1
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Wang AH, Sawyer K, Shah AD. Persistent peritonitis in peritoneal dialysis: a comphrenesive review of recurrent, relapsing, refractory, and repeat peritonitis. Int Urol Nephrol 2024; 56:583-595. [PMID: 37563501 DOI: 10.1007/s11255-023-03731-w] [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: 05/16/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
Peritonitis is a major cause of morbidity and technique failure in patients receiving peritoneal dialysis. Complicated peritonitis that manifests as multiple or unresolving episodes is classified as refractory, recurrent, relapsing, or repeat peritonitis, and often possesses higher risk of technique failure and mortality as well as lower complete cure rates than primary or uncomplicated episodes. While these peritonitis subtypes affect a considerable portion of PD patients, details regarding their epidemiology, pathogenesis, diagnosis, clinical sequelae, and management have not yet been fully elucidated. Improved clinical awareness and understanding of complicated peritonitis subtypes is crucial to ensure optimal management for these patients; thus, we consolidate and report the pertinent findings of recent literature on these four entities.
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Affiliation(s)
- Aaron H Wang
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Kelsey Sawyer
- Health and Biomedical Library Services, Brown University, Providence, RI, USA
| | - Ankur D Shah
- Warren Alpert Medical School, Brown University, Providence, RI, USA.
- Division of Kidney Disease and Hypertension, Rhode Island Hospital, Warren Alpert Medical School at Brown University, 593 Eddy St, Providence, RI, 02903, USA.
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2
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Figueiredo AE, Bowes E, Chow JSF, Hurst H, Neumann JL, Walker R, Brunier G. PD effluent specimen collection: Your questions answered. Perit Dial Int 2023; 43:442-447. [PMID: 36475557 DOI: 10.1177/08968608221136389] [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] [Indexed: 12/12/2022] Open
Abstract
When a patient on peritoneal dialysis (PD) presents with suspected PD-related peritonitis (e.g. cloudy PD fluid and abdominal pain), one of the most important initial aspects of management is for the nephrology nurse/home dialysis nurse to collect PD effluent specimens for white blood cells count, Gram stain, culture and sensitivity for inspection and to send for laboratory testing before antibiotics are started. A review by seven members of the International Society for Peritoneal Dialysis (ISPD) Nursing Committee of all 133 questions posted to the ISPD website 'Questions about PD' over the last 4 years (January 2018-December 2021), revealed 97 posted by nephrology nurses from around the world. Of these 97 questions, 10 were noted to be related to best practices for PD effluent specimen collection. For our review, we focused on these 10 questions along with their responses by the members of the ISPD 'Ask The Experts Team', whereby existing best practice recommendations were considered, if available, relevant literature was cited and differences in international practice discussed. We revised the original responses for clarity and updated the references. We found that these 10 questions were quite varied but could be organised into four categories: how to collect PD effluent safely; how to proceed with PD effluent collection; how to collect PD effluent for assessment; and how to proceed with follow-up PD effluent collection after intraperitoneal antibiotics have been started. In general, we found that there was limited evidence in the PD literature to answer several of these 10 questions posted to the ISPD website 'Questions about PD' by nephrology nurses from around the world on this important clinical topic of best practices for PD effluent specimen collection. Some of these questions were also not addressed in the latest ISPD Peritonitis Guidelines. Moreover, when polling members of our ISPD Nursing Committee we found when answering a few of these questions, nursing practice varied within and among countries. We encourage PD nurses to conduct their own research on this important topic, focusing on areas where research evidence is lacking.
