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PubMed1991

Effect of bile on growth, peritoneal absorption, and blood clearance of Escherichia coli in E coli peritonitis.

The effect of intraperitoneal bile on growth, peritoneal absorption, and clearance of Escherichia coli was determined in E coli peritonitis in the rat. In E coli peritonitis, intraperitoneal bacterial counts gradually decreased, whereas they increased (after 2 hours) with subsequent development of bacteremia in E coli plus bile peritonitis. After an intraperitoneal injection of labeled bacteria, blood radioactivity was only initially lower in E coli plus bile peritonitis compared with E coli peritonitis. Clearance from blood was lower in E coli plus bile peritonitis than in E coli peritonitis. Organ localization was similar in E coli peritonitis and E coli plus bile peritonitis with decreased splenic, increased pulmonary, and unchanged hepatic uptakes compared with controls. Impaired peritoneal absorption of bacteria, together with impaired local host defense, is likely to enhance the noxious effect of bile in E coli peritonitis.

Animals↗
PubMed1993

The epidemiology of peritonitis in acute peritoneal dialysis: a comparison between open- and closed-drainage systems.

We performed a prospective study to examine the epidemiology and microbiology of peritonitis complicating acute intermittent peritoneal dialysis (IPD) performed in an in-hospital setting for the management of acute and chronic renal failure and to see the effect of a closed-drainage system on altering the frequency and cause of peritonitis. Over a 15-month period, 79 patients were treated with acute IPD for a total of 136 treatments each ranging in length from 2 to 40 days (median, 4 days). The majority of cases had acute renal failure (ARF; 65%) and were treated in intensive care units (ICUs; 74%) with serious comorbid conditions (60%). About half were treated with a two-bag, ventable (open)-drainage system with unprotected spikes, and the other half were treated with a single-bag, spike-protected, closed-drainage system. There were 27 cases of peritonitis for a rate of 4.5 cases/100 patient-days at risk. About half were gram-positive infections; the remainder were gram-negative or mixed (25%) or Candida sp (25%). The use of a closed-drainage system reduced the incidence of system-related peritonitis from 3.6 to 1.5 cases/100 patient-days. There was a high rate of peritonitis in the first 48 hours of treatment, which fell to a low stable rate thereafter and remained so for up to 15 days of continuous IPD. The use of a closed-drainage system eliminated the early (< 48 hours) high rate of peritonitis and maintained a low constant rate of peritonitis throughout treatment. There was an association of ARF and severe comorbid disease with more virulent organisms (gram-negative, mixed, and Candida sp), which, in turn, were both associated with antecedent broad-spectrum antibiotic therapy. Random positive surveillance cultures showed a frequency distribution similar to that of peritonitis cases over the duration of treatment, but with less virulent organisms. Peritonitis in acute IPD occurs when large or repeated inocula of organisms from the prevailing flora overwhelm the peritoneal immune clearance mechanisms. Prolonged courses of broad-spectrum antibiotic therapy provide no protection, but shift the resulting infecting flora toward more virulent pathogens. A closed-drainage system provides one method to reduce the frequency of peritoneal contamination.

Adolescent↗
PubMed2001

Peritoneal washings are not predictive of occult peritoneal disease in patients with hilar cholangiocarcinoma.

BACKGROUND: Evaluation of peritoneal cytology provides valuable staging information in patients with gastric and pancreatic adenocarcinoma, but its usefulness in patients with extrahepatic cholangiocarcinoma is unclear. The aim of this study was to evaluate the predictive value of peritoneal cytology in patients with potentially resectable hilar cholangiocarcinoma. This study evaluated a possible association between positive peritoneal cytology and percutaneous transhepatic biliary drainage, which is commonly used in these patients and may result in peritoneal biliary leakage and peritoneal seeding. STUDY DESIGN: From October 1997 through June 2000 26 patients with hilar cholangiocarcinoma underwent staging laparoscopy immediately before planned open exploration and resection. Peritoneal washings were obtained during laparoscopic examination before any biopsies were taken. Cytologic analysis was performed using the Papanicolau technique. RESULTS: There were 18 men and 8 women, with a median age of 69 years (range 42 to 81 years). The most common presenting symptom was jaundice (n = 19). Previous biliary drainage was performed in 23 patients: 9 percutaneous and 14 endoscopic. Metastatic disease was suspected preoperatively in six patients, three to the liver, two to the peritoneum, and one to regional lymph nodes, all of which were confirmed at laparoscopy. Laparoscopy identified five additional patients with metastatic disease. Peritoneal cytology was positive for malignant cells in two patients, both of whom had gross peritoneal metastases. Nine other patients had metastatic disease to distant sites within the abdomen, but none had positive cytology. Overall, six patients had metastatic disease to the peritoneal cavity, only one of whom had undergone earlier percutaneous biliary drainage. CONCLUSIONS: Peritoneal cytology was not predictive of occult metastatic disease. Laparoscopic staging identified some patients with unresectable hilar cholangiocarcinoma, but analysis of peritoneal cytology provided no additional information. There was no association between percutaneous transhepatic biliary drainage and peritoneal tumor seeding.

