scholarly journals Dialysate White Blood Cell Change after Initial Antibiotic Treatment Represented the Patterns of Response in Peritoneal Dialysis-Related Peritonitis

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Pichaya Tantiyavarong ◽  
Opas Traitanon ◽  
Piyatida Chuengsaman ◽  
Jayanton Patumanond ◽  
Adis Tasanarong
Keyword(s):  
Peritoneal Dialysis ◽  
Blood Cell ◽  
Cell Count ◽  
Antibiotic Treatment ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Early Response ◽  
Delayed Response ◽  
Blood Cell Count ◽  
Failure Patterns

Background. Patients with peritoneal dialysis-related peritonitis usually have different responses to initial antibiotic treatment. This study aimed to explore the patterns of response by using the changes of dialysate white blood cell count on the first five days of the initial antibiotic treatment.Materials and Methods. A retrospective cohort study was conducted. All peritoneal dialysis-related peritonitis episodes from January 2014 to December 2015 were reviewed. We categorized the patterns of antibiotic response into 3 groups: early response, delayed response, and failure group. The changes of dialysate white blood cell count for each pattern were determined by multilevel regression analysis.Results. There were 644 episodes in 455 patients: 378 (58.7%) of early response, 122 (18.9%) of delayed response, and 144 (22.3%) of failure episodes. The patterns of early, delayed, and failure groups were represented by the average rate reduction per day of dialysate WBC of 68.4%, 34.0%, and 14.2%, respectively (pvalue < 0.001 for all comparisons).Conclusion. Three patterns, which were categorized by types of responses, have variable rates of WBC declining. Clinicians should focus on the delayed response and failure patterns in order to make a decision whether to continue medical therapies or to aggressively remove the peritoneal catheter.

Patients with Early T-Cell Precursor (ETP) Acute Lymphoblastic Leukemia (ALL) Have High Levels of Minimal Residual Disease (MRD) at the End of induction—A Children's Oncology Group (COG) Study.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 9-9 ◽  
Author(s):  
Brent Wood ◽  
Stuart Winter ◽  
Kimberly Dunsmore ◽  
Elizabeth Raetz ◽  
Michael J. Borowitz ◽  
...  
Keyword(s):  
T Cell ◽  
High Risk ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Induction Therapy ◽  
Early Response ◽  
Response To Therapy ◽  
Blood Cell Count

Abstract Abstract 9 Current risk stratification algorithms in children with B-lineage ALL have facilitated the identification of subgroups with adverse outcomes that benefit from intensified therapy. However, many of the features that are highly prognostic of outcome in B-precursor ALL, such as the combination of age and white blood cell count (WBC) at diagnosis, have limited ability to predict outcome in T-ALL. In contrast, early response to induction therapy, as measured by bone marrow (BM) morphology at days 8, 15 or 29, and day 29 (end induction) BM MRD are highly predictive of outcome in both B-precursor and T-ALL. Coustan-Smith and colleagues (Lancet Oncology 10:147-156 2009) have recently identified a subset of children with ETP ALL that have an extremely high risk of induction failure or relapse. The ETP ALL blasts exhibit stem cell-like features as defined by the presence of antigens seen on early progenitors including CD117, CD34, HLA-DR and/or CD13/33, the absence of antigens seen on later stage immature T cells including CD1a and CD8, and decreased to absent expression of the early T cell antigen CD5. We analyzed patients enrolled in current generation COG ALL trials, including patients with B-precursor ALL treated on AALL0232 (high risk, n=2129) or AALL0331 (standard risk, n=3747), and 416 patients with T-ALL enrolled on AALL03B1. Clinical features including age, WBC, gender, and CNS status were compared between ETP-positive (n=25) and –negative (n=391) T-ALL patients. We also compared response to four weeks of induction therapy (prednisone, vincristine, PEG-asparaginase, and daunorubicin) as measured by day 15 and 29 BM morphology and day 29 BM MRD determined by flow cytometry. Twenty-five of 416 (6%) T-ALL patients had an ETP phenotype. The ETP-positive patients were older and presented with a lower white blood cell count than the ETP-negative patients (see Table). There was no difference in the gender distribution or the presence of CNS disease at diagnosis between the two groups. Strikingly, the ETP-positive patients had a dramatically inferior early response to therapy with 100% having ≥ 0.01% day 29 MRD (vs. 46% of ETP-negative T-ALL and 23.4% of precursor B-ALL) and 74% having ≥ 1% day 29 MRD (vs. 21% of ETP-negative T-ALL and 5% of precursor B-ALL). These results confirm the poor response of ETP T-ALL and suggest that novel treatment strategies are warranted in this patient subgroup. Disclosures: No relevant conflicts of interest to declare.

