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Paul S, Todd OA, Eichelberger KR, Tkaczyk C, Sellman BR, Noverr MC, Cassat JE, Fidel PL, Peters BM. A fungal metabolic regulator underlies infectious synergism during Candida albicans-Staphylococcus aureus intra-abdominal co-infection. Nat Commun 2024; 15:5746. [PMID: 38982056 PMCID: PMC11233573 DOI: 10.1038/s41467-024-50058-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/26/2024] [Indexed: 07/11/2024] Open
Abstract
Candida albicans and Staphylococcus aureus are two commonly associated pathogens that cause nosocomial infections with high morbidity and mortality. Our prior and current work using a murine model of polymicrobial intra-abdominal infection (IAI) demonstrates that synergistic lethality is driven by Candida-induced upregulation of functional S. aureus α-toxin leading to polymicrobial sepsis and organ damage. In order to determine the candidal effector(s) mediating enhanced virulence, an unbiased screen of C. albicans transcription factor mutants was undertaken revealing that zcf13Δ/Δ fails to drive augmented α-toxin or lethal synergism during co-infection. A combination of transcriptional and phenotypic profiling approaches shows that ZCF13 regulates genes involved in pentose metabolism, including RBK1 and HGT7 that contribute to fungal ribose catabolism and uptake, respectively. Subsequent experiments reveal that ribose inhibits the staphylococcal agr quorum sensing system and concomitantly represses toxicity. Unlike wild-type C. albicans, zcf13Δ/Δ did not effectively utilize ribose during co-culture or co-infection leading to exogenous ribose accumulation and agr repression. Forced expression of RBK1 and HGT7 in the zcf13Δ/Δ mutant fully restores pathogenicity during co-infection. Collectively, our results detail the interwoven complexities of cross-kingdom interactions and highlight how intermicrobial metabolism impacts polymicrobial disease pathogenesis with devastating consequences for the host.
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Affiliation(s)
- Saikat Paul
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Olivia A Todd
- Integrated Program in Biomedical Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kara R Eichelberger
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christine Tkaczyk
- Early Vaccines and Immune Therapies, AstraZeneca, Gaithersburg, MD, USA
| | - Bret R Sellman
- Early Vaccines and Immune Therapies, AstraZeneca, Gaithersburg, MD, USA
| | - Mairi C Noverr
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA, USA
| | - James E Cassat
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Institute for Infection, Immunology, and Inflammation (VI4), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paul L Fidel
- Department of Oral and Craniofacial Biology, Louisiana State University Health - School of Dentistry, New Orleans, LA, USA
| | - Brian M Peters
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN, USA.
- Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, USA.
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2
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Cho Y, Chow KM, Kam-Tao Li P, Runnegar N, Johnson DW. Peritoneal Dialysis-Related Infections. Clin J Am Soc Nephrol 2024; 19:641-649. [PMID: 37574658 PMCID: PMC11108252 DOI: 10.2215/cjn.0000000000000280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
Peritoneal dialysis (PD) represents an important treatment choice for patients with kidney failure. It allows them to dialyze outside the hospital setting, facilitating enhanced opportunities to participate in life-related activities, flexibility in schedules, time and cost savings from reduced travel to dialysis centers, and improved quality of life. Despite its numerous advantages, PD utilization has been static or diminishing in parts of the world. PD-related infection, such as peritonitis, exit-site infection, or tunnel infection, is a major concern for patients, caregivers, and health professionals-which may result in hesitation to consider this as treatment or to cease therapy when these complications take place. In this review, the definition, epidemiology, risk factors, prevention, and treatment of PD-related infection on the basis of the contemporary evidence will be described.
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Affiliation(s)
- Yeoungjee Cho
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Kai-Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Naomi Runnegar
- Infectious Management Services, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - David W. Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
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3
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Sidhu C, Davies HE, Muruganandan S, Lui MMS, Lau EPM, Lee YCG. Indwelling Pleural Catheter: Management of Complications. Semin Respir Crit Care Med 2023. [PMID: 37257836 DOI: 10.1055/s-0043-1769093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Multiple randomized clinical trials have established the advantages of indwelling pleural catheter (IPC) in the management of malignant pleural effusions, resulting in its widespread adoption in clinical practice. Complications can occur with IPC use and must be recognized and managed effectively. This review provides a comprehensive overview of IPC complications and their best care. Pain postinsertion or during drainage of IPC is easily manageable and must be distinguished from tumor-related chest wall pain. IPC-related infections require systemic antibiotics and often intrapleural fibrinolytic/deoxyribonuclease therapy. The removal of IPC for infection is usually unnecessary. Symptomatic loculation usually responds to fibrinolytics but may recur. Catheter tract metastases are common in mesothelioma patients and usually respond to radiotherapy without inducing damages to the IPC. Less common complications include dislodgement, irreversible blockage, and fractures (upon removal) of the catheter. Recommendations on the management of IPC complications by recent consensus statement/guideline are discussed. Expert opinions on management approaches are included in areas where evidence is lacking to guide care.
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Affiliation(s)
- Calvin Sidhu
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Helen E Davies
- Department of Respiratory Medicine, University Hospital of Wales, Cardiff, United Kingdom
| | - Sanjeevan Muruganandan
- Department of Respiratory Medicine, Northern Health, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Macy M S Lui
- Division of Respiratory Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Estee P M Lau
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Y C Gary Lee
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
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4
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Forté V, Novelli S, Zaidan M, Snanoudj R, Verger C, Beaudreuil S. Microbiology and outcomes of polymicrobial peritonitis associated with peritoneal dialysis: a register-based cohort study from the French Language Peritoneal Dialysis Registry (RDPLF). Nephrol Dial Transplant 2022; 38:1271-1281. [PMID: 36130870 DOI: 10.1093/ndt/gfac267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Previous studies have reported that polymicrobial peritonitis in peritoneal dialysis (PD) is associated with poor outcomes, but recent data from European cohorts are scarce. METHODS We included from the French Language Peritoneal Dialysis Registryall patients ≥ 18 years who started PD between January 2014 and November 2020. We compared microbiology and patient characteristics associated with mono- and polymicrobial peritonitis. We assessed patient outcomes after a first polymicrobial peritonitis using survival analysis with competing events. We differentiated microorganisms isolated from dialysis effluent as enteric or non-enteric pathogens. RESULTS 8848 patients contributed 13 023 patient-years of follow-up and 3348 culture-positive peritonitis, including 251 polymicrobial ones. This corresponded to rates of 0.32 and 0.02 episodes/patient-year, respectively. For most patients (72%) who experienced polymicrobial peritonitis, this was their first peritonitis episode. Enteric pathogens were more frequently isolated in poly- than in monomicrobial peritonitis (57 vs 44%, P < 0.001). In both cases of peritonitis with or without enteric pathogens, the poly- versus monomicrobial character of the peritonitis was not associated with mortality in patients who did not switch to hemodialysis (adjusted cause-specific hazard ratio, a.cs-HR, 1.2 [95% CI, 0.3-5.0], P = 0.78 and 1.1 [0.7-1.8], P = 0.73, respectively). However, the risks of death and switch to hemodialysis were higher for monomicrobial peritonitis with enteric pathogens, compared to those without (a.cs-HR, 1.3 [1.1-1.7], P = 0.02 and 1.9 [1.5-2.4], P < 0.0001, respectively). CONCLUSION Isolation of enteric pathogens, rather than the polymicrobial character of the peritonitis, is associated with poorer outcomes.