Adult↗
PubMed2001

Clinical course of peritonitis due to Pseudomonas species complicating peritoneal dialysis: a review of 104 cases.

BACKGROUND: Peritonitis due to Pseudomonas species is a serious complication in continuous ambulatory peritoneal dialysis (CAPD) patients. The clinical course of peritonitis due to Pseudomonas complicating CAPD remains unclear. METHODS: All of the Pseudomonas species episodes of peritonitis in our dialysis unit were studied from 1995 to 1999. During this period, there were 859 episodes of peritonitis recorded, 113 of which were caused by the Pseudomonas species. Nine episodes were excluded because they were mixed growth. The remaining 104 episodes in 68 patients were reviewed. RESULTS: The underlying renal diagnosis and prevalence of comorbid conditions of the 68 patients were similar to those found in our entire dialysis population. There was a history of antibiotic therapy within 30 days of the onset of peritonitis due to the Pseudomonas species in 69 episodes (66.3%). In 47 episodes (45.2%) there was a concomitant exit site infection. The overall primary response rate was 60.6% and the complete cure rate was 22.1%. The presence of exit site infection was associated with a lower primary response rate (22 in 47 vs. 41 in 57 episodes, P < 0.01) and a lower complete cure rate (5 in 47 vs. 18 in 57 episodes, P < 0.02). The episodes that had received recent antibiotic therapy had a significantly lower complete cure rate than the de novo cases (8 in 69 vs. 15 in 35 episodes, P < 0.001). Episodes receiving third-generation cephalosporin as part of the initial antibiotic regimen had a significantly higher primary response rate than the ones that initially received aminoglycoside (54 in 81 episodes vs. 8 in 22 episodes, P < 0.05), but their complete cure rates were similar. Twenty-four cases failed to respond to antibiotics and the Tenckhoff catheter was removed. The chance of returning to CAPD was higher when the Tenckhoff catheter was removed on day 10 than on day 15 (9 in 14 cases vs. 5 in 10 cases), although the result was not statistically significant. The Tenckhoff catheter was removed and replaced at another site simultaneously in another 14 cases after the effluent cleared up. None of these patients had a relapse of peritonitis within three months. CONCLUSIONS: Recent antibiotic therapy is the major risk factor for peritonitis due to the Pseudomonas species. Exit site infection and recent antibiotic therapy are associated with poor therapeutic response to antibiotics. When the therapeutic response is suboptimal, early Tenckhoff catheter removal may help preserve the peritoneum for further peritoneal dialysis. Elective Tenckhoff catheter exchange after clearing up the peritoneal dialysis effluent may also reduce the likelihood of relapse. It is desirable to use third-generation cephalosporin in the initial antibiotic regimen for peritonitis treatment in localities with a high incidence of peritonitis due to the Pseudomonas species.

Adult↗
PubMed2003

Connective tissue growth factor and its regulation in the peritoneal cavity of peritoneal dialysis patients.