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Affiliation(s)
- Ana E Figueiredo
- School of Health Sciences and Life, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegra, Brazil
| | - Elaine Bowes
- Kings College Hospital, NHS Foundation Trust, London, UK
| | - Josephine Sau Fan Chow
- Clinical Innovation & Business Unit, South Western Sydney Local Health District, Australia
- Faculty of Nursing, University of Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Faculty of Medicine, Western Sydney University, Australia
| | - Helen Hurst
- The University of Manchester, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, UK
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3
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Phenotypic and Molecular Characterization of Nonfermenting Gram-Negative Bacilli Causing Peritonitis in Peritoneal Dialysis Patients. Pathogens 2022; 11:pathogens11020218. [PMID: 35215161 PMCID: PMC8879723 DOI: 10.3390/pathogens11020218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 11/23/2022] Open
Abstract
(1) Background: Peritonitis due to nonfermenting Gram-negative bacilli (NF-GNB) is a dramatic complication of peritoneal dialysis (PD) with bad outcomes. Previous studies of PD-related peritonitis due to Pseudomonas species have shown a low-resolution rate, without a high resistance rate to antipseudomonal antibiotics. This suggests that bacterial virulence factors can act and influence peritonitis evolution. This study aimed to describe the microbiological characteristics of NF-GNB causing PD-related peritonitis and analyze their influence on the outcome. (2) Methods: We analyze the 48 isolates from NF-GNB peritonitis, which were stored in our culture collection regarding bacterial resistance, biofilm, and other virulence factors’ production, and clonal profile. Additionally, we collected data on treatment and outcomes from patients’ clinical registers. (3) Results: The etiologies were species of Pseudomonas (50%), Acinetobacter (36%), and other NF-GNB (14%). There was a high (75%) proportion of biofilm producer lineages. The in vitro susceptibility rate of Pseudomonas spp. to amikacin, ciprofloxacin, and ceftazidime was significantly greater than that of Acinetobacter spp. and other species; however, there was a similar low-resolution rate (<45%) among the episodes attributable to them. Pseudomonas species have a polyclonal profile, while we found a clone of five multiresistant Acinetobacter baumannii over an 8-year interval (2000–2008), which suggest an origin from the healthcare environment. (4) Conclusions: We are not able to identify any predictor of outcome, but it is possible that biofilm and others virulence factors can act in concert and contribute to the bad outcome.
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4
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Szeto CC, Ng JKC, Wing-Shing Fung W, Chan GCK, Cheng PMS, Lai KB, Pang WF, Chow KM, Leung CB, Li PKT. Extended antibiotic therapy for the prevention of relapsing and recurrent peritonitis in peritoneal dialysis patients: a randomized controlled trial. Clin Kidney J 2021; 14:991-997. [PMID: 34840733 PMCID: PMC8612137 DOI: 10.1093/ckj/sfaa256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/16/2020] [Indexed: 01/13/2023] Open
Abstract
Background Relapsing and recurrent peritonitis episodes are major causes of technique failure in peritoneal dialysis (PD). We examined the efficacy of extended antibiotic therapy for the prevention of relapsing and recurrent peritonitis. Methods From February 2016 to November 2018 we recruited 254 PD patients who fulfilled the diagnostic criteria for PD peritonitis. They were randomized to a standard group, with the duration of intraperitoneal (IP) antibiotic treatment following the International Society for Peritoneal Dialysis (ISPD) guideline according to the causative microorganisms, and an extended group, with 1 extra week of IP antibiotics. The primary endpoint was relapsing, recurrent or repeat peritonitis episodes within 6 months. Results The primary endpoint developed in 36 and 29 patients of the extended and standard groups, respectively (28.3% versus 22.8%; P = 0.34). The rate of complete cure, without relapsing, recurrent or repeat peritonitis within 6 months, was 63.8 and 69.3% for the extended and standard groups, respectively (P = 0.35). Repeat peritonitis episodes were more common in the extended than the standard group (15.0% versus 5.5%; P = 0.013). Conclusions In patients with PD-related peritonitis, extending the antibiotic therapy for 1 extra week beyond the ISPD protocol should not be recommended. Extending the treatment does not reduce the risk of relapsing or recurrent peritonitis episodes but rather is associated with a higher risk of repeat peritonitis episodes.