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Affiliation(s)
- Valentine Forté
- Sorbonne Université, Faculty of Medicine, APHP, Paris, France
| | - Sophie Novelli
- Université Paris-Saclay, UVSQ, Inserm, CESP, Villejuif, France
| | - Mohamad Zaidan
- Nephrology Dialysis Transplantation department, University Hospital Paris Saclay, APHP, Le Kremlin Bicêtre, France
| | - Renaud Snanoudj
- Nephrology Dialysis Transplantation department, University Hospital Paris Saclay, APHP, Le Kremlin Bicêtre, France
| | | | - Séverine Beaudreuil
- Nephrology Dialysis Transplantation department, University Hospital Paris Saclay, APHP, Le Kremlin Bicêtre, France
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5
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Li PKT, Chow KM, Cho Y, Fan S, Figueiredo AE, Harris T, Kanjanabuch T, Kim YL, Madero M, Malyszko J, Mehrotra R, Okpechi IG, Perl J, Piraino B, Runnegar N, Teitelbaum I, Wong JKW, Yu X, Johnson DW. ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Perit Dial Int 2022; 42:110-153. [PMID: 35264029 DOI: 10.1177/08968608221080586] [Citation(s) in RCA: 225] [Impact Index Per Article: 112.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Peritoneal dialysis (PD)-associated peritonitis is a serious complication of PD and prevention and treatment of such is important in reducing patient morbidity and mortality. The ISPD 2022 updated recommendations have revised and clarified definitions for refractory peritonitis, relapsing peritonitis, peritonitis-associated catheter removal, PD-associated haemodialysis transfer, peritonitis-associated death and peritonitis-associated hospitalisation. New peritonitis categories and outcomes including pre-PD peritonitis, enteric peritonitis, catheter-related peritonitis and medical cure are defined. The new targets recommended for overall peritonitis rate should be no more than 0.40 episodes per year at risk and the percentage of patients free of peritonitis per unit time should be targeted at >80% per year. Revised recommendations regarding management of contamination of PD systems, antibiotic prophylaxis for invasive procedures and PD training and reassessment are included. New recommendations regarding management of modifiable peritonitis risk factors like domestic pets, hypokalaemia and histamine-2 receptor antagonists are highlighted. Updated recommendations regarding empirical antibiotic selection and dosage of antibiotics and also treatment of peritonitis due to specific microorganisms are made with new recommendation regarding adjunctive oral N-acetylcysteine therapy for mitigating aminoglycoside ototoxicity. Areas for future research in prevention and treatment of PD-related peritonitis are suggested.
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Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Kai Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yeoungjee Cho
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Stanley Fan
- Translational Medicine and Therapeutic, William Harvey Research Institute, Queen Mary University, London, UK
| | - Ana E Figueiredo
- Nursing School Escola de Ciências da Saúde e da Vida Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tess Harris
- Polycystic Kidney Disease Charity, London, UK
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Magdalena Madero
- Division of Nephrology, Department of Medicine, National Heart Institute, Mexico City, Mexico
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Diseases, The Medical University of Warsaw, Poland
| | - Rajnish Mehrotra
- Division of Nephrology, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, DC, USA
| | - Ikechi G Okpechi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, South Africa
| | - Jeff Perl
- St Michael's Hospital, University of Toronto, ON, Canada
| | - Beth Piraino
- Department of Medicine, Renal Electrolyte Division, University of Pittsburgh, PA, USA
| | - Naomi Runnegar
- Infectious Management Services, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Isaac Teitelbaum
- Division of Nephrology, Department of Medicine, University of Colorado, Aurora, CO, USA
| | | | - Xueqing Yu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangzhou, China
- Guangdong Academy of Medical Sciences, Guangzhou, China
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
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6
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Nai JWR, Renaud CJ. Looking beyond catheter removal in polymicrobial peritonitis from unusual enteric bugs. Nephrology (Carlton) 2021; 27:467-468. [PMID: 34553461 DOI: 10.1111/nep.13976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 12/01/2022]
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7
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Liu M, Yang L, Zhu X, Zhang X, Zhang Y, Zhuang X, Bai X, Zhou W, Luo P, Cui W. [Risk factors of occurrence and treatment failure of peritoneal dialysis-associated polymicrobial peritonitis: a multicenter retrospective study]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:1350-1357. [PMID: 34658349 DOI: 10.12122/j.issn.1673-4254.2021.09.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the risk factors of occurrence and treatment failure of peritoneal dialysis associatedperitonitis (PDAP) due to polymicrobial infections. METHODS We retrospectively collected the clinical data of patients with PDAP from the peritoneal dialysis (PD) centers in 4 general hospitals in Jilin Province from 2013 to 2019. The patients were divided, according to the results of peritoneal dialysate culture, into polymicrobial PDAP group and control group for comparison of the clinical data, treatment outcomes, and long-term prognosis. The independent risk factors of the occurrence and treatment failure of polymicrobial PDAP were explored using multivariate regression analysis. RESULTS We recruited a total of 625 patients from the 4 PD centers, among whom 1085 episodes of PDAP were recorded. Polymicrobial PDAP accounted for 7.6% of the total PDAP episodes, and this proportion increased from 5.3% in 2013-2016 to 9.4% in 2017-2019 (P= 0.012). Compared with the control group, polymicrobial PDAP group had higher proportions of elderly patients and patients with refractory PDAP, with greater white blood cell counts in the first-day dialysate and longer course of antibiotic treatment (P < 0.05). The risk of catheter removal and treatment failure (catheter removal or PDAP-related death) in polymicrobial PDAP group was 2.972 times (OR=2.972, 95% CI: 1.634-5.407, P < 0.001) and 2.692 times (OR=2.692, 95% CI: 1.578-4.591, P < 0.001) that in the control group, respectively. The risk of withdrawal from PD (technical failure + all-cause death) was 1.5- fold higher in polymicrobial PDAP group than that in the control group (OR=1.500, 95% CI: 1.085-2.074, P=0.014). Elderly patients (>65 years) had a 1.937-fold higher risk of experiencing polymicrobial PDAP than younger patients (OR=1.937, 95% CI: 1.207-3.109, P= 0.006). Diabetes mellitus (OR=5.554, 95% CI: 1.021-30.201, P=0.047), mixed fungal infeciton (OR=343.687, 95% CI: 21.554- 5480.144, P < 0.001), and Pseudomonas aeruginosa infection (OR=11.518, 95% CI: 1.632 to 81.310, P=0.014) were associated with increased risks of treatment failure by 4.554, 342.687 and 10.518 times, respectively. CONCLUSION The proportion of polymicrobial PDAP in the total PDAP cases tends to increase in recent years. Polymicrobial infection is an independent risk factor of both treatment failure and poor prognosis in patients with PDAP. An old age is an independent risk factor for polymicrobial PDAP, while diabetes mellitus and infections with mixed fungi or Pseudomonas aeruginosa are independent risk factors for treatment failure.