BACKGROUND: Connective tissue growth factor (CTGF) is a fibrogenic cytokine that is highly expressed in wound healing and fibrotic lesions. The role of transforming growth factor-beta (TGF-beta) in fibrosis is well documented, and the emerging understanding that its fibrogenic actions are mediated through CTGF has provided an attractive target molecule for the modulation of matrix overproduction in fibrotic disease. The involvement of CTGF in the pathogenesis of peritoneal membrane fibrosis in peritoneal dialysis (PD) patients has not been investigated, and so the aim of this study was to ascertain whether CTGF is produced in the peritoneal cavity of PD patients and to investigate its regulation by cytokines. METHODS: Reverse transcription-polymerase chain reaction (RT-PCR), Northern blotting, and Western blotting were used to study CTGF expression by cultured human peritoneal mesothelial cells (HPMC) from peritoneal dialysis patients. Western blotting was used to detect CTGF expression in spent peritoneal dialysate from patients with and without peritonitis. RESULTS: RT-PCR analysis demonstrated the expression of CTGF mRNA in cultured primay HPMCs isolated from spent peritoneal effluent. The production of the major 36 to 38 kD CTGF protein doublet by HPMC in addition to a 23 to 25 kD proteolytically processed form was confirmed by Western blotting. Several molecular weight forms of CTGF (18 to 38 kD) were also detected by Western blotting in peritoneal dialysate, with levels markedly elevated during episodes of peritonitis. Northern and Western blot analysis revealed that CTGF mRNA and protein production by HPMC was up-regulated by TGF-beta, with mRNA levels significantly increasing above the control (P < 0.01). In contrast, platelet-derived growth factor (PDGF), epidermal growth factor (EGF), and tumor necrosis factor-alpha (TNF-alpha) had no measurable effects on CTGF mRNA expression. CONCLUSION: These results are the first to demonstrate the production of CTGF by HPMC and its presence in the peritoneal cavity of PD patients. The marked increase in CTGF levels by factors implicated in the development of peritoneal membrane fibrosis suggests its involvement in the underlying pathophysiologic mechanism(s).

Base Sequence↗
PubMed2002

What's new in peritoneal dialysis: biocompatibility and continuous flow peritoneal dialysis.

PURPOSE OF REVIEW: This review examines recent developments in the understanding of the effect of conventional, bioincompatible peritoneal dialysis fluids on structural and functional changes in the peritoneal membrane. Emphasis is placed on the clinically relevant outcome of failure of long-term peritoneal dialysis. Therapeutic strategies to prevent technique failure, including the use of new peritoneal dialysis fluids and continuous flow peritoneal dialysis, are explored. RECENT FINDINGS: Long-term (greater than 6 months) exposure to new peritoneal dialysis fluids with physiologic pH, lower lactate concentrations, or lower concentrations of glucose degradation products results in improved leukocyte cytokine release, ultrafiltration, and mesothelial cell mass, respectively. Continuous flow peritoneal dialysis allows efficient small molecule removal using dialysate with lower glucose concentration and possibly less glucose degradation products. Recent technical advances include creation of a double-lumen peritoneal dialysis catheter, and methods of monitoring intra-abdominal pressure and ultrafiltration. SUMMARY: Though initial reports with biocompatible peritoneal dialysis fluids are promising, the efficacy of these new solutions in preventing long-term peritoneal dialysis failure is unproven. Conditions in which new peritoneal dialysis fluids may be beneficial are suggested. Continuous flow peritoneal dialysis requires substantial technical improvements before this technique can be widely accepted.

Biocompatible Materials↗
PubMed1999

Growth factors in continuous ambulatory peritoneal dialysis effluent. Their relation with peritoneal transport of small solutes.

Recent studies reveal conflicting results on the change of solute transfer with time on continuous ambulatory peritoneal dialysis (CAPD) and recurrent peritonitis. Herein, we performed a cross-sectional study of 76 patients on CAPD to examine their peritoneal permeability by measuring the dialysate to serum ratio of creatinine (D/P) and the mass transfer area coefficients of creatinine (MTACCr) or glucose (MTACGlu). Transforming growth factor-beta1 (TGF-beta1), platelet-derived growth factor (PDGF), and epidermal growth factor (EGF) were measured in the dialysate by ELISA. TGF-beta1 mRNA in peritoneal macrophages were determined by a quantitative polymerase chain reaction. We failed to observe any correlation between the duration on dialysis and the peritoneal permeability in those patients with no previous peritonitis. Frequency of peritonitis episode did not affect the MTACCr, MTACGlu, or D/P. The MTACCr correlated well with MTACGlu (r = 0.78, p = 0. 001) and with D/P (r = 0.98, p < 0.0001). No inverse correlation was demonstrated between dialysate PDGF or EGF and the peritoneal permeability. A positive correlation was demonstrated between the dialysate TGF-beta1 and MTACCr, MTACGlu or D/P (r = 0.64, 0.54, and 0.64 respectively, p < 0.001). The dialysate TGF-beta1 levels in patients with low D/P (</=0.5) were only half of that in patients with normal or high D/P (p = 0.0002). The dialysate levels of TGF-beta1 did not correlate with PDGF or EGF. These findings raise the possibility that, other than diffusion across the peritoneal membrane from circulation, there could also be an intrinsic production of TGF-beta1 by peritoneal cells in these CAPD patients. Our findings raise the speculation that TGF-beta1 in dialysate from stable CAPD patients may exert an inhibitory action to fibroblast. Such action of TGF-beta1 could reduce the risk of peritoneal sclerosis and hence, maintains a satisfactory peritoneal permeability to small solutes.