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Affiliation(s)
- Cheuk-Chun Szeto
- Department of Medicine, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, China.,Department of Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, China.,Faculty of Medicine, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Shatin, China
| | - Jack Kit-Chung Ng
- Department of Medicine, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, China.,Department of Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, China
| | - Winston Wing-Shing Fung
- Department of Medicine, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, China.,Department of Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, China
| | - Gordon Chun-Kau Chan
- Department of Medicine, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, China.,Department of Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, China
| | - Phyllis Mei-Shan Cheng
- Department of Medicine, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, China.,Department of Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, China.,Faculty of Medicine, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Shatin, China
| | - Ka-Bik Lai
- Department of Medicine, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, China.,Department of Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, China.,Faculty of Medicine, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Shatin, China
| | - Wing-Fai Pang
- Department of Medicine, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, China.,Department of Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, China
| | - Kai-Ming Chow
- Department of Medicine, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, China.,Department of Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, China
| | - Chi-Bon Leung
- Department of Medicine, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, China.,Department of Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, China
| | - Philip Kam-Tao Li
- Department of Medicine, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, China.,Department of Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, China
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5
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Dos Santos ACML, Hernandes RT, Montelli AC, Monteiro ACM, Barbosa TA, Camargo CH, Ferreira AM, Mondelli AL, de Lourdes Ribeiro de Souza da Cunha M, Barretti P. Clinical and microbiological factors predicting outcomes of nonfermenting gram-negative bacilli peritonitis in peritoneal dialysis. Sci Rep 2021; 11:12248. [PMID: 34112833 PMCID: PMC8192548 DOI: 10.1038/s41598-021-91410-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 05/18/2021] [Indexed: 01/02/2023] Open
Abstract
Peritonitis due to gram-negative bacilli (GNB), particularly nonfermenting GNB (NF-GNB), is a serious complication of peritoneal dialysis with a low resolution rate. Beyond the patient’s condition, microbiological properties such as antimicrobial resistance, biofilm production and other virulence factors can explain the poor outcomes. This study aimed to evaluate the influence of patient condition, microbiological characteristics, including biofilm production, and treatment on peritonitis outcome. We reviewed the records of 62 index episodes caused by NF-GNB that occurred between 1997 and 2015 in our center. The etiologies were species of Pseudomonas (51.6%), Acinetobacter (32.2%), and other NF-GNB (16.1%). There was a high (72.9%) proportion of biofilm producer lineages. The in vitro susceptibility rate of Pseudomonas spp. to amikacin, ciprofloxacin, and ceftazidime was significantly greater than that of Acinetobacter spp. and other species; however, there was a similar low resolution rate (< 45%) among the episodes attributable to them. Preexisting exit-site infection was independently associated with nonresolution. No other factor, including biofilm production, was associated with the outcome. The higher in vitro susceptibility of Pseudomonas compared to other NF-GNB that presented a similar resolution rate suggests that bacterial virulence factors such as biofilms can act in concert, thereby worsening the outcome.
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Affiliation(s)
| | - Rodrigo Tavanelli Hernandes
- Biosciences Institute of Botucatu, Sao Paulo State University Julio de Mesquita Filho (UNESP), Botucatu, Brazil
| | - Augusto Cezar Montelli
- Biosciences Institute of Botucatu, Sao Paulo State University Julio de Mesquita Filho (UNESP), Botucatu, Brazil.,Botucatu Medical School, Sao Paulo State University Julio de Mesquita Filho (UNESP), Botucatu, Brazil
| | | | - Thais Alves Barbosa
- Biosciences Institute of Botucatu, Sao Paulo State University Julio de Mesquita Filho (UNESP), Botucatu, Brazil
| | | | | | - Alessandro Lia Mondelli
- Botucatu Medical School Clinics Hospital, Botucatu, Brazil.,Botucatu Medical School, Sao Paulo State University Julio de Mesquita Filho (UNESP), Botucatu, Brazil
| | | | - Pasqual Barretti
- Botucatu Medical School, Sao Paulo State University Julio de Mesquita Filho (UNESP), Botucatu, Brazil.