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Affiliation(s)
- M Liu
- Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
| | - L Yang
- Department of Nephrology, Second Division of First Hospital of Jilin University, Changchun 130031, China
| | - X Zhu
- Department of Nephrology, Jilin Central Hospital, Jilin 132011, China
| | - X Zhang
- Department of Nephrology, Jilin FAW General Hospital, Changchun 130011, China
| | - Y Zhang
- Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
| | - X Zhuang
- Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
| | - X Bai
- Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
| | - W Zhou
- Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
| | - P Luo
- Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
| | - W Cui
- Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
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Ito Y, Ryuzaki M, Sugiyama H, Tomo T, Yamashita AC, Ishikawa Y, Ueda A, Kanazawa Y, Kanno Y, Itami N, Ito M, Kawanishi H, Nakayama M, Tsuruya K, Yokoi H, Fukasawa M, Terawaki H, Nishiyama K, Hataya H, Miura K, Hamada R, Nakakura H, Hattori M, Yuasa H, Nakamoto H. Peritoneal Dialysis Guidelines 2019 Part 1 (Position paper of the Japanese Society for Dialysis Therapy). RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00348-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AbstractApproximately 10 years have passed since the Peritoneal Dialysis Guidelines were formulated in 2009. Much evidence has been reported during the succeeding years, which were not taken into consideration in the previous guidelines, e.g., the next peritoneal dialysis PD trial of encapsulating peritoneal sclerosis (EPS) in Japan, the significance of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), the effects of icodextrin solution, new developments in peritoneal pathology, and a new international recommendation on a proposal for exit-site management. It is essential to incorporate these new developments into the new clinical practice guidelines. Meanwhile, the process of creating such guidelines has changed dramatically worldwide and differs from the process of creating what were “clinical practice guides.” For this revision, we not only conducted systematic reviews using global standard methods but also decided to adopt a two-part structure to create a reference tool, which could be used widely by the society’s members attending a variety of patients. Through a working group consensus, it was decided that Part 1 would present conventional descriptions and Part 2 would pose clinical questions (CQs) in a systematic review format. Thus, Part 1 vastly covers PD that would satisfy the requirements of the members of the Japanese Society for Dialysis Therapy (JSDT). This article is the duplicated publication from the Japanese version of the guidelines and has been reproduced with permission from the JSDT.
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Hwang TY, Kim MG, Oh SW, Jo SK, Cho WY, Yang J. Pathogens of peritoneal dialysis peritonitis: Trends from a single-center experience over 15 years. Kidney Res Clin Pract 2020; 39:221-227. [PMID: 32449332 PMCID: PMC7321667 DOI: 10.23876/j.krcp.19.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 02/20/2020] [Accepted: 03/05/2020] [Indexed: 11/14/2022] Open
Abstract
Background Concerns are increasing about the emergence of pathogens with antibiotic resistance in peritoneal dialysis (PD) peritonitis. We investigated the current pathogen trends and risk factors in PD peritonitis. Methods We conducted a retrospective study analyzing data from 643 patients who maintained PD over 3 months between January 2001 and December 2015. The isolated pathogens from PD peritonitis were compared between period A (2001-2008) and period B (2009-2015). Results Among 643 PD patients, 252 patients experienced one or more episodes of PD peritonitis (total 308 episodes) during the median follow-up of 66 months. In both periods, gram-positive bacteria were the dominant pathogens (22.2% vs. 53.8%, P < 0.01). Gram-negative bacteria showed an increasing tendency in period B, but without statistical significance (17.0% vs. 23.7%, P = 0.15). The culture-negative rate was improved from 57% in period A to 18% in period B (P < 0.01). There was no increase in the prevalence of resistant pathogens such as methicillin-resistant Staphylococcus epidermidis (MRSE), Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli between periods A and B. Preserved residual renal function was associated with a lower risk of PD peritonitis (odds ratio, 0.53; 95% confidence interval, 0.31-0.88; P = 0.01). Conclusion Over the past two decades, the pathogens of PD peritonitis have not significantly changed in Korea. Gram-positive organisms remained dominant, with S. epidermidis being the most common pathogen. Resistant bacteria such as MRSE, MRSA, ESBL-producing Gram-negative bacilli did not increase, but should be monitored.
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Affiliation(s)
- Tae Yeon Hwang
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Myung Gyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Se Won Oh
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sang-Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Won-Yong Cho
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jihyun Yang
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
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10
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Szeto CC, Chow KM, Wong TYH, Leung CB, Li PKT. Influence of Climate on the Incidence of Peritoneal Dialysis-Related Peritonitis. Perit Dial Int 2020. [DOI: 10.1177/089686080302300611] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
ObjectiveThe use of peritoneal dialysis has expanded in many developing subtropical countries; however, the role of climatic factors in dialysis-related peritonitis has not been studied in detail.DesignRetrospective study.SettingA single regional dialysis unit in a university teaching hospital.PatientsWe reviewed all cases of dialysis-related peritonitis treated in our dialysis unit from January 1995 to December 2001. Information was collected on demographic data, microbiologic etiology, associated catheter exit-site infection, and clinical response.ResultsIn 24 059 patient-months of follow-up, 1344 episodes of peritonitis were recorded. There were significantly more peritonitis episodes in July and August [odds ratio 1.17, 95% confidence interval (CI) 1.03 – 1.32], and fewer peritonitis episodes in December (odds ratio 0.79, 95% CI 0.61 – 0.98). There was also a trend of more peritonitis in March (odds ratio 1.18, 95% CI 0.97 – 1.41), but the difference was not statistically significant. When the incidence of peritonitis caused by individual bacterial species was further analyzed, we found a significant seasonal variation in the rate of peritonitis caused by gram-negative bacteria, except Pseudomonas (overall chi-square test, p = 0.002). A similar trend of seasonal variation was also observed in gram-positive peritonitis, but the result was not statistically significant. There was significant seasonal variation in the rate of peritonitis that had coexisting exit-site infection (overall chi-square test, p = 0.02), with peak incidence in July. However, the proportion of peritonitis that had coexisting exit-site infection did not have significant seasonal variation. There was significant correlation between monthly peritonitis rate and average humidity ( r = –0.346, p < 0.002) and temperature ( r = –0.264, p = 0.015).ConclusionsThere is substantial seasonal variation in the incidence of dialysis-related peritonitis, with peak incidence in the months that are hot and humid. Keeping a cool and dry living environment may help to reduce peritonitis in peritoneal dialysis patients in tropical countries.
