Continuous ambulatory peritoneal dialysis peritonitis: Microbiology and outcomes

Adhesion of Klebsiella oxytoca to bladder or lung epithelial cells is promoted by the presence of other opportunistic pathogens

The intestinal and respiratory tracts of healthy individuals serve as habitats for a diverse array of microorganisms, among which Klebsiella oxytoca holds significance as a causative agent in numerous community- and hospital-acquired infections, often manifesting in polymicrobial contexts. In specific circumstances, K. oxytoca, alongside other constituents of the gut microbiota, undergoes translocation to distinct physiological niches. In these new environments, it engages in close interactions with other microbial community members. As this interaction may progress to co-infection where the virulence of involved pathogens may be promoted and enhance disease severity, we investigated how K. oxytoca affects the adhesion of commonly co-isolated bacteria and vice versa during co-incubation of different biotic and abiotic surfaces. Co-incubation was beneficial for the adhesion of at least one of the two co-cultured strains. K. oxytoca enhanced the adhesion of other enterobacteria strains to polystyrene and adhered more efficiently to bladder or lung epithelial cell lines in the presence of most enterobacteria strains and S. aureus. This effect was accompanied by bacterial coaggregation mediated by carbohydrate-protein interactions occurring between bacteria. These interactions occur only in sessile, but not planktonic populations, and depend on the features of the surface. The data are of particular importance for the risk assessment of the urinary and respiratory tract infections caused by K. oxytoca, including those device-associated. In this paper, we present the first report on K. oxytoca ability to acquire increased adhesive capacities on epithelial cells through interactions with common causal agents of urinary and respiratory tract infections.

Persistent peritonitis in peritoneal dialysis: a comphrenesive review of recurrent, relapsing, refractory, and repeat peritonitis

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.

The prophylactic omentectomy procedure in reducing the complication rate of continuous ambulatory peritoneal dialysis in pediatric: A systematic review and meta-analysis

INTRODUCTION

The role of the omentectomy procedure on Continuous Ambulatory Peritoneal Dialysis (CAPD) catheter placement in pediatric patients has been differently evaluated in the literature, with some studies showing improvement while others showing no difference. Our study aims to define the advantages of omentectomy compared to a procedure without omentectomy.

METHODS

The literature searching in online databases (PubMed/MEDLINE, Cochrane Library, EMBASE, Scopus, and ClinicalTrial.gov) following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, has been registered on PROSPERO (CRD42023412846). The protocol was performed through April 2023 and focused on pediatric patients treated with an omentectomy procedure and related complications. The risk of bias in each study was assessed using the risk of bias for the non-randomized control trials (ROBINS-I). The effect estimates were extracted as risk ratios with 95% confidence intervals (CI). The heterogeneity of the studies was considered as high heterogeneity if I2 values above 50% or p < 0.05.

RESULTS

In the total of 676 articles identified in the database searching for screening, nine studies with 775 patients met the criteria for inclusion. The omentectomy procedure significantly showed a lower incidence of catheter obstruction compared to the control group, (OR 0.24 [95% CI, 0.12-0.49], p < 0.0001, I2 = 0%). Moreover, omentectomy demonstrated a similar trend in the rate of removal or reinsertion of the catheter with high heterogeneity, OR 0.25 [95% CI, 0.12-0.51), p = 0.0002, I2 = 70%).

CONCLUSIONS

The omentectomy procedure showed a lower incidence of catheter obstruction and complications leading to removal or reinsertion of the catheter.

Microbial Profile, Peritoneal Fluid White Blood Cell Count, and Outcome of Peritoneal Dialysis-Related Peritonitis at Indonesian Tertiary Hospital

Introduction

Peritonitis caused by peritoneal dialysis (PD) remains a common complication of continuous ambulatory PD (CAPD). The purpose of this study is to determine the microbial profile in CAPD-related peritonitis, the optimal cutoff of white blood cell (WBC) count, and the percentage of polymorphonuclear (PMN) in CAPD fluid in the prediction of CAPD-related peritonitis, together with the outcome of CAPD-related peritonitis at an Indonesian tertiary hospital. This is a retrospective cohort study of CAPD-related peritonitis patients at Indonesian tertiary hospitals from November 2020 to October 2022.

Methods

Patients with suspected CAPD-related peritonitis who were tested for CAPD fluid culture and WBC count in CAPD fluid were eligible for this study. Patient's diagnosis and outcome obtained from medical records. Differences in clinical outcomes by category of microorganisms were analyzed with Fisher exact test. The Mann-Whitney test and receiver operating characteristic curve were used to determine optimal WBC and PMN cutoff.