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6
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Time until treatment initiation is associated with catheter survival in peritoneal dialysis-related peritonitis. Sci Rep 2021; 11:6547. [PMID: 33753829 PMCID: PMC7985378 DOI: 10.1038/s41598-021-86071-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
For peritonitis, a serious complication of peritoneal dialysis (PD), we investigated the relation between duration from the sign (PD effluent abnormalities) to treatment with appropriate antibiotics (ST time) and catheter removal. For 62 PD hospital patients, data of PD-related peritonitis (n = 109) were collected retrospectively. We examined ST time and PD catheter removal times using univariate and multivariate analyses. The catheter removal rate in the delayed ST time group (≥ 24 h) was higher than that in early ST time group (< 24 h) (38 vs. 16%, p = 0.02). Concomitant tunnel infection and delayed ST time were associated with catheter removal (OR [95% CI] 32.3 [3.15–329] and 3.52 [1.11–11.1]). Rates of catheter removal and re-development of peritonitis within 1 month after starting treatment were higher in the delayed ST time group (p = 0.02). PD duration at peritonitis and the first peritonitis episode were associated with delayed ST time (1.02 [1.00–1.04] and 3.42 [1.09–10.7]). Significant association was found between PD catheter removal and the start of treatment more than 24 h after appearance of abnormal effluent. Education for patients about prompt visitation at the onset of peritonitis with long PD duration might improve outcomes.
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7
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Mirzaei R, Mohammadzadeh R, Alikhani MY, Shokri Moghadam M, Karampoor S, Kazemi S, Barfipoursalar A, Yousefimashouf R. The biofilm‐associated bacterial infections unrelated to indwelling devices. IUBMB Life 2020; 72:1271-1285. [DOI: 10.1002/iub.2266] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 02/23/2020] [Accepted: 02/24/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Rasoul Mirzaei
- Department of Microbiology, School of MedicineHamadan University of Medical Sciences Hamadan Iran
| | - Rokhsareh Mohammadzadeh
- Department of Microbiology, School of MedicineIran University of Medical Sciences Tehran Iran
| | - Mohammad Yousef Alikhani
- Department of Microbiology, School of MedicineHamadan University of Medical Sciences Hamadan Iran
| | | | - Sajad Karampoor
- Department of Virology, School of MedicineIran University of Medical Sciences Tehran Iran
| | - Sima Kazemi
- Department of Microbiology, School of MedicineHamadan University of Medical Sciences Hamadan Iran
| | | | - Rasoul Yousefimashouf
- Department of Microbiology, School of MedicineHamadan University of Medical Sciences Hamadan Iran
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8
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Haivas CD, Teitelbaum I. Eradication of Repeated Episodes of Coagulase-Negative Staphylococcus Peritonitis: a Multipronged Approach. Perit Dial Int 2019; 39:568-570. [PMID: 31690701 DOI: 10.3747/pdi.2019.00247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Bacterial peritonitis continues to be a significant cause of morbidity and mortality in patients undergoing peritoneal dialysis. Episodes of peritonitis due to coagulase-negative staphylococci (CNS) are especially prone to relapse or repeat, often culminating in catheter removal and technique failure. This pattern is thought to be associated with the production of a biofilm that offers protection against antimicrobials and the host defense systems. We report the successful eradication of repeated episodes of CNS peritonitis using an aggressive multipronged therapeutic approach combining several antibiotics and a thrombolytic agent.