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Affiliation(s)
- Cheuk-Chun Szeto
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Kai-Ming Chow
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Teresa Yuk-Hwa Wong
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Chi-Bon Leung
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Philip Kam-Tao Li
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Piraino B, Bailie GR, Bernardini J, Boeschoten E, Gupta A, Holmes C, Kuijper EJ, Li PKT, Lye WC, Mujais S, Paterson DL, Fontan MP, Ramos A, Schaefer F, Uttley L. Peritoneal Dialysis-Related Infections Recommendations: 2005 Update. Perit Dial Int 2020. [DOI: 10.1177/089686080502500203] [Citation(s) in RCA: 516] [Impact Index Per Article: 129.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Beth Piraino
- Renal Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Judith Bernardini
- Renal Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Amit Gupta
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Clifford Holmes
- Renal Division, Baxter Healthcare Corporation, McGaw Park, Illinois, USA
| | - Ed J. Kuijper
- Department of Medical Microbiology, University Medical Center, Leiden, The Netherlands
| | - Philip Kam-Tao Li
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | - Wai-Choong Lye
- Centre for Kidney Diseases, Mount Elizabeth Medical Centre, Singapore
| | - Salim Mujais
- Renal Division, Baxter Healthcare Corporation, McGaw Park, Illinois, USA
| | - David L. Paterson
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Alfonso Ramos
- Division of Nephrology, Hospital General de Zona #2, Instituto Mexicano del Seguro Social, Hermosillo, Mexico
| | - Franz Schaefer
- Pediatric Nephrology Division, University Children's Hospital, Heidelberg, Germany
| | - Linda Uttley
- Renal Dialysis Treatment, Manchester Royal Infirmary, Manchester, United Kingdom
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12
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Brown F, Liu WJ, Kotsanas D, Korman TM, Atkins RC. A Quarter of a Century of Adult Peritoneal Dialysis-Related Peritonitis at an Australian Medical Center. Perit Dial Int 2020. [DOI: 10.1177/089686080702700518] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Peritonitis remains one of the major complications of peritoneal dialysis (PD) and results in reduced technique survival and increased patient morbidity and mortality. Methods We prospectively recorded comprehensive data on all episodes of PD peritonitis over a 25-year period, including organisms isolated and antibiotic sensitivities. Data on 1588 PD patient-years with 2073 episodes of peritonitis were analyzed; 2089 organisms were isolated in 608 patients. Peritoneal dialysis technique and patient survival were also recorded. Results There was a significant decline over the years in the incidence of peritonitis, from 6.5 to 0.35 episodes/patient-year, with the decline in the post twin-bag era from 2.3 to 0.47 ( p < 0.001) due primarily to a decrease in gram-positive organisms. The most common isolates (68.9%) were gram-positive organisms; gram-negative organisms comprised 26.8% and fungi 4.1%. Coagulase-negative staphylococci were the most common pathogen isolated (35.3%). Culture-negative peritonitis was seen in 13.4% of episodes. Conclusion This is the largest series of PD peritonitis reported, demonstrating a dramatic reduction over a 25-year period and also detailing the changing trends of organisms isolated in association with improved technique and patient survival. Although rates have improved, peritonitis remains a major complication and further research needs to be done to improve both PD technique and patient survival.
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Affiliation(s)
- Fiona Brown
- Departments of Nephrology Monash Medical Centre, Clayton, Victoria, Australia
| | - Wen Jiun Liu
- Departments of Nephrology Monash Medical Centre, Clayton, Victoria, Australia
| | - Despina Kotsanas
- Infectious Diseases, Monash Medical Centre, Clayton, Victoria, Australia
| | - Tony M. Korman
- Infectious Diseases, Monash Medical Centre, Clayton, Victoria, Australia
| | - Robert C. Atkins
- Departments of Nephrology Monash Medical Centre, Clayton, Victoria, Australia
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Leung CB, Szeto CC, Chow KM, Kwan BCH, Wang AYM, Lui SF, Li PKT. Cefazolin plus Ceftazidime versus Imipenem / Cilastatin Monotherapy for Treatment of Capd Peritonitis — a Randomized Controlled Trial. Perit Dial Int 2020. [DOI: 10.1177/089686080402400508] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BackgroundPeritonitis is a serious complication of peritoneal dialysis (PD). We studied the efficacy of imipenem / cilastatin monotherapy in the treatment of PD-related peritonitis.MethodsWe performed an open-label, randomized control study comparing imipenem / cilastatin monotherapy (treatment group) versus cefazolin plus ceftazidime (control group) in the treatment of PD peritonitis. The result was further compared to a historic group treated with cefazolin plus netilmycin. Outcome measures were primary response rate at day 10 and complete cure rate.ResultsWe enrolled 51 patients in the treatment group, 51 in the control group, and identified 96 in the historic group. The primary response rate to the assigned antibiotics was 49.0%, 51.0%, and 49.0% for the treatment, control, and historic groups, respectively ( p = 0.97). The primary response rate allowing for change in antibiotic was 82.4%, 90.2%, and 82.3%, respectively, for the three groups ( p = 0.41). The complete cure rate was 72.5%, 80.4%, and 82.3%, respectively ( p = 0.60). Tenckhoff catheter removal was needed in 6 cases in the treatment group, 6 cases in the control group, and 13 cases in the historic group ( p = 0.90).ConclusionsWe concluded that monotherapy of imipenem / cilastatin has similar efficacy compared to the two standard regimens of cefazolin plus ceftazidime or netilmycin in the treatment of PD peritonitis.
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Affiliation(s)
- Chi-Bon Leung
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Cheuk-Chun Szeto
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Kai-Ming Chow
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Bonnie Ching-Ha Kwan
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Angela Yee-Moon Wang
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Siu-Fai Lui
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Philip Kam-Tao Li
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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14
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Abstract
Peritonitis is a common and severe complication in peritoneal dialysis (PD). Detailed recommendations on the prevention and treatment of PD-associated peritonitis have been published by the International Society for Peritoneal Dialysis (ISPD), but there is a substantial variation in clinical practice among dialysis units. Prophylactic antibiotics administered before PD catheter insertion, colonoscopy, or invasive gynecologic procedures, daily topical application of antibiotic cream or ointment to the catheter exit site, and prompt treatment of exit site or catheter infection are key measures to prevent PD-associated peritonitis. When a patient on PD presents with clinical features compatible with PD-associated peritonitis, empirical antibiotic therapy, with coverage of both Gram-positive and Gram-negative organisms (including Pseudomonas species), should be started once the appropriate microbiologic specimens have been obtained. Intraperitoneal is the preferred route of administration. Antifungal prophylaxis, preferably oral nystatin, should be added to prevent secondary fungal peritonitis. Once the PD effluent Gram stain or culture and sensitivity results are available, antibiotic therapy can be adjusted accordingly. A detailed description on the dosage of individual antibiotic can be found in the latest recommendations by the ISPD. The duration of antibiotics is usually 2-3 weeks, depending on the specific organisms identified. Catheter removal and temporary hemodialysis support is recommended for refractory, relapsing, or fungal peritonitis. In some patients, a new PD catheter could be inserted after complete resolution of the peritonitis. PD catheter removal should also be considered for refractory exit site or tunnel infections. After the improvement in clinical practice, there is a worldwide trend of reduction in PD-associated peritonitis rate, supporting the use of PD as a first-line dialysis modality.
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Affiliation(s)
- Cheuk-Chun Szeto
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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15
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Fujii K, Washida N, Arai E, Tsuruta M, Wakino S, Itoh H. Adhesive intestinal obstruction increases the risk of intestinal perforation in peritoneal dialysis patients: a case report. BMC Nephrol 2018; 19:153. [PMID: 29954334 PMCID: PMC6022445 DOI: 10.1186/s12882-018-0954-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 06/20/2018] [Indexed: 11/30/2022] Open
Abstract
Background Peritonitis secondary to bowel perforation is a rare and potentially fatal complication in peritoneal dialysis (PD) patients. However, the early diagnosis of bowel perforation is difficult in PD patients because the initial symptoms and signs of bowel perforation are similar to those of PD-associated peritonitis. Furthermore, the risk of bowel perforation in PD patients is unclear. Here, we present a case of intestinal perforation located at the site of adhesive intestinal obstruction in a PD patient. Case presentation A 73-year-old man on PD presented with progressive worsening of abdominal pain and cloudy peritoneal fluid. The peritoneal fluid cell count was increased to 980/ml and peritoneal dialysis-associated peritonitis was diagnosed. Computed tomography showed local adhesions causing agglomeration of the dilated intestine. He initially responded to antibiotic treatment; however, his abdominal pain was rapidly worsened after resumption of oral intake. On hospital day 23, computed tomography showed loss of contents from the dilated intestine and discharge of fecal material from the PD tube was noted. Thus, small bowel perforation was diagnosed, and he underwent ileocecal resection with colostomy creation. As indicators of EPS was not evident, PD catheter was removed. Since then, he has been on maintenance of hemodialysis since then. Conclusion The findings of the present case suggest that adhesive intestinal obstruction in PD patients can increase the risk of intestinal perforation. Careful monitoring for the early detection of intestinal perforation is required in such cases.