Biological Transport↗
PubMed2005

Histological and functional characteristics of peritoneal membrane in peritoneal sclerosis of PD patients.

BACKGROUND: Function and structure of peritoneal membrane (PM) are impaired on peritoneal dialysis (PD). Peritoneal sclerosis is a common finding in peritoneal biopsies (PB) of PD patients. The aim of this study was to examine the impact of peritoneal sclerosis on peritoneal function and clinical parameters in PD patients submitted to peritoneal biopsy. METHODS: A PB was performed on 31 PD patients during catheter removal due to malfunction or after drop-out from treatment. For each patient PM transport was evaluated by the last peritoneal equilibration test before PB. Each daily glucose load was calculated. Tissue was formalin-embedded and stained for histological and immunohistochemical studies. RESULTS: Patients with submesothelial sclerosis and those with impairment of submesothelial basement membrane and subendothelial vascular membrane were submitted to a larger daily glucose load. Peritoneal sclerosis > 50 microns was more frequent in high transporters, who were exposed to larger daily glucose load compared to medium-high transporters. Mesothelial loss is correlated to peritoneal sclerosis and vascular injuries. CONCLUSIONS: Peritoneal sclerosis is not constant in PD patients: it is related to the loss of mesothelium integrity, to the daily glucose load of PD treatment and to vascular injuries, but apparently not to the presence of inflammatory infiltrate. It remains a matter of debate how much the peritoneal sclerosis modifies the function of PM and how new more biocompatible PD solutions could reduce PM injury.

Actins↗
PubMed2003

Peritoneal dialysis fluid concentrations of linezolid in the treatment of vancomycin-resistant Enterococcus faecium peritonitis.

OBJECTIVE: To determine linezolid concentrations in peritoneal dialysis fluid after multiple oral doses of the drug in a 46-year-old man with vancomycin-resistant Enterococcus faecium peritonitis who was undergoing peritoneal dialysis. METHODS: After administration of oral linezolid 600 mg twice/day was started, peritoneal dialysis fluid was collected at the end of several 4- and 8-hour dwell times and submitted for analysis of linezolid concentration. Before linezolid therapy was begun, and immediately after several peritoneal dialysis exchanges, 30 ml of expended peritoneal dialysis fluid was collected in a sterile container and immediately frozen at -70 degrees C until analysis by high-performance liquid chromatography. RESULTS: Peritoneal dialysis concentrations of linezolid greater than 4 microg/ml were achieved after the first dose of linezolid and maintained after repeated doses. During the course of therapy, mean linezolid concentrations in peritoneal dialysis fluid tended to increase (mean 7.60 pg/ml, range 3.54-16.2 microg/ml). All assayed peritoneal dialysis samples demonstrated linezolid concentrations greater than 4 microg/ml at the end of 4- or 8-hour dwell times, except for one level after a missed dose on linezolid treatment day 3. Duration of dwell times did not appear to correlate with linezolid concentrations. CONCLUSION: In this patient, linezolid 600 mg twice/day penetrated into peritoneal dialysis fluid at or above the concentrations necessary to treat common gram-positive bacteria. Linezolid therapy is likely to have a role in peritoneal dialysis-associated peritonitis based on its antimicrobial activity, pharmacokinetic properties, ease of administration, and tolerability.

Acetamides↗
PubMed2004

Eosinophilic peritonitis in a patient with continuous ambulatory peritoneal dialysis (CAPD).