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Affiliation(s)
- Claudia-Denise Haivas
- Department of Internal Medicine, Division of Renal Disease and Hypertension, University of Colorado/Anschutz Medical Center, Aurora, CO, USA
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9
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Szeto CC, Lo WK, Li PK. Clinical practice guidelines for the provision of renal service in Hong Kong: Peritoneal Dialysis. Nephrology (Carlton) 2019; 24 Suppl 1:27-40. [PMID: 30900337 DOI: 10.1111/nep.13505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Cheuk Chun Szeto
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and TherapeuticsPrince of Wales Hospital, The Chinese University of Hong Kong Shatin Hong Kong SAR, China
| | - Wai Kei Lo
- Department of MedicineTung Wah Hospital Hong Kong SAR, China
- Dialysis CentreGleneagles Hospital Hong Kong SAR, China
| | - Philip Kam‐Tao Li
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and TherapeuticsPrince of Wales Hospital, The Chinese University of Hong Kong Shatin Hong Kong SAR, China
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10
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A Case of Relapsing Peritoneal Dialysis-Associated Peritonitis by Dokdonella koreensis. Case Rep Infect Dis 2018; 2018:3820513. [PMID: 30073100 PMCID: PMC6057316 DOI: 10.1155/2018/3820513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/14/2018] [Indexed: 12/05/2022] Open
Abstract
Peritonitis is a common and serious complication of peritoneal dialysis (PD) with significant morbidity. We report the first case of relapsing Dokdonella koreensis peritonitis in a patient on peritoneal dialysis. A 63-year-old Chinese man, with history of renal failure on continuous ambulatory peritoneal dialysis, presented with cloudy peritoneal effluent and abdominal pain. There was no sign or symptom suggestive of exit-site/tunnel tract infection. Peritoneal effluent cultures yielded Dokdonella koreensis which was initially misidentified as Weeksella virosa and Brevundimonas species by the API® 20 NE and VITEK® 2 GN ID card, respectively. He was treated with intraperitoneal amikacin, but the infection relapsed within a few days upon completing each antibiotic course. He eventually required removal of catheter and was transferred to hemodialysis. Infections due to unusual organisms may pose a diagnostic issue as currently available commercial tests will not be able to identify them. There is a role for using 16S rRNA sequencing to help identify these organisms and guide patient management.
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11
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Tobudic S, Harrison N, Forstner C, Kussman M, Burgmann H. Effect of peritoneal dialysis fluids on activity of echinocandins against Candida spp. biofilm. Med Mycol 2018; 55:790-793. [PMID: 28204565 DOI: 10.1093/mmy/myw145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 12/28/2016] [Indexed: 11/13/2022] Open
Abstract
Peritoneal dialysis fluids (PDFs) impair microorganisms' growth, which may compromise effectivity of some antimicrobials. The purpose of this study was to investigate the effect of three different PDFs (lactate/bicarbonate-buffered Physioneal 40® with 2.2% glucose, lactate-buffered Nutrineal PD4® with 1.1% amino acid, and lactate-buffered Extraneal® with 7.5% icodextrin) on biofilm formation of four different Candida spp and antibiofilm effectiveness of anidulafungin, caspofungin and micafungin against Candida spp. biofilm in PDFs. All tested PDFs attained inhibitory effect on the biofilm formation but also reduced biofilm effectiveness of echinocandins against biofilm in PDFs was detected.