Results

This study included 58 patients and 102 episodes of CAPD-related peritonitis. CAPD-related peritonitis was caused by 29.4% Gram-negative bacteria, 21.5% Gram-positive bacteria, 7.8% fungi, and 6.9% polymicrobial bacteria. CAPD fluid WBC count >79 cells/μL and PMN percentage >50% had a sensitivity of 76.4% and a specificity of 92.9% in predicting CAPD-related peritonitis. There was a significant difference in outcome between Gram-negative and Gram-positive bacterial peritonitis.

Conclusions

It is critical to understand the microbial profile in CAPD-related peritonitis. Lower WBC count cutoff points in CAPD fluids may improve sensitivity in predicting CAPD-related peritonitis.

Multidrug-resistant organism-peritoneal dialysis associated peritonitis: clinical and microbiological features and risk factors of treatment failure

Background

Multidrug-resistant (MDR) bacterial infection causes difficulty in the therapy of peritoneal dialysis-associated peritonitis (PDAP); however, there are few studies on multidrug-resistant organism (MDRO)-PDAP. In view of growing concerns about MDRO-PDAP, the aim of this study was to investigate the clinical features, risk factors of treatment failure, and causative pathogens of MDRO-PDAP.

Methods

In total, 318 patients who underwent PD between 2013 and 2019 were included in this multicenter retrospective study. Clinical features, patient outcomes, factors related to treatment failure, and microbiological profiles associated with MDRO-PDAP were analyzed and risk factors for treatment failure associated with MDR-Escherichia coli (E. coli) were further discussed.

Results

Of 1,155 peritonitis episodes, 146 eligible episodes of MDRO-PDAP, which occurred in 87 patients, were screened. There was no significant difference in the composition ratio of MDRO-PDAP between 2013-2016 and 2017-2019 (p > 0.05). E. coli was the most prevalent MDRO-PDAP isolate, with high sensitivity to meropenem (96.0%) and piperacillin/tazobactam (89.1%). Staphylococcus aureus was the second most common isolate and was susceptible to vancomycin (100%) and linezolid (100%). Compared to non-multidrug-resistant organism-PDAP, MDRO-PDAP was associated with a lower cure rate (66.4% vs. 85.5%), higher relapse rate (16.4% vs. 8.0%), and higher treatment failure rate (17.1% vs.6.5%). Dialysis age [odds ratio (OR): 1.034, 95% confidence interval (CI): 1.016-1.052, p < 0.001] and >2 previous peritonitis episodes (OR: 3.400, 95% CI: 1.014-11.400, p = 0.047) were independently associated with treatment failure. Furthermore, longer dialysis age (OR: 1.033, 95% CI: 1.003-1.064, p = 0.031) and lower blood albumin level (OR: 0.834, 95% CI: 0.700-0.993, p = 0.041) increased the risk of therapeutic failure for MDR-E. coli infection.

Conclusion

The proportion of MDRO-PDAP has remained high in recent years. MDRO infection is more likely to result in worse outcomes. Dialysis age and previous multiple peritonitis infections were significantly associated with treatment failure. Treatment should be promptly individualized based on local empirical antibiotic and drug sensitivity analyses.

Spectrum of Complications of Patients with Chronic Kidney Disease on Maintenance Continuous Ambulatory Peritoneal Dialysis: An Experience of Tertiary Nephrology Center in Najaf City-Iraq

BACKGROUND: Chronic kidney disease (CKD), also called chronic kidney failure, is described as gradual loss of kidney function. CKD can progress to end-stage kidney failure, which is fatal without artificial filtering (dialysis) or kidney transplant. Peritoneal dialysis (PD) has a widespread renal replacement therapy with great acceptance because of simplicity, flexibility, and independence. AIM: The aim of this study was to evaluate the complications of continuous ambulatory PD (CAPD) in patients with CKD. METHODS: A cross-sectional study, involved 140 patients, aged between 18 and 80 years old and suffered from CKD under maintenance CAPD in the dialysis unit of the renal center. All data regarding the sociodemographic profile of the patient, vitals, etiological diagnosis, frequency and duration of dialysis, and dialysis-related complications were taken. RESULTS: In the current study, there is a significant difference in the distribution of complications among gender where the female patients had a higher incidence of both infectious and non-infectious complications. The study also reported that there is much lower rate of complications among patients on laparoscope operation in compared with the open operation. In addition, patients with open abdomen PD developed the complications earlier than those with laparoscope maintenance CAPD. CONCLUSION: Peritoneal infection is the most prevalent complication among the other complications in the current study. There is much lower rate of complications among patients on PD in compared with hemodialysis and on laparoscope in compared with the open operation.

Opportunistic peritonitis in peritoneal dialysis: The example of Paracoccus yeei

Paracoccus yeei, a Gram-negative coccobacillus, is an emergent opportunistic pathogen. It originates from soil and water. VITEK and MALDI-TOF are used for identification. There are few reports of peritoneal dialysis peritonitis. Its presentation is usually indolent. It can be successfully treated with several antibiotics: β-lactams, aminoglycosides, without removing the catheter.