In conclusion, Neisseria sicca should be considered as a rare cause of PD peritonitis. Our case report further illustrates the importance of ultrafiltration failure as an early and main symptom of peritoneal inflammation. The frequently used peritonitis criteria may not apply to cases of mild PD peritonitis.
Collapse
|
1462
|
Canon HL, Buckingham SC, Wyatt RJ, Jones DP. Fungal peritonitis caused by Curvularia species in a child undergoing peritoneal dialysis. Pediatr Nephrol 2001; 16:35-7. [PMID: 11198600 DOI: 10.1007/s004670000481] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report the first case of peritonitis caused by Curvularia species in a child undergoing peritoneal dialysis. He presented with gray-black proteinaceous material obstructing the lumen of his Tenckhoff catheter. Although the peritoneal fluid was cloudy, the patient suffered neither significant abdominal tenderness nor systemic symptoms. Catheter removal and treatment with amphotericin B allowed complete recovery and return to peritoneal dialysis within 7 days. Outdoor play in a wooded environment may have allowed contact of this saprophytic fungus with the child's indwelling catheter transfer set.
Collapse
|
1463
|
Ryoo NH, Chun HJ, Jeon DS, Kim JR, Park SB. Bacillus licheniformis peritonitis in a CAPD patient. Perit Dial Int 2001; 21:97. [PMID: 11280510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
|
1464
|
Wazz G, Taji H, Chishti I, Branicki F. Primary coliform peritonitis in a male adult. ANZ J Surg 2001; 71:72-3. [PMID: 11167608 DOI: 10.1046/j.1440-1622.2001.02018.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
1465
|
Wallet F, Touré F, Devalckenaere A, Pagniez D, Courcol RJ. Molecular identification of Pasteurella dagmatis peritonitis in a patient undergoing peritoneal dialysis. J Clin Microbiol 2000; 38:4681-2. [PMID: 11101625 PMCID: PMC87666 DOI: 10.1128/jcm.38.12.4681-4682.2000] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pasteurella dagmatis was identified as the etiologic agent of peritonitis in a continuous ambulatory peritoneal dialysis patient by utilizing a molecular kit in our hospital's clinical laboratory. This method would appear a useful approach to identify a species of Pasteurella not included in the existing database of commercial identification kits when discrepancies exist between phenotypic tests.
Collapse
|
1466
|
Fattal O, Deville JG. Leclercia adecarboxylata peritonitis in a child receiving chronic peritoneal dialysis. Pediatr Nephrol 2000; 15:186-7. [PMID: 11149108 DOI: 10.1007/s004670000436] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A 5 year old boy with end-stage renal disease presented with clinical and laboratory findings of peritonitis. Peritoneal fluid revealed infection with Leclercia adecarboxylata. This is a motile, gram-negative bacillus, formerly designated enteric group 41 and Escherichia adecarboxylata. To our knowledge, this is the first reported case of peritonitis due to this organism.
Collapse
|
1467
|
Furth SL, Donaldson LA, Sullivan EK, Watkins SL. Peritoneal dialysis catheter infections and peritonitis in children: a report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol 2000; 15:179-82. [PMID: 11214588 DOI: 10.1007/s004670000441] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Peritonitis and catheter-related infections remain the two most-common causes of peritoneal dialysis (PD) treatment failure. To define the frequency and risks associated with exit site/tunnel infections (ESI/TI), as well as peritonitis, in pediatric patients on PD, we undertook a retrospective cohort study of patients initiated on PD in the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). We examined demographic data and PD catheter characteristics of 1,258 patients, aged < or = 21 years, initiated on PD from 1992 to 1997. We examined the frequency and complications of ESI/TI occurring within 30 days, 6 months, and 1 year of follow-up. For peritonitis episodes, we examined patient risk factors for peritonitis. Almost 11% of patients had an ESI/TI at 30 days, 26% between 30 days and 6 months, and 30% between 6 months and 1 year of follow-up. There was no increased risk of ESI/TI associated with patient age, race, or catheter characteristics. Peritonitis occurred in dialysis patients at a rate of 1 episode per 13.2 patient months. Proportional hazards regression analysis demonstrated that black race, single-cuffed catheters, and upward pointing exit sites were independent risk factors for peritonitis in the pediatric PD population. Patients with ESI/TI had twice the risk of those without these infections of developing peritonitis or needing access revision, and an almost threefold increased risk of hospitalization for access complications/malfunction. ESI/TI occurs commonly in pediatric PD patients. These infections cause significant morbidity, through risk of peritonitis, access revision, and hospitalization for catheter complications. Further study of potentially modifiable risk factors for ESI/TI in pediatric end-stage renal disease patients is warranted.