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Affiliation(s)
- Selma Tobudic
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Guertel 18-20, 1090 Vienna, Austria
| | - Nicole Harrison
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Guertel 18-20, 1090 Vienna, Austria
| | - Christina Forstner
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Guertel 18-20, 1090 Vienna, Austria.,Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, 07749 Jena, Germany
| | - Manuel Kussman
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Guertel 18-20, 1090 Vienna, Austria
| | - Heinz Burgmann
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Guertel 18-20, 1090 Vienna, Austria
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12
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The microbiome in chronic kidney disease patients undergoing hemodialysis and peritoneal dialysis. Pharmacol Res 2018; 130:143-151. [DOI: 10.1016/j.phrs.2018.02.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 12/19/2022]
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13
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Archaeal tetraether lipid coatings-A strategy for the development of membrane analog spacer systems for the site-specific functionalization of medical surfaces. Biointerphases 2018; 13:011004. [PMID: 29382205 DOI: 10.1116/1.5008816] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The primary goal of our investigation was the development of a versatile immobilization matrix based on archaeal tetraether lipids that meets the most important prerequisites to render an implant surface bioactive by binding specific functional groups or functional polymers with the necessary flexibility and an optimal spatial arrangement to be bioavailable. From this point of view, it appears obvious that numerous efforts made recently to avoid initial bacterial adhesion on catheter surfaces as an important prerequisite of material associated infection episodes have shown only a limited efficiency since the bioactive entities could not be presented in an optimal conformation and a stable density. A significant improvement of this situation can be achieved by highly specific biomimetic modifications of the catheter surfaces. The term "biomimetic" originates from the fact that specific archaeal tetraether lipids were introduced to form a membrane analog monomolecular spacer system, which (1) can be immobilized on nearly all solid surfaces and (2) chemically modified to present a tailor-made functionality in contact with aqueous media either to avoid or inhibit surface fouling or to equip any implant surface with the necessary chemical functionality to enable cell adhesion and tissue integration. Ultrathin films based on tetraether lipids isolated from archaea Thermoplasma acidophilum were used as a special biomimetic immobilization matrix on the surface of commercial medical silicon elastomers. A complete performance control of the membrane analog coatings was realized in addition to biofunctionality tests, including the proof of cytotoxicity and hemocompatibility according to DIN EN ISO 10993. In order to make sure that the developed immobilization matrix including the grafted functional groups are biocompatible under in vivo-conditions, specific animal tests were carried out to examine the in vivo-performance. It can be concluded that the tetraether lipid based coating systems on silicone have shown no signs of cytotoxicity and a good hemocompatibility. Moreover, no mutagenic effects, no irritation effects, and no sensitization effects could be demonstrated. After an implantation period of 28 days, no irregularities were found.
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14
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Montravers P, Tashk P, Tran Dinh A. Unmet needs in the management of intra-abdominal infections. Expert Rev Anti Infect Ther 2017; 15:839-850. [PMID: 28841096 DOI: 10.1080/14787210.2017.1372750] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Intra-abdominal infections remain a leading cause of death, morbidity and resource use in surgical wards and intensive care units. The growing complexity of their management has led to new paradigms and unresolved issues in anti-infective therapy described in the current review. Areas covered: We analyzed the literature, recent guidelines, and expert opinions published over the last decade. Expert commentary: Prospective randomized trials are difficult to perform and observational studies or database analyses should be encouraged. Epidemiologic and microbiologic reports should be promoted, especially in developing/resource-limited countries and in specific subpopulations such as children, older people and patients with underlying diseases. The diagnostic process, including imaging procedures, could be improved. The value of biomarkers for diagnosis, monitoring and discontinuation of therapy should be clarified and improved. New microbiologic techniques are needed to speed up the diagnostic process and to improve the adequacy of anti-infective therapy. Very little progress has been made in the detection of clinical failures. Many aspects of anti-infective management, both for bacteria and fungi, remain unresolved, such as the high inoculum, the type of microorganisms to be treated, the timing of therapy, the value of de-escalation, drug monitoring and duration of therapy. New antibiotics are expected.