Eosinophilic peritonitis is defined as when there are more than 100 eosinophils present per milliliter of peritoneal effluent, of which eosinophils constitute more than 10% of its total WBC count. Most cases occur within the first 4 weeks of peritoneal catheter insertion and they usually have a benign and self-limited course. We report a patient of eosinophilic peritonitis that was successfully resolved without special treatment. An 84-year-old man with end stage renal disease secondary to diabetic nephropathy was admitted for dyspnea and poor oral intake. Allergic history was negative. and physical examination was unremarkable. Complete blood count showed a hemoglobin level of 11.1 g/dL, WBC count was 24,500/mm3 (neutrophil, 93%; lymphocyte, 5%; monocyte, 2%), platelet count was 216,000/mm3, serum BUN was 143 mg/dL, Cr was 5.7 mg/dL and albumin was 3.5 g/dL. Creatinine clearance was 5.4 mL/min. Three weeks after peritoneal catheter insertion, he was started on peritoneal dialysis with a 6-hour exchange of 2L 1.5% peritoneal dialysate. After nine days, he developed turbid peritoneal effluents with fever (38.4 degrees C), abdominal pain and tenderness. Dialysate WBC count was 180/mm3 (neutrophil, 20%; lymphocyte, 4%; eosinophil, 76% [eosinophil count: 136/mm3]). Cultures of peritoneal fluid showed no growth of aerobic or anaerobic bacteria, or of fungus. Continuous ambulatory peritoneal dialysis (CAPD) was commenced, and he was started on intraperitoneal ceftazidime (1.0 g/day) and cefazolin (1.0 g/day). After two weeksr, the dialysate had cleared up and clinical symptoms were improved. Dialysate WBC count decreased to 8/mm3 and eosinophils were not detected in peritoneal fluid. There was no recurrence of eosinophilic peritonitis on follow-up evaluation, but he died of sepsis and pneumonia fifteen weeks after admission.

Aged, 80 and over↗
PubMedDate not supplied

Effect of duration of chronic peritoneal dialysis therapy on the development of peritonitis.

OBJECTIVE: Long-term chronic peritoneal dialysis (CPD) therapy has been associated with alterations in peritoneal membrane structure and peritoneal macrophage function. We thus reviewed our experience with the development of peritonitis among patients maintained on CPD therapy for various time periods to determine if the spectrum of organisms, rates of peritonitis, and outcome changed with the duration of CPD therapy. SETTING AND PATIENTS: Patients maintained on CPD therapy in our out-patient unit in New Haven, Connecticut. DESIGN: Retrospective review of the charts of patients maintained on CPD therapy (HomeChoice Cycler or Ultrabag, Baxter, McGaw Park, IL, U.S.A.) between 1 January 1997 and 31 March 1998. These patients were divided into three groups: group 1, patients maintained on CPD therapy < or = 12 months; group 2, patients maintained on CPD therapy for 13-36 months; and group 3, patients maintained on CPD therapy for > or = 37 months. RESULTS: The study included 256 patients: 101 patients in group 1, 110 patients in group 2, and 45 patients in group 3. All groups of patients were similar in age. There were significantly fewer Caucasians and fewer males in group 3 in comparison to groups 1 and 2. The incidence of diabetes mellitus, coronary artery disease, and peripheral vascular disease was significantly lower among patients in group 3 in comparison to groups 1 and 2. There were 155 episodes of peritonitis during the study period for an overall rate of 1 episode in 18.7 patient-months. The overall, gram-positive, and gram-negative rates of peritonitis were not significantly different among the patients in groups 1, 2, and 3. There were more episodes of Staphylococcus aureus peritonitis among patients in group 3 in comparison to group 2 (1 episode in 59.6 vs 1 episode in 280.2 patient-months, respectively). Two weeks after the development of peritonitis, 94.6% of the patients in group 3 continued CPD therapy, while 79.4% of the patients in group 1 continued CPD therapy (p < 0.05). No patient in group 3 transferred to hemodialysis, while 10.3% and 8.2% of the patients in groups 1 and 2 transferred to hemodialysis (p < 0.05). The death rate 2 weeks after the onset of peritonitis was 10.3%, 9.8%, and 5.4% in groups 1, 2, and 3, respectively (p = NS). CONCLUSIONS: Despite the immunological and morphological changes that occur in the peritoneal cavity with increased time on CPD therapy, there was no difference in the overall, gram-positive, or gram-negative rates of peritonitis for patients maintained on CPD therapy for various time periods. Patients in group 3 continued CPD therapy more often than did patients in group 1. Patients in group 3 transferred to hemodialysis less often than did the remaining patients in the study period. The incidence of death was not significantly different for the three groups of patients.