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Affiliation(s)
- Kentaro Fujii
- Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Naoki Washida
- Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Nephrology, International University of Health and Welfare School of Medicine, 4-3 Kouzunomori, Narita, Chiba, 286-8686, Japan
| | - Eri Arai
- Department of Pathology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masashi Tsuruta
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shu Wakino
- Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Itoh
- Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Lin WH, Tseng CC, Wu AB, Chang YT, Kuo TH, Chao JY, Wang MC, Wu JJ. Clinical and microbiological characteristics of peritoneal dialysis-related peritonitis caused by Escherichia coli in southern Taiwan. Eur J Clin Microbiol Infect Dis 2018; 37:1699-1707. [PMID: 29931659 DOI: 10.1007/s10096-018-3302-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/11/2018] [Indexed: 12/11/2022]
Abstract
Peritonitis is a serious complication and major cause of treatment failure in patients undergoing peritoneal dialysis (PD). Escherichia coli is the major pathogen in extraintestinal Gram-negative infections, including PD-related peritonitis. The outcomes of E. coli peritonitis in PD varied from relatively favorable outcomes to a higher incidence of treatment failure. The aim of this study was to investigate the impact of bacterial virulence and host characteristics on the outcomes of PD-related peritonitis caused by E. coli. From January 2000 to June 2016, a total of 47 episodes of monomicrobial and 10 episodes of polymicrobial E. coli PD-related peritonitis, as well as 89 episodes of monomicrobial Gram-positive (56 Staphylococcus spp. and 33 Streptococcus spp.) PD-related peritonitis cases, were retrospectively enrolled. Clinical features, E. coli bacterial virulence, and outcomes were analyzed. Compared to Streptococcus spp. peritonitis, E. coli peritonitis had a higher peritoneal catheter removal rate (38 versus 12%; P = 0.0115). Compared to the monomicrobial group, patients in polymicrobial group were older and had higher peritoneal catheter removal rate (80 versus 38%; P = 0.0324). Treatment failure of E. coli peritonitis was associated with more polymicrobial peritonitis and immunocompromised comorbidity, longer duration of PD therapy, and more antimicrobial resistance. E. coli isolates with more iron-related genes had higher prevalence of phylogenetic group B2 and papG II, iha, ompT, and usp genes. This study demonstrates the important roles of clinical and bacterial characteristics in the outcomes of monomicrobial and polymicrobial E. coli PD-related peritonitis.
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Affiliation(s)
- Wei-Hung Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chin-Chung Tseng
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan, 70428, Taiwan
| | - An-Bang Wu
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan, 70428, Taiwan
| | - Yu-Tzu Chang
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan, 70428, Taiwan
| | - Te-Hui Kuo
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan, 70428, Taiwan
| | - Jo-Yen Chao
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan, 70428, Taiwan
| | - Ming-Cheng Wang
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan, 70428, Taiwan. .,Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Jiunn-Jong Wu
- Department of Biotechnology and Laboratory Science in Medicine, School of Biomedical Science and Engineering, National Yang Ming University, No. 155, Section 2, Li-Nong Street, Taipei, 11221, Taiwan.
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Abstract
Peritoneal dialysis is an effective treatment modality for patients with end-stage renal disease. The relative use of peritoneal dialysis versus hemodialysis varies widely by country. Data from a 2004 survey reports the percentage of patients with end-stage renal disease treated with peritoneal dialysis to be 5%-10% in economically developed regions like the US and Western Europe to as much as 75% in Mexico. This disparity is probably related to the availability and access to hemodialysis, or in some cases patient preference for peritoneal over hemodialysis. Peritoneal dialysis-related peritonitis remains the major complication and primary challenge to the long-term success of peritoneal dialysis. Fifty years ago, with the advent of the Tenckhoff catheter, patients averaged six episodes of peritonitis per year on peritoneal dialysis. In 2016, the International Society for Peritoneal Dialysis proposed a benchmark of 0.5 episodes of peritonitis per year or one episode every 2 years. Despite the marked reduction in peritonitis over time, peritonitis for the individual patient is problematic. The mortality for an episode of peritonitis is 5% and is a cofactor for mortality in another 16% of affected patients. Prevention of peritonitis and prompt and appropriate management of peritonitis is essential for the long-term success of peritoneal dialysis in all patients. In this review, challenges and solutions are addressed regarding the pathogenesis, clinical features, diagnosis, treatment, and prevention of peritoneal dialysis-related peritonitis from the viewpoint of an infectious disease physician.
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18
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Ma TKW, Chow KM, Kwan BCH, Pang WF, Leung CB, Li PKT, Szeto CC. Peritonitis before Peritoneal Dialysis Training: Analysis of Causative Organisms, Clinical Outcomes, Risk Factors, and Long-Term Consequences. Clin J Am Soc Nephrol 2016; 11:1219-1226. [PMID: 27269302 PMCID: PMC4934830 DOI: 10.2215/cjn.00830116] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/14/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Peritonitis before peritoneal dialysis (PD) training (pretraining peritonitis [PTP]) is an uncommon event. The study aim was to examine the causative organisms, clinical outcomes, risk factors, and long-term consequences of PTP. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this single-center, retrospective, observational study involving all incident patients on PD who developed PTP between 1998 and 2012, we examined the causative organisms, primary response rate, complete cure rate, risk factors, and associations of PTP with peritoneal equilibration test (PET) and patient survival. For each patient in the PTP group, the patients who underwent catheter insertion immediately before and after the index case were identified as controls. RESULTS Among 1252 incident patients on PD, 52 (4.2%) patients developed PTP, and 104 patients were identified as controls. The two groups were similar in age, sex distribution, comorbidities, and residual renal function, but the PTP group had significantly lower hemoglobin and serum albumin. Patients were followed up for a median of 37.5 months (interquartile range [IQR], 16.3-62.2 months). The most common causative organisms of PTP were Staphylococcus aureus (30.8%) and polymicrobial (21.2%); 25% had negative growth. The primary response and complete cure rates were 82.7% and 78.8%, respectively. In the PTP group, 7.7% of patients died, 9.6% of patients required catheter removal, and PD training was significantly delayed (median =42.0; IQR, 26.0-65.8 days versus 27.5; IQR, 23.0-35.0 days; P=0.01). Multivariate logistic regression analysis showed that serum albumin was the only predictor of PTP (adjusted odds ratio, 0.89 per 1-g/dl increase; 95% confidence interval, 0.82 to 0.97). There were no differences in PET results and dialysis adequacy (measured around 1 month after PD training). The PTP group had significantly worse patient survival (median =41.2; IQR, 21.8-60.5 months versus 55.8; IQR, 40.4-71.2 months; P=0.02). Technique failure occurred in 11.5% and 10.6% of patients in the PTP and control groups, respectively. CONCLUSIONS S. aureus is the most common causative organism of PTP. Nutritional interventions in patients who are hypoalbuminemic before catheter insertion deserve additional study.