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Affiliation(s)
- Philippe Montravers
- a Paris Diderot Sorbonne Cite University, and Anesthesiology and Critical Care Medicine , Bichat-Claude Bernard University Hospital, HUPNSV, AP-HP , Paris , France.,b INSERM UMR 1152 , Paris , France
| | - Parvine Tashk
- a Paris Diderot Sorbonne Cite University, and Anesthesiology and Critical Care Medicine , Bichat-Claude Bernard University Hospital, HUPNSV, AP-HP , Paris , France
| | - Alexy Tran Dinh
- a Paris Diderot Sorbonne Cite University, and Anesthesiology and Critical Care Medicine , Bichat-Claude Bernard University Hospital, HUPNSV, AP-HP , Paris , France.,c INSERM UMR 1148 , Paris , France
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15
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Teixeira L, Cadarso-Suárez C, Rodrigues A, Mendonça D. Time-dependent ROC methodology to evaluate the predictive accuracy of semiparametric multi-state models in the presence of competing risks: An application to peritoneal dialysis programme. STAT MODEL 2016. [DOI: 10.1177/1471082x16658731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Abstract: The evaluation of peritoneal dialysis (PD) programmes requires the use of statistical methods that suit the complexity of such programmes. Multi-state regression models taking competing risks into account are a good example of suitable approaches. In this work, multi-state structured additive regression (STAR) models combined with penalized splines (P-splines) are proposed to evaluate peritoneal dialysis programmes. These models are very flexible since they may consider smooth estimates of baseline transition intensities and the inclusion of time-varying and smooth covariate effects at each transition. A key issue in survival analysis is the quantification of the time-dependent predictive accuracy of a given regression model, which is typically assessed using receiver operating characteristic (ROC)’based methodologies. The main objective of the present study is to adapt the concept of time-dependent ROC curve, and their corresponding area under the curve (AUC), to a multi-state competing risks framework. All statistical methodologies discussed in this work were applied to PD survival data. Using a multi-state competing risks framework, this study explored the effects of major clinical covariates on survival such as age, sex, diabetes and previous renal replacement therapy. Such multi-state model was composed of one transient state (peritonitis) and several absorbing states (death, transfer to haemodialysis and renal transplantation). The application of STAR models combined with time-dependent ROC curves revealed important conclusions not previously reported in the nephrology literature when using standard statistical methodologies. For practical application, all the statistical methods proposed in this article were implemented in R and we wrote and made available a script named as NestedCompRisks.
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Affiliation(s)
- Laetitia Teixeira
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- ISPUP-EPIUnit, University of Porto, Porto, Portugal
| | - Carmen Cadarso-Suárez
- Unit of Biostatistics, Department of Statistics and Operations Research, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Anabela Rodrigues
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- Nephrology Department, CHP-Hospital Geral de Santo António, Porto, Portugal
| | - Denisa Mendonça
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- ISPUP-EPIUnit, University of Porto, Porto, Portugal
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Deciphering the Contribution of Biofilm to the Pathogenesis of Peritoneal Dialysis Infections: Characterization and Microbial Behaviour on Dialysis Fluids. PLoS One 2016; 11:e0157870. [PMID: 27336367 PMCID: PMC4918928 DOI: 10.1371/journal.pone.0157870] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/06/2016] [Indexed: 12/20/2022] Open
Abstract
Infections are major complications in peritoneal dialysis (PD) with a multifactorial etiology that comprises patient, microbial and dialytic factors. This study aimed at investigating the contribution of microbial biofilms on PD catheters to recalcitrant infections and their interplay with PD related-factors. A prospective observational study was performed on 47 patients attending Centro Hospitalar of Porto and Vila Nova de Gaia/Espinho to whom the catheter was removed due to infectious (n = 16) and non-infectious causes (n = 31). Microbial density on the catheter was assessed by culture methods and the isolated microorganisms identified by matrix-assisted laser desorption/ionization time-of-flight intact cell mass spectrometry. The effect of conventional and three biocompatible PD solutions on 16 Coagulase Negative Staphylococci (CNS) and 10 Pseudomonas aeruginosa strains planktonic growth and biofilm formation was evaluated. Cultures were positive in 87.5% of the catheters removed due infectious and 90.3% removed due to non-infectious causes. However, microbial yields were higher on the cuffs of catheters removed due to infection vs. non-infection. Staphylococci (CNS and Staphylococcus aureus) and P. aeruginosa were the predominant species: 32% and 20% in the infection and 43.3% and 22.7% in the non-infection group, respectively. In general, PD solutions had a detrimental effect on planktonic CNS and P. aeruginosa strains growth. All strains formed biofilms in the presence of PD solutions. The solutions had a more detrimental effect on P. aeruginosa than CNS strains. No major differences were observed between conventional and biocompatible solutions, although in icodextrin solution biofilm biomass was lower than in bicarbonate/lactate solution. Overall, we show that microbial biofilm is universal in PD catheters with the subclinical menace of Staphylococci and P. aeruginosa. Cuffs colonization may significantly contribute to infection. PD solutions differentially impact microbial species. This knowledge is important for the development of infection diagnosis, treatment and preventive strategies.
