Effluent lipopolysaccharide is a prompt marker of peritoneal dialysis-related gram-negative peritonitis

2020 ◽  
Vol 40 (5) ◽  
pp. 455-461
Author(s):  
Hao Yan ◽  
Dahua Ma ◽  
Shuang Yang ◽  
Zhaohui Ni ◽  
Wei Fang
Keyword(s):  
Peritoneal Dialysis ◽  
Roc Analysis ◽  
Operating Characteristic ◽  
Leukocyte Count ◽  
The Other ◽  
Cutoff Value ◽  
Gram Negative ◽  
Lower Blood ◽  
Blood Leukocyte ◽  
Culture Negative

Background: To investigate the value of effluent lipopolysaccharide (LPS) for early detection of gram-negative peritonitis (GNP) in peritoneal dialysis (PD) patients. Methods: PD-related peritonitis episodes occurring between January 2016 and December 2018 were included in the study. Effluent LPS and the other infectious parameters were measured at peritonitis presentation, and peritonitis was categorized as GNP, non-GNP, and culture-negative peritonitis. Receiver operating characteristic (ROC) analysis was employed to evaluate the efficacy of effluent LPS to distinguish GNP. Results: A total of 161 peritonitis episodes were analyzed, including 49 GNP episodes and 82 non-GNP episodes. In contrast with non-GNP, GNP presented with higher effluent leukocyte count (3236 (1497–6144) vs. 1904 (679–4071) cell mm−3, p = 0.008), increased effluent LPS (1.552 (0.502–2.500) vs. 0.016 (0.010–0.030) EU mL−1, p < 0.001), lower blood leukocyte count (9.95 ± 3.18 vs. 11.56 ± 4.37 × 109 L−1, p = 0.017), greater neutrophil predominance (87.1 ± 4.6% vs. 83.4 ± 7.7%, p = 0.001), and greater “procalcitonin” (PCT, 4.90 (2.20–12.60) vs. 1.00 (0.51–4.07) µg L−1, p < 0.001). It took 5.2 ± 3.1 h to report the results of effluent LPS. Effluent LPS cutoff value of >0.035 EU mL−1 showed an area under the ROC curve of 0.972 (95% CI 0.951–0.994, p < 0.001) in differentiating GNP from non-GNP with a sensitivity of 100% and a specificity of 80.5%, and its joint utilization with PCT further increased the specificity (91.4%) to discriminate GNP. Conclusions: PD effluent LPS could be an applicable early marker of gram-negative organism-related peritonitis in PD patients.

scholarly journals The Effect of Exit-Site Antibacterial Honey versus Nasal Mupirocin Prophylaxis on the Microbiology and Outcomes of Peritoneal Dialysis-Associated Peritonitis and Exit-Site Infections: A Sub-Study of the Honeypot Trial

2015 ◽  
Vol 35 (7) ◽  
pp. 712-721 ◽  
Author(s):  
Lei Zhang ◽  
Sunil V. Badve ◽  
Elaine M. Pascoe ◽  
Elaine Beller ◽  
Alan Cass ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Site Infection ◽  
Control Groups ◽  
Exit Site ◽  
Exit Site Infection ◽  
Gram Negative ◽  
Nasal Mupirocin ◽  
And Control ◽  
Technique Failure ◽  
Culture Negative

Background The HONEYPOT study recently reported that daily exit-site application of antibacterial honey was not superior to nasal mupirocin prophylaxis for preventing overall peritoneal dialysis (PD)-related infection. This paper reports a secondary outcome analysis of the HONEYPOT study with respect to exit-site infection (ESI) and peritonitis microbiology, infectious hospitalization and technique failure. Methods A total of 371 PD patients were randomized to daily exit-site application of antibacterial honey plus usual exit-site care ( N = 186) or intranasal mupirocin prophylaxis