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Affiliation(s)
- Terry King-Wing Ma
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Li PKT, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE, Fish DN, Goffin E, Kim YL, Salzer W, Struijk DG, Teitelbaum I, Johnson DW. ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment. Perit Dial Int 2016; 36:481-508. [PMID: 27282851 PMCID: PMC5033625 DOI: 10.3747/pdi.2016.00078] [Citation(s) in RCA: 620] [Impact Index Per Article: 77.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/04/2016] [Indexed: 12/19/2022] Open
Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Cheuk Chun Szeto
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Beth Piraino
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Javier de Arteaga
- Department of Nephrology, Hospital Privado and Catholic University, Cordoba, Argentina
| | - Stanley Fan
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
| | - Ana E Figueiredo
- Nursing School-FAENFI, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Douglas N Fish
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Eric Goffin
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Belgium
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - William Salzer
- University of Missouri-Columbia School of Medicine, Department of Internal Medicine, Section of Infectious Disease, MI, USA
| | - Dirk G Struijk
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
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21
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Candida albicans-Staphylococcus aureus polymicrobial peritonitis modulates host innate immunity. Infect Immun 2013; 81:2178-89. [PMID: 23545303 DOI: 10.1128/iai.00265-13] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Despite advances in medical device fabrication and antimicrobial treatment therapies, fungal-bacterial polymicrobial peritonitis remains a serious complication for surgery patients, those on peritoneal dialysis, and the critically ill. Using a murine model of peritonitis, we have demonstrated that monomicrobial infection with Candida albicans or Staphylococcus aureus is nonlethal. However, coinfection with these same doses leads to a 40% mortality rate and increased microbial burden in the spleen and kidney by day 1 postinfection. Using a multiplex enzyme-linked immunosorbent assay, we have also identified a unique subset of innate proinflammatory cytokines (interleukin-6, granulocyte colony-stimulating factor, keratinocyte chemoattractant, monocyte chemoattractant protein-1, and macrophage inflammatory protein-1α) that are significantly increased during polymicrobial versus monomicrobial peritonitis, leading to increased inflammatory infiltrate into the peritoneum and target organs. Treatment of coinfected mice with the cyclooxygenase (COX) inhibitor indomethacin reduces the infectious burden, proinflammatory cytokine production, and inflammatory infiltrate while simultaneously preventing any mortality. Further experiments demonstrated that the immunomodulatory eicosanoid prostaglandin E2 (PGE2) is synergistically increased during coinfection compared to monomicrobial infection; indomethacin treatment also decreased elevated PGE2 levels. Furthermore, addition of exogenous PGE2 into the peritoneal cavity during infection overrode the protection provided by indomethacin and restored the increased mortality and microbial burden. Importantly, these studies highlight the ability of fungal-bacterial coinfection to modulate innate inflammatory events with devastating consequences to the host.
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22
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Li PKT, Szeto CC, Piraino B, Bernardini J, Figueiredo AE, Gupta A, Johnson DW, Kuijper EJ, Lye WC, Salzer W, Schaefer F, Struijk DG. Peritoneal dialysis-related infections recommendations: 2010 update. Perit Dial Int 2012; 30:393-423. [PMID: 20628102 DOI: 10.3747/pdi.2010.00049] [Citation(s) in RCA: 585] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
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Chang MJ, Namgung H, Choi HD, Song YR, Kim SG, Oh JM, Shin WG. Pharmacokinetics of clindamycin in the plasma and dialysate after intraperitoneal administration of clindamycin phosphoester to patients on continuous ambulatory peritoneal dialysis: an open-label, prospective, single-dose, two-institution study. Basic Clin Pharmacol Toxicol 2012; 110:504-9. [PMID: 22151828 DOI: 10.1111/j.1742-7843.2011.00842.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We evaluated the pharmacokinetics of clindamycin and the dose of clindamycin phosphate necessary to treat peritonitis after intraperitoneal administration of clindamycin phosphate to patients on continuous ambulatory peritoneal dialysis (CAPD). This was an open-label, prospective, single-dose study conducted at the two levels of institutional clinical care in South Korea. Twelve patients (six men and six women; all older than 25 years), mean CAPD duration of 38.2 months with various origins without peritonitis, received 600 mg clindamycin phosphate mixed with only the first 2-L dialysate (1.5% dextrose). The 1.5%, 1.5%, 2.5% and 1.5% dextrose dialysates were serially exchanged every 6 hr. If patients were non-anuric, 24-hr urine samples were also collected. Clindamycin phosphate was incompletely activated to clindamycin in the dialysate. The clindamycin concentration in the dialysate was greater than the effective concentration (5 μg/mL) at 6.87 μg/mL up to 6 hr. So, 600 mg clindamycin phosphate per every 6 hr dialysate is effective for treatment of peritonitis. It has been reported that the clindamycin concentrations in the dialysate may be higher in CAPD patients with peritonitis. Thus, we can expect that intraperitoneal administration of <600 mg clindamycin phosphate per every 6 hr dialysate could be maintained over 5 μg/mL in patients with peritonitis. The transfer of clindamycin was unidirectional from the dialysate to the plasma.
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Affiliation(s)
- Min J Chang
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea
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24
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Lin YC, Lin WP, Huang JY, Lee SY. Polymicrobial peritonitis following colonoscopic polypectomy in a peritoneal dialysis patient. Intern Med 2012; 51:1841-3. [PMID: 22821097 DOI: 10.2169/internalmedicine.51.7485] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) are at an increased risk of peritonitis following colonoscopy with or without polypectomy. Guidelines for peritoneal dialysis patients recommend administration of prophylactic antibiotics and drainage of the abdomen before colonoscopy. In this report, we describe a 53-year-old woman on CAPD who underwent colonoscopy with polypectomy and developed peritonitis within 24 hours. She presented with severe abdominal pain, typical rebounding tenderness, and turbid dialysate containing increased white blood cells with a predominance of neutrophils. A culture of the patient's peritoneal fluid grew polymicrobial species including Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis. She was treated with intraperitoneal and intravenous administration of combination antibiotics, and she fully recovered within 3 weeks. We suggest that nephrologists and endoscopists should be familiar with the risks and follow the guidelines to prevent such complications in CAPD patients. If peritonitis occurs, medical therapy with antibiotics should be considered before surgical intervention for catheter salvage.