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Percival SL, Vuotto C, Donelli G, Lipsky BA. Biofilms and Wounds: An Identification Algorithm and Potential Treatment Options. Adv Wound Care (New Rochelle) 2015; 4:389-397. [PMID: 26155381 DOI: 10.1089/wound.2014.0574] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 08/04/2014] [Indexed: 01/22/2023] Open
Abstract
Significance: The presence of a "pathogenic" or "highly virulent" biofilm is a fundamental risk factor that prevents a chronic wound from healing and increases the risk of the wound becoming clinically infected. There is presently no unequivocal gold standard method available for clinicians to confirm the presence of biofilms in a wound. Thus, to help support clinician practice, we devised an algorithm intended to demonstrate evidence of the presence of a biofilm in a wound to assist with wound management. Recent Advances: A variety of histological and microscopic methods applied to tissue biopsies are currently the most informative techniques available for demonstrating the presence of generic (not classified as pathogenic or commensal) biofilms and the effect they are having in promoting inflammation and downregulating cellular functions. Critical Issues: Even as we rely on microscopic techniques to visualize biofilms, they are entities which are patchy and dispersed rather than confluent, particularly on biotic surfaces. Consequently, detection of biofilms by microscopic techniques alone can lead to frequent false-negative results. Furthermore, visual identification using the naked eye of a pathogenic biofilm on a macroscopic level on the wound will not be possible, unlike with biofilms on abiotic surfaces. Future Direction: Lacking specific biomarkers to demonstrate microscopic, nonconfluent, virulent biofilms in wounds, the present focus on biofilm research should be placed on changing clinical practice. This is best done by utilizing an anti-biofilm toolbox approach, rather than speculating on unscientific approaches to identifying biofilms, with or without staining, in wounds with the naked eye. The approach to controlling biofilm should include initial wound cleansing, periodic debridement, followed by the application of appropriate antimicrobial wound dressings. This approach appears to be effective in removing pathogenic biofilms.
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Affiliation(s)
- Steven L. Percival
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
- Surface Science Research Centre, University of Liverpool, Liverpool, United Kingdom
- Scapa Healthcare, Manchester, United Kingdom
| | - Claudia Vuotto
- Microbial Biofilm Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy
| | | | - Benjamin A. Lipsky
- Division of Medical Sciences, University of Oxford, Oxford, United Kingdom
- Department of Medicine (Infectious Diseases) University of Geneva, Geneva, Switzerland
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Vuotto C, Donelli G. Anaerobes in Biofilm-Based Healthcare-Associated Infections. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 830:97-112. [DOI: 10.1007/978-3-319-11038-7_6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Rodrigues A, Maciel M, Santos C, Machado D, Sampaio J, Lima N, Carvalho MJ, Cabrita A, Martins M. Peritoneal dialysis infections: an opportunity for improvement. Am J Infect Control 2014; 42:1016-8. [PMID: 25179339 DOI: 10.1016/j.ajic.2014.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 05/29/2014] [Accepted: 05/30/2014] [Indexed: 10/24/2022]
Abstract
Peritoneal dialysis (PD) catheter-associated infections remain a challenging cause of technique failure. Patient training and preventive measures are key elements in the management of infection rates. Twenty-seven of the 167 PD catheter transfer sets analyzed (19%) yielded a positive microbial culture (58% gram-negative bacteria). These results show that subclinical contamination, particularly from environmental gram-negative bacteria, is a potential hazard, indicating the need for a protocol for regular transfer set changes.
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