Association of white blood cell count with metabolic syndrome in patients undergoing peritoneal dialysis

Metabolism ◽  
2009 ◽  
Vol 58 (10) ◽  
pp. 1379-1385 ◽  
Author(s):  
Jung Tak Park ◽  
Tae Ik Chang ◽  
Dong Ki Kim ◽  
Hoon Young Choi ◽  
Jung Eun Lee ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Peritoneal Dialysis ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Blood Cell Count

scholarly journals Clinical Characteristics Associated with Antibiotic Treatment Failure for Tuboovarian Abscesses

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Huma Farid ◽  
Trevin C. Lau ◽  
Anatte E. Karmon ◽  
Aaron K. Styer
Keyword(s):  
Blood Cell ◽  
Treatment Failure ◽  
Cell Count ◽  
Antibiotic Treatment ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Clinical Characteristics ◽  
Maximum Diameter ◽  
Blood Cell Count ◽  
Parenteral Antibiotic

Objective. Although parenteral antibiotic treatment is a standard approach for tuboovarian abscesses, a significant proportion of patients fail therapy and require interventional radiology (IR) guided drainage. The objective of this study is to assess if specific clinical factors are associated with antibiotic treatment failure.Study Design. Retrospective medical record review of patients hospitalized for tuboovarian abscesses from 2001 through 2012 was performed. Clinical characteristics were compared for patients who underwent successful parenteral antibiotic treatment, failed antibiotic treatment necessitating subsequent IR drainage, initial drainage with concurrent antibiotics, and surgery.Results. One hundred thirteen patients admitted for inpatient treatment were identified. Sixty-one (54%) patients were treated with antibiotics alone. Within this group, 24.6% failed antibiotic treatment and required drainage. Mean white blood cell count (K/μL) (18.7±5.94versus13.9±5.12) (p=0.003), mean maximum diameter of tuboovarian abscess (cm) (6.8±2.9versus5.2±2.0) (p=0.03), and length of stay (days) (9.47±7.43versus4.59±2.4) (p=0.002) were significantly greater for patients who failed antibiotic treatment.Conclusions. Admission white blood cell count greater than 16 K/μL and abscess size greater than 5.18 cm are associated with antibiotic treatment failure. These factors may provide guidance for initial selection of IR guided drainage.

Clinical and Cost-Effectiveness of Outpatient Strategies for Management of Febrile Infants

PEDIATRICS ◽  
1992 ◽  
Vol 89 (6) ◽  
pp. 1135-1144
Author(s):  
Tracy A. Lieu ◽  
Marc N. Baskin ◽  
J. Sanford Schwartz ◽  
Gary R. Fleisher
Keyword(s):  
High Risk ◽  
Blood Cell ◽  
Cell Count ◽  
Lumbar Puncture ◽  
Antibiotic Treatment ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Clinical Judgment ◽  
Outpatient Management ◽  
Blood Cell Count