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Affiliation(s)
- Yu-Cheng Lin
- Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taiwan
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Jarvis EM, Hawley CM, McDonald SP, Brown FG, Rosman JB, Wiggins KJ, Bannister KM, Johnson DW. Predictors, treatment, and outcomes of non-Pseudomonas Gram-negative peritonitis. Kidney Int 2010; 78:408-14. [DOI: 10.1038/ki.2010.149] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Barraclough K, Hawley CM, McDonald SP, Brown FG, Rosman JB, Wiggins KJ, Bannister KM, Johnson DW. Polymicrobial peritonitis in peritoneal dialysis patients in Australia: predictors, treatment, and outcomes. Am J Kidney Dis 2009; 55:121-31. [PMID: 19932543 DOI: 10.1053/j.ajkd.2009.08.020] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 08/21/2009] [Indexed: 12/27/2022]
Abstract
BACKGROUND The study aim was to examine the frequency, predictors, treatment, and clinical outcomes of peritoneal dialysis-associated polymicrobial peritonitis. STUDY DESIGN Observational cohort study using ANZDATA (The Australia and New Zealand Dialysis and Transplant Registry) data. SETTING & PARTICIPANTS All Australian peritoneal dialysis patients between October 2003 and December 2006. PREDICTORS Age, sex, race, body mass index, baseline renal function, late referral, kidney disease, smoking status, comorbidity, peritoneal permeability, center, state, organisms, and antibiotic regimen. OUTCOMES & MEASUREMENTS Polymicrobial peritonitis occurrence, relapse, hospitalization, catheter removal, hemodialysis transfer, and death. RESULTS 359 episodes of polymicrobial peritonitis occurred in 324 individuals, representing 10% of all peritonitis episodes during 6,002 patient-years. The organisms isolated included mixed Gram-positive and Gram-negative organisms (41%), pure Gram-negative organisms (22%), pure Gram-positive organisms (25%), and mixed bacteria and fungi (13%). There were no significant independent predictors of polymicrobial peritonitis except for the presence of chronic lung disease. Compared with single-organism infections, polymicrobial peritonitis was associated with higher rates of hospitalization (83% vs 68%; P < 0.001), catheter removal (43% vs 19%; P < 0.001), permanent hemodialysis transfer (38% vs 15%; P < 0.001), and death (4% vs 2%; P = 0.03). Isolation of fungus or Gram-negative bacteria was the primary predictor of adverse clinical outcomes. Pure Gram-positive peritonitis had the best clinical outcomes. Patients who had their catheters removed >1 week after polymicrobial peritonitis onset were significantly more likely to be permanently transferred to hemodialysis therapy than those who had earlier catheter removal (92% vs 81%; P = 0.05). LIMITATIONS Limited covariate adjustment. Residual confounding and coding bias could not be excluded. CONCLUSIONS Polymicrobial peritonitis can be treated successfully using antibiotics alone without catheter removal in most cases, particularly when only Gram-positive organisms are isolated. Isolation of Gram-negative bacteria (with or without Gram-positive bacteria) or fungi carries a worse prognosis and generally should be treated with early catheter removal and appropriate antimicrobial therapy.
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Barraclough K, Hawley CM, McDonald SP, Brown FG, Rosman JB, Wiggins KJ, Bannister KM, Johnson DW. Corynebacterium peritonitis in Australian peritoneal dialysis patients: predictors, treatment and outcomes in 82 cases. Nephrol Dial Transplant 2009; 24:3834-9. [DOI: 10.1093/ndt/gfp322] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Al-Allak A, Jones R, Stiff R, Dharmasena D, Morris-Stiff G. Long-term outcome of continuous ambulatory peritoneal dialysis (CAPD) peritonitis: surgery can be avoided. Ann R Coll Surg Engl 2008; 91:118-22. [PMID: 19102818 DOI: 10.1308/003588409x359088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Continuous ambulatory peritoneal dialysis (CAPD) has become the preferred method of home dialysis for patients with end-stage renal failure. Peritonitis is a common and serious complication and requires prompt diagnosis and treatment. The aim of this study was to assess what proportion of patients with CAPD peritonitis that required surgical intervention for on-going sepsis or for peritonitis-related bowel obstruction. PATIENTS AND METHODS All patients presenting with a first episode of CAPD peritonitis during the 5-year period from 1994-1998 were identified from a prospectively maintained database. Data collected included patient demographics, details of peritonitis episodes and their treatment, and details of any surgical intervention undertaken. RESULTS A total of 500 episodes were identified in 168 patients of whom 162 had complete follow-up representing 488 peritonitis episodes. Sixty-three patients experienced one episode of peritonitis, 33 two episodes, 20 had three episodes, and 46 had more than three episodes. None of the patients underwent surgery either primarily or for complications of the infective episode. A total of 465 episodes were due to a single organism (95%) and the remainder were due to multiple organisms (5%). The most common causative organisms were Gram-positive cocci (308 episodes; 71%) followed by Gram-negative bacilli (106 episodes; 24%). In 55 patients (34%), the same organism was implicated in consecutive admissions. Patients with autosomal dominant polycystic kidney disease (ADPKD), whilst accounting for 12 of 169 (7%) patients in the cohort, experienced 23 of 125 (18.4%) episodes of peritonitis by Gram-negative cocci. Such infections were seen in 8 of 12 (66.7%) ADPKD patients and accounted for 23 of 40 (57.5%) infections experienced by the ADPKD patients. CONCLUSIONS Whilst CAPD peritonitis is a common problem in the renal failure population, with almost 100 episodes per year, it would appear that most episodes can be managed using intraperitoneal antibiotics without the need for surgical intervention.
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Affiliation(s)
- A Al-Allak
- Department of Surgery, Princess of Wales Hospital, Bridgend, UK
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Abstract
In this short review we highlight the diagnostic challenge presented by surgical peritonitis in peritoneal dialysis patients, giving attention to etiology, clinical presentation, diagnosis, and management. Despite improvements in medical imaging and a reduction in overall rates of peritonitis in peritoneal dialysis, the mortality of surgical peritonitis has not changed in recent years and remains a challenge for the clinical team.
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Affiliation(s)
- Badri M. Shrestha
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, United Kingdom
| | - Peter Brown
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, United Kingdom
| | - Martin Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, United Kingdom
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Yang CY, Chen TW, Lin YP, Lin CC, Ng YY, Yang WC, Chen JY. Determinants of Catheter Loss following Continuous Ambulatory Peritoneal Dialysis Peritonitis. Perit Dial Int 2008. [DOI: 10.1177/089686080802800410] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Few patients are able to resume peritoneal dialysis (PD) therapy after an episode of peritonitis that requires catheter removal. PD catheter loss is therefore regarded as an important index of patient morbidity. The aim of the present study was to evaluate factors influencing catheter loss in patients suffering from continuous ambulatory PD (CAPD) peritonitis. Patients and Methods We retrospectively reviewed 579 episodes of CAPD peritonitis from 1999 to 2006 in a tertiary-care referral hospital. Demographic, biochemical, and microbiological characteristics were recorded. Episodes resulting in PD catheter removal ( n = 68; 12%) were compared by both univariate and multivariate analyses with those in which PD catheters were preserved. Results The incidence of PD catheter loss increased as the number of organisms cultured increased ( p = 0.001). Also, PD catheter removal was more likely to occur after peritonitis episodes with low serum albumin level ( p = 0.004), those with long duration of PD effluent leukocyte count remaining above 100/μL ( p < 0.001), those with concomitant tunnel infection ( p < 0.001), those with concomitant exit-site infection ( p = 0.005), and those with presence of catastrophic intra-abdominal visceral events ( p < 0.001). Duration on PD preceding the peritonitis episode was of borderline significance ( p = 0.080). On the contrary, initial PD effluent leukocyte count and serum level of C-reactive protein were not predictive of PD catheter loss. Micro-organisms of the Enterobacteriaceae family were the major pathogens responsible for PD catheter loss following polymicrobial peritonitis. Furthermore, we found that there was no association between polymicrobial peritonitis and the catastrophic intra-abdominal visceral event, although both resulted in a greater incidence of PD catheter loss. Among the single-organism group in our population, the microbiological determinants of PD catheter loss included fungi ( p < 0.001), anaerobes ( p = 0.018), and Pseudomonas sp (borderline significance: p = 0.095). Conclusion PD catheter loss as a consequence of peritonitis is related primarily to hypoalbuminemia, longer duration of PD effluent leukocyte count remaining above 100/μL, the etiologic source of the infection, and the organism causing the infection. Peritonitis associated with concomitant tunnel or exit-site infections and abdominal catastrophes were more likely to proceed to PD catheter loss. The microbiological determinants of PD catheter loss in the present study included polymicrobial infections caused by Enterobacteriaceae as well as monomicrobial pseudomonal, anaerobic, and fungal infections.