Collapse
|
1468
|
Bosscha K, Nieuwenhuijs VB, Gooszen AW, van Duijvenbode-Beumer H, Visser MR, Verweij WR, Akkermans LM. A standardised and reproducible model of intraabdominal infection and abscess formation in rats. THE EUROPEAN JOURNAL OF SURGERY = ACTA CHIRURGICA 2000; 166:963-7. [PMID: 11152259 DOI: 10.1080/110241500447146] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To develop a standardised and reproducible model of intra-abdominal infection and abscess formation in rats. DESIGN Experimental study. SETTING University hospital, The Netherlands. SUBJECTS 36 adult male Wistar rats. INTERVENTIONS In 32 rats, peritonitis was produced using two different concentrations of Escherichia coli (E. coli) and Bacteroides fragilis (B. fragilis) incorporated in fibrin clots (E. coii 1 x 10(5) colony forming units (CFU)/ml or 1 x 10(8) CFU/ml, B. fragilis: 1 x 10(8) CFU/ml). Four rats with fibrin clots without bacteria served as uninfected controls. MAIN OUTCOME MEASUREMENTS Macroscopy and bacterial counts in peritoneal fluid, blood, and fibrin clots after 24 hours, 4 days, 7 days, and 4 weeks. RESULTS Macroscopically, there were signs of intra-abdominal infection and abscesses. With the higher starting concentration of E. coli, macroscopic signs were more pronounced and in nearly all rats bacterial counts in peritoneal fluid and fibrin clots showed persistently high numbers of E. coli and B. fragilis for at least 7 days (E. coli = 2 x 10(3) to 1 x 10(6) CFU/ml and 5 x 10(7) to 9 x 10(8) CFU/clot; B. fragilis = 1 x 10(3) to 1 x 10(6) CFU/ml and 5 x 10(7) to 6 x 10(8) CFU/clot). CONCLUSION This standardised and reproducible model of intra-abdominal infection and abscess formation seems well suited for further use and development in experiments on the pathophysiology of intra-abdominal infection and abscesses.
Collapse
|
1469
|
van der Bijl AE, Kamper AM, de Fijter JW, Paul LC. Mycoplasma hominis peritonitis after renal transplantation. Nephron Clin Pract 2000; 86:541-2. [PMID: 11124622 DOI: 10.1159/000045862] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
1470
|
|
1471
|
Huang JW, Chu TS, Wu MS, Peng YS, Hsieh BS. Visible Penicillium spp. colonization plaques on a Tenckhoff catheter without resultant peritonitis in a peritoneal dialysis patient. Nephrol Dial Transplant 2000; 15:1872-3. [PMID: 11071981 DOI: 10.1093/ndt/15.11.1872] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
1472
|
Chang HR, Lian JD, Shu KH, Cheng CH, Wu MJ, Chen CH, Lau YJ, Hu BS. Use of pulsed-field gel electrophoresis in the analysis of recurrent Staphylococcus aureus infections in patients on continuous ambulatory peritoneal dialysis. Am J Nephrol 2000; 20:463-7. [PMID: 11146313 DOI: 10.1159/000046200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM The purpose of this study was to evaluate pulsed-field gel electrophoresis (PFGE) for distinguishing between relapse and reinfection of Staphylococcus aureus infections in patients on continuous ambulatory peritoneal dialysis (CAPD). METHODS Between July 1993 and May 1997, 4 patients with recurrent CAPD-associated infections caused by S. aureus we enrolled in this study. There were nine episodes of peritonitis, one episode of temporary double lumen catheter infection, and one episode of Hickman catheter infection. A total of eleven S. aureus isolates were collected from peritoneal fluid (n = 9) and blood (n = 2). PFGE typing was applied. RESULTS In our study, from PFGE typing, the 11 S. aureus isolates were classified into seven patterns. Antibiogram profiling classified only four patterns. Patient A had a reinfection by another strain of S. aureus, and patient B had three episodes of peritonitis caused by the same strain of S. aureus due to exit site infections. Patient C had two episodes of CAPD peritonitis caused by two different strains, respectively. Patient D had four episodes of S. aureus infection (three CAPD peritonitis and one bacteremia); the first two episodes of peritonitis were caused by an identical strain of S. aureus, whereas the subsequent two infections were caused by other organisms. CONCLUSION PFGE has a high discriminatory power and can be an assistant method to antibiogram profiling for distinguishing relapse from reinfection in CAPD-associated peritonitis.