Female↗
PubMedDate not supplied

Incidence of peritonitis in chronic peritoneal dialysis patients infused with intravenous iron dextran.

BACKGROUND: The Dialysis Outcomes Quality Initiative (DOQI) guidelines, published in 1997, emphasize the need for careful monitoring of iron stores and for provision of adequate iron replacement therapy to achieve target goals of hemoglobin concentration in end-stage renal disease (ESRD) patients, especially those treated with recombinant erythropoietin (rHuEPO). Intravenous iron dextran (IVID) therapy, which has long been used in hemodialysis patients, is increasingly being used in chronic peritoneal dialysis (CPD) patients. In 1997, we began using this form of iron therapy for our CPD patients. However, because considerable data exists to show a relationship between iron metabolism and acute infections, we questioned whether IVID infusion placed our patients at greater risk for peritonitis, the leading cause of death and patient drop-out from CPD therapy. OBJECTIVE: To evaluate the relationship between iron and infection, we studied episodes of peritonitis in CPD patients who were infused with IVID. DESIGN: In a retrospective study of adult CPD patients who received IVID during 1998, we investigated the occurrence of peritonitis episodes and the spectrum of causative organisms. Patients with a hemoglobin level of < 12.5 g/dL who also had a ferritin level < 100 ng/mL or a transferrin saturation level < 20% (or both) and who did not respond to oral iron therapy, were administered between 0.5 g and 1.0 g of IVID in an outpatient hospital setting. We calculated the expected and observed number of peritonitis episodes in these patients within 30, 60, and 90 days after infusion of IVID. RESULTS: During the study period, 56 patients received 77 doses of IVID, with 14 patients requiring 2 or more infusions. Of the 77 doses, 71 were given as a 1-g bolus. The IVID was well tolerated by all patients. Within 90 days of IVID administration, 14 patients developed peritonitis: 6 episodes occurred within 30 days, 7 episodes occurred between 31 and 60 days, and 1 episode occurred between 61 and 90 days after the IVID dosing. The peritonitis rate for patients not receiving IVID was 1 episode per 13.7 patient-months. Taking this rate as the "expected" rate, the expected number of episodes of peritonitis for the study population was 5.6 episodes within 30 days, 11.2 episodes within 60 days, and 16.8 episodes within 90 days following IVID administration. The difference between the expected and observed rates of peritonitis in patients who were dosed with IVID was not statistically different. The spectrum of organisms seen in the peritonitis episodes in the study population was not significantly different from that seen in the peritonitis episodes in our CPD unit population. CONCLUSIONS: There is evidence that IVID infusion therapy can improve anemia and reduce rHuEPO requirements in CPD patients, usually without adverse reaction and without exposing patients to an increased risk of peritonitis. More research is needed in the area of potential increased risk of infection in ESRD patients who are (1) infused with large doses of IVID, and (2) iron-overloaded.

Female↗
PubMed2002

[Clinical investigations of children with chronic renal failure and peritonitis treated with peritoneal dialysis].

UNLABELLED: Peritonitis and catheter-related infection are the most-common complications of peritoneal dialysis treatment. The aim of study was to analyse frequency causes, effectiveness of therapy and risk factors of peritonitis in patients treated with continuous peritoneal dialysis (CAPD). We described 13 patients aged 6-21 years, mean 12 years, who initiated CAPD between 1995 to 2000. The most-common primary cause of end-stage renal disease were chronic glomerulonephritis in 8 children, renal dysplasia in 3 children, hemolytic-uremic syndrome in 1 child and obstruction uropathy in 1 child. Peritonitis rate was 1 episode for 9 patient months. Staphylococcus aureus was the most-common infection factor. We performed exchange of catheter in 8 children. Causes of exchange were exit site infection, cuff excision, tunnel infection and peritonitis. Children were usually treated with two antibiotics for two weeks. Effect of treatment was better in these episodes treated longer than two weeks. As a risk factors of increasing peritonitis relapses we suggest immunosuppressive therapy, protein deficiency, catheter dislocation, not adequate education of patient family and chronic skin infections. We observed lower rate of peritonitis relapses in patients treated longer than two years on CAPD. CONCLUSIONS: 1. In patients with chronic renal failure treated with CAPD the preceding immunosupressive therapy increases the frequency of peritonitis. 2. More intensive treatment can cause decreasing frequency of peritonitis relapses. 3. Some risk factors increase the frequency of peritonitis relapses. 4. A better education of patient and his family decreases the frequency of peritonitis relapses.