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Affiliation(s)
- Chih-Yu Yang
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
| | - Tzen-Wen Chen
- Division of Nephrology, Department of Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yao-Ping Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
| | - Yee-Yung Ng
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
| | - Wu-Chang Yang
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
| | - Jinn-Yang Chen
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
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Faber MD, Yee J. Diagnosis and management of enteric disease and abdominal catastrophe in peritoneal dialysis patients with peritonitis. Adv Chronic Kidney Dis 2006; 13:271-9. [PMID: 16815232 DOI: 10.1053/j.ackd.2006.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Peritoneal dialysis (PD)-associated peritonitis rates have decreased significantly in recent years, especially Staphylococcus epidermidis and Staphylococcus aureus infections. Rates of gram-negative, polymicrobial, and fungal peritonitis have remained steady. The reported mortality of gram-negative and polymicrobial peritonitis varies widely (4%-50%). Most likely, the reason for this variability is that prognosis depends on the underlying etiology more than the specific microorganisms isolated. Gram-negative, polymicrobial, and fungal infection have variable association with documented visceral disease, and the highest mortality occurs in reports with the highest prevalence of intra-abdominal pathology. The odds ratio of death in PD patients with documented abdominal catastrophe and peritonitis is reported to be 20:1 compared with all other causes. Further reductions in PD-associated peritonitis mortality are likely to depend on earlier diagnosis and better management of intra-abdominal pathology. Presentation with hypotension, sepsis, lactic acidosis, and/or elevation of peritoneal fluid amylase should raise immediate concern for "surgical" peritonitis. Suspicion for visceral disease should also be high in patients with gram-negative, polymicrobial, and fungal infection or those who fail to improve rapidly as judged by clinical signs and symptoms, cell counts, and repeat cultures. Nonlocalizing physical examination and negative or nonspecific results of abdominal computed tomography do not rule out serious intra-abdominal disease. Immediate initiation of broad antibiotic coverage including for anaerobic infection is indicated when bowel pathology is suspected. Urgent surgical consultation, with active discussion and participation by the nephrologist, is advisable when visceral pathology is suspected and the patient is unstable or fails to improve rapidly.
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Affiliation(s)
- Mark D Faber
- Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI 48202, USA.
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Szeto CC, Leung CB, Chow KM, Kwan BCH, Law MC, Wang AYM, Lui SF, Li PKT. Change in bacterial aetiology of peritoneal dialysis-related peritonitis over 10 years: experience from a centre in South-East Asia. Clin Microbiol Infect 2005; 11:837-9. [PMID: 16153259 PMCID: PMC7128646 DOI: 10.1111/j.1469-0691.2005.01222.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study reviewed 1787 episodes of peritoneal dialysis (PD)-related peritonitis in 544 patients between 1994 and 2003. The overall rate of peritonitis was 0.68 episodes/year of PD, but decreased from 1.10 to 0.46 episodes/year between 1994 and 2003. The incidence of peritonitis caused by coagulase-negative staphylococci declined between 1994 and 1998 from 0.21 to 0.06 episodes/year of PD, coinciding with a reduction in the use of spike PD sets. There was a 60.1% response rate to antibiotics throughout the period, but the percentage of cases that required modification of the initial empirical antibiotic regimen rose from 13.6% to 58.7%, indicating that treatment should be individualised.
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Affiliation(s)
- C-C Szeto
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
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Laurain C, Durand PY, Albert M, Weber M, Kessler M, Chanliau J, Dailloux M. [Infection peritonitis in patients undergoing continuous ambulatory peritoneal dialysis: microbiological review during an four-year period]. ACTA ACUST UNITED AC 2004; 52:575-8. [PMID: 15596305 DOI: 10.1016/j.patbio.2004.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2004] [Accepted: 07/07/2004] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to analyse the microbiological characteristics of infectious peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. This study was conducted at the CHU Nancy from 1999 to 2002. The diagnosis of peritonitis was based on cloudy peritoneal effluent (>100 cells per mm(3)) with an elevated leukocyte count (>50%), on isolation of bacteria or fungi and on symptoms such as abdominal discomfort or pain. The majority of infections associated with continuous ambulatory peritoneal dialysis were caused by Gram-positive bacteria (68%), Gram-negative bacteria (31%), and Candida (1%). The coagulase-negative staphylococci were the most common cause of peritonitis. The antibiotic sensitivity of species corresponded to community-acquired isolation.
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Affiliation(s)
- C Laurain
- Laboratoire de bactériologie, Vandoeuvre-lès-Nancy, France
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Szeto CC, Wong TYH, Chow KM, Leung CB, Li PKT. The clinical course of culture-negative peritonitis complicating peritoneal dialysis. Am J Kidney Dis 2003; 42:567-74. [PMID: 12955686 DOI: 10.1016/s0272-6386(03)00790-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Culture-negative peritonitis is a serious complication in peritoneal dialysis patients. METHODS We studied all consecutive episodes of culture-negative peritonitis in our unit from 1995 to 2001. We identified 1,182 episodes of peritonitis recorded; 212 episodes in 149 patients had negative culture results. RESULTS The overall primary response rate was 67.5%, and the complete cure rate was 37.7%. In 95 episodes (44.8%), technical problems during the collection of dialysis effluent were suspected. There was a history of antibiotic therapy within 30 days before the onset in 56 episodes (26.4%). Recent antibiotic therapy was associated with a lower primary response rate (31 of 56 versus 113 of 156 episodes; P = 0.019) and lower complete cure rate (12 of 56 versus 68 of 156 episodes; P = 0.003). Furthermore, a history of peritonitis from 31 to 120 days before the onset also was associated with a lower complete cure rate (P = 0.001). Multivariate analysis showed that recent peritonitis was the only independent predictor of treatment failure (odds ratio, 2.87; 95% confidence interval, 1.56 to 5.29). CONCLUSION Most of the culture-negative peritonitis could be explained by recent antibiotic therapy or technical problems during dialysate culture. Recent peritonitis and antibiotic therapy are associated with a poor treatment response. Early Tenckhoff catheter removal is recommended in this group of patients.
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Affiliation(s)
- Cheuk-Chun Szeto
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China People's Republic of China.
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