Collapse
MESH Headings
- Anti-Bacterial Agents/pharmacology
- Chromosomes, Bacterial/genetics
- DNA, Bacterial/genetics
- Diagnosis, Differential
- Electrophoresis, Gel, Pulsed-Field/methods
- Electrophoresis, Gel, Pulsed-Field/statistics & numerical data
- Humans
- Kidney Failure, Chronic/complications
- Kidney Failure, Chronic/microbiology
- Kidney Failure, Chronic/therapy
- Microbial Sensitivity Tests/statistics & numerical data
- Peritoneal Dialysis, Continuous Ambulatory
- Peritonitis/diagnosis
- Peritonitis/etiology
- Peritonitis/microbiology
- Recurrence
- Staphylococcal Infections/diagnosis
- Staphylococcal Infections/etiology
- Staphylococcal Infections/microbiology
- Staphylococcus aureus/drug effects
- Staphylococcus aureus/genetics
- Staphylococcus aureus/isolation & purification
Collapse
|
1473
|
Warady BA, Schaefer F, Holloway M, Alexander S, Kandert M, Piraino B, Salusky I, Tranaeus A, Divino J, Honda M, Mujais S, Verrina E. Consensus guidelines for the treatment of peritonitis in pediatric patients receiving peritoneal dialysis. Perit Dial Int 2000; 20:610-24. [PMID: 11216549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
|
1474
|
Kim GC, Korbet SM. Polymicrobial peritonitis in continuous ambulatory peritoneal dialysis patients. Am J Kidney Dis 2000; 36:1000-8. [PMID: 11054357 DOI: 10.1053/ajkd.2000.19102] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We retrospectively evaluated 232 continuous ambulatory peritoneal dialysis (CAPD) patients entering our program from January 1, 1987, to December 31, 1997, for polymicrobial peritonitis. Polymicrobial peritonitis occurred in 16% of the patients (polymicrobial-peritonitis group), whereas 52% of the patients had peritonitis episodes with only a single organism (single-organism group), and 32% of the patients had no episode of peritonitis. Polymicrobial peritonitis accounted for 8% of the 554 peritonitis episodes, occurred after 23 +/- 20 months on peritoneal dialysis (PD), and was preceded by greater than three episodes of peritonitis in 73% of the patients. Peritonitis rates were greater in the polymicrobial-peritonitis group compared with patients in the single-organism group (1.8 versus 1.2 episodes/patient-year; P: < 0.001). The majority of polymicrobial infections involved gram-negative and/or fungal pathogens, but in 21% of the episodes, only gram-positive organisms were identified. An intra-abdominal process was identified in only 7% of the patients. Catheter loss overall was greatest in the polymicrobial-peritonitis group (65% versus single-organism group, 30% versus patients without peritonitis, 5%; P < 0.001), but only 33% of the polymicrobial infections resulted in catheter loss. At last follow-up, 70% of the patients in the polymicrobial-peritonitis group had permanently transferred to hemodialysis compared with 25% from the single-organism group and 15% from the no-peritonitis group (P < 0.001). In conclusion, polymicrobial peritonitis is an infrequent but serious complication of CAPD that occurs late in the course of PD and is often preceded by recurrent episodes of peritonitis. Polymicrobial peritonitis is rarely the result of a catastrophic intra-abdominal process, and although the majority of patients can be successfully treated without catheter removal, the long-term prognosis is poor, with a high rate of transfer to hemodialysis.
Collapse
|
1475
|
Wauters G, Van Bosterhaut B, Avesani V, Cuvelier R, Charlier J, Janssens M, Delmée M. Peritonitis due to Brevibacterium otitidis in a patient undergoing continuous ambulatory peritoneal dialysis. J Clin Microbiol 2000; 38:4292-3. [PMID: 11060116 PMCID: PMC87589 DOI: 10.1128/jcm.38.11.4292-4293.2000] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Brevibacterium otitidis is a coryneform rod and, as far as is known, is isolated only from infected ears. We report the first known case of peritonitis caused by B. otitidis in a patient undergoing continuous ambulatory peritoneal dialysis.
Collapse
|