Adolescent↗
PubMed2002

Peritonitis in acute peritoneal dialysis in a university hospital.

OBJECTIVE: Although acute peritoneal dialysis is a useful procedure, peritonitis is often a complication. When the patient is mainly at risk of peritonitis is controversial. The purpose of this study was to find the incidence time of peritonitis, the infecting microorganism, and risk factors. DESIGN: A retrospective study. PATIENTS: 118 cases of acute peritoneal dialysis in 93 patients were included in this study. METHOD: Data were collected from medical records. RESULTS: Overall, the peritonitis rate was 36.45 per cent. The peritonitis rate rose following the duration of dialysis from 11 per cent on the first day to 21 per cent on the third day, although the difference was not statistically significant. Gram-negative bacilli were predominant, at 81.6 per cent. Acinetobacter baumanii and Enterobacter cloacae were the two most common organisms (23.7 and 21.1% respectively). There was a significantly higher male to female ratio in the peritonitis group than the no-peritonitis group (3.33:1 and 1.2:1 respectively, p=0.028). CONCLUSION: There was a high peritonitis rate in acute peritoneal dialysis. The most common microorganisms were gram-negative bacilli, Acinetobacter baumanii and Enterobacter cloacae. The risk factor was male sex. Duration of dialysis of more than 2 days tended to increase the risk of peritonitis.

Adult↗
PubMed2002

Rapid diagnosis of Mycobacterium tuberculous peritonitis in two continuous ambulatory peritoneal dialysis patients, using DNA amplification by polymerase chain reaction.

Tuberculous peritonitis is not an uncommon cause of continuous ambulatory peritoneal dialysis (CAPD) peritonitis in endemic countries. The diagnosis is usually delayed because peritoneal fluid smears for acid-fast bacilli (AFB) are insensitive, and cultures for Mycobacterium tuberculosis require weeks. The present paper reports two cases of tuberculous CAPD peritonitis that were rapidly diagnosed using gene amplification for M. tuberculosis DNA complex by polymerase chain reaction with the commercial Amplicor M. tuberculosis nucleic acid amplification test (Roche Diagnostic Systems, Branchburg, NJ, U.S.A.). A 18-year-old man and a 50-year-old man, both on CAPD, developed culture-negative peritonitis. Empirical therapy with intraperitoneal vancomycin and gentamicin failed. Peritoneal fluid AFB smears were negative. In both patients, M. tuberculosis DNA complex was detected by nucleic acid amplification using the Amplicor test. Anti-tuberculosis treatment was unsuccessful and their catheters were removed. Six weeks later, their peritoneal fluid cultures isolated M. tuberculosis. The use of molecular techniques to assist in the diagnosis of pulmonary tuberculosis is well accepted. Little information exists regarding the use of molecular techniques in the diagnosis of tuberculous CAPD peritonitis. The diagnosis of tuberculous peritonitis in CAPD patients is frequently delayed and may cause increased morbidity and mortality. Molecular diagnosis of tuberculous peritonitis using nucleic acid amplification tests may allow more rapid diagnosis. Further studies are required to determine the sensitivity and specificity of the technique in CAPD patients with tuberculous peritonitis.

Adolescent↗
PubMed2001

[Effect of peritonitis pathomorphology on rabbit model in peritoneal dialysis].

The study about peritonitis rabbit model is rarely, although peritonitis have been considered mainly complication in peritoneal dialysis. Twelve New Zealand rabbit were divided into peritonitis group and control group. The peritonitis group rabbit were injected with the dialysate containing alive staphylococcus aureus and the control ones with 0.9% saline into the peritoneum. The pathomorphology changes of the peritonitis were observed. The results showed (1) There was proliferation and swollen of mesothelial cells, vessel dilation and infiltration of inflammation cells in the peritoneum in the peritonitis group; and no such changes in the control group. (2) The D/D0 glucose concentration in the dialysate of peritonitis group was lower than that of the control ones at any point except the 0 min (P < 0.01). (3) The ratio of Cr concentration in the dialysate to Cr concentration in the plasma in the peritnitis group was significantly higher than that of the control group (P < 0.05). (4) The WBC count in the dialysate of peritonitis group was obviously higher than that of the control group all points except 0. These results implied that after injection of alive staphylococcus aureus to the peritoneal cavity of New Zealand rabbit for 48 hours, the pathomorphology change was similar with the characteristics of peritonitis complicated with peritoneal dialysis in patient.