Young infants with fever are at risk for serious bacterial infection, but no consensus exists on the optimal approach to diagnosis and treatment. Although the traditional recommendation is always to perform all sepsis tests, including lumbar puncture, and administer intravenous (IV) antibiotics until culture results are negative, recent studies suggest administering intramuscular (IM) ceftriaxone with outpatient follow-up or using laboratory and clinical data to exclude low-risk patients from hospitalization, further testing, and antibiotic treatment. A decision analysis model was used to evaluate six strategies for the diagnosis and treatment of infants aged 28 to 90 days with temperature ≥38.0°C. Data from the literature, data from a 1991 study of 503 febrile infants, and direct, short-term costs from the Children's Hospital of Philadelphia were used as model inputs. The model was run for a hypothetical cohort of 100 000 febrile infants who did not require admission for focal infection or for other reasons that clearly necessitated admission. The model included six strategies: (1) no intervention; (2) all sepsis tests (lumbar puncture, blood culture, urine culture, white blood cell count, and urinalysis) followed by hospitalization and IV antibiotics for all infants; (3) all sepsis tests followed by IM ceftriaxone and outpatient management for most infants; (4) blood and urine cultures with white blood cell count and urinalysis followed by either lumbar puncture and IV antibiotics for high-risk infants or outpatient management without antibiotics for low-risk infants; (5) white blood cell count and urinalysis followed by either lumbar puncture, blood and urine cultures, and IV antibiotics for high-risk infants or outpatient management without antibiotics for low risk infants; and (6) clinical judgment followed by either all sepsis tests and IV antibiotics for high-risk infants or outpatient management without antibiotics for low-risk infants. The two "all sepsis tests" strategies prevented the most cases of death or neurologic impairment, 78% (when IV antibiotics were used) and 76% (when IM ceftriaxone was used) of all potential cases. The most cost-effective strategy was to use all sepsis tests followed by IM ceftriaxone for all patients without meningitis, at an incremental cost of only $3900 per sequela prevented relative to no intervention. Strategies under which only those patients selected as high-risk by laboratory criteria received antibiotic treatment were less effective but incurred lower rates of antibiotic complications. Clinical judgment alone was the least clinically effective and the second least cost-effective strategy. The model's results depended most on assumptions about the effectiveness of IM ceftriaxone, the sensitivity of the white blood cell count, and the sensitivity of clinical judgment in identifying young infants with serious bacterial infection. Combining all sepsis tests with IM ceftriaxone has superior clinical and cost-effectiveness compared with other strategies for managing febrile infants in this model. Strategies that use selective antibiotic treatment based on laboratory tests or clinical judgment are acceptable when the sensitivity of the criterion used is high, but they do not surpass strategies that combine all sepsis tests and antibiotic treatment until the criterion's sensitivity is greater than 96%.

scholarly journals Successful Treatment of Idiopathic Eosinophilic Peritonitis by Oral Corticosteroid Therapy in a Continuous Ambulatory Peritoneal Dialysis Patient

2015 ◽  
Vol 5 (2) ◽  
pp. 130-134 ◽  
Author(s):  
Yaowen Xu ◽  
Chenni Gao ◽  
Jing Xu ◽  
Nan Chen
Keyword(s):  
Peritoneal Dialysis ◽  
Blood Cell ◽  
Antibiotic Therapy ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Peritoneal Fluid ◽  
Oral Corticosteroid ◽  
Blood Cell Count ◽  
Peritoneal Dialysis Effluent

Eosinophilic peritonitis is a well-described complication of peritoneal dialysis and is often associated with either a reaction to the dialysis system constituent (tubing, sterilant or solution) or an underlying bacterial or fungal reaction. We report a case of eosinophilic peritonitis, which is treated by oral prednisone acetate therapy. A 43-year-old female patient developed end-stage renal disease and underwent continuous ambulatory peritoneal dialysis for 2.5 years. The patient received 2,000 ml of 1.5% dialysis solution (PD2) with three exchanges daily and 2,000 ml of 2.5% PDF overnight (PD2). She went to the consultation because of a constant turbid peritoneal dialysis effluent for 3 months without abdominal pain. Repeated peritoneal effluent samples showed an elevated white blood cell count of 500 cells/mm3, with 87% eosinophils. The peripheral blood test revealed a white blood cell count of 3.8 × 109/l, with 32.2% eosinophils. Etiology like bacterial and fungal infection was excluded by peritoneal fluid culture. Turbidness persisted in spite of diagnostic antibiotic treatment. Given the fact that we found a significant elevation of eosinophils in the peripheral blood and an absolute increase in the eosinophil count of >30/mm3 in dialysis fluid (up to 400/mm3 in our patient), obvious dialysate effluent turbidness, negative results of repeated peritoneal fluid cultures, inefficacy of antibiotic therapy, and negativity of serum tumor and immunological markers, we drew the conclusion that the patient had idiopathic eosinophilic peritonitis. Oral corticosteroid was administered at once (20 mg prednisone acetate daily), which was gradually weaned off and stopped over an 8-week period. Afterwards, the dialysis effluent became clear, and the cytological analysis showed that the white blood cell count decreased to 1 × 106/l, with no eosinophils. This case reminds us that the diagnosis of eosinophilic peritonitis should be considered when repeated cultures are always negative and the turbidness of peritoneal dialysis effluent persists in spite of an antibiotic therapy.

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