Animals↗
PubMedDate not supplied

Rapid diagnosis of peritonitis in peritoneal dialysis patients.

BACKGROUND: Peritonitis is the major complication of peritoneal dialysis (PD) and has acute morbidity and resources implications. Episodes of peritonitis are associated with higher risk of peritoneal membrane failure. Rapid diagnosis of peritonitis would allow early antibiotic commencement with potential benefits of reduced need for in-patient care and dialysis modality change. This study examined the utility of a rapid peritonitis diagnosis method (Periscreen). METHODS: This was a prospective study in a single unit and included all PD patients presenting with symptoms or signs of peritonitis over 12 months. In each clinical circumstance in which the diagnosis or exclusion of peritonitis was required and in follow-up peritonitis cases, PD fluid was sent for standard laboratory analysis but also tested using the Periscreen strip. The relationship between this rapid diagnostic strip and standard laboratory methods for determination of PD fluid neutrophil count was determined. RESULTS: This study found the Periscreen strip easy to use and interpret. All 17 episodes of peritonitis (defined by ISPD criteria) were detected and results of the strip correlated closely with the laboratory cell count. In this study sensitivity of the Periscreen was 100% and specificity was 98%, positive predictive value was 95.6% and negative predictive value was 100%. Results were equally good in glucose containing fluids and icodextrin. CONCLUSIONS: Periscreen is a sensitive, specific rapid tool for the presumptive diagnosis of peritonitis in PD patients used at the "point of care". Results correlated with the laboratory white cell count, a test that takes longer to perform. Widespread use in PD would aid in the early recognition and treatment of peritonitis.

Adult↗
PubMedDate not supplied

The impact of relapsing sterile icodextrin-associated peritonitis on peritoneal dialysis outcome.

BACKGROUND: The emphasis in peritoneal dialysis (PD) has shifted from a therapy with short-term goals to one of prolonging the life of the peritoneal membrane. Icodextrin (ICO), a starch-derived glucose polymer that is metabolized to maltose, is a valuable osmotic agent in the treatment of PD patients with defective ultrafiltration. However, ICO can cause sterile peritonitis. The manufacturer has recently withdrawn a series of batches of ICO solutions due to evidence of bacterial contamination (a bacterial cell wall breakdown, peptidoglycan). Some cases have been reported of culture-negative ICO-associated peritonitis which relapse on re-challenge. METHODS: We started to use ICO in chronic uremic PD patients in 1997. Ten patients out of 82 treated in our PD unit were exposed to ICO from 1997-2002. We registered 50 peritonitis episodes in this period: 34 were bacterial and 16 culture-negative. Among the 16 episodes of sterile peritonitis, 6 occurred in patients treated with ICO. Four of the 6 ICO treated patients experienced relapsing culture-negative episodes of peritonitis. We reviewed the records of the four patients. RESULTS: The first episodes of sterile ICO-associated peritonitis occurred between February-May 2002. These were clinically very mild and the only sign was abdominal discomfort and a cloudy dialysate containing a number of WBC/mm(3) ranging from 500-800. Cultures were negative. All the ICO solutions were from the batches withdrawn by the manufacturer. ICO (with new batches of solution) was re-introduced in all patients some weeks later to improve ultrafiltration. A new episode of sterile peritonitis occurred with the same characteristics as described above. Three of the four patients were re-challenged with new batches of ICO solution and again sterile peritonitis occurred. One patient was switched directly to hemodialysis (HD); the others were transferred to a program of automated PD including hypertonic glucose solutions. In 8 months all patients were switched to HD because of the failure of ultra-filtration. It is possible that the first episode of sterile peritonitis, associated with the use of an ICO batch suspected of having high peptidoglycan levels could have induced sensitization to ICO, which in turn could have been the cause of the relapse on re-challenge. CONCLUSIONS: The disappointing result of the relapsing culture-negative ICO-associated peritonitis in our patients was the unavoidable switch to HD, due to the inability of the hypertonic glucose solutions to ensure an adequate ultrafiltration. The moral of the story is that the pharmaceutical industry should market products that are more biocompatible and safer for chronic treatments such as PD.

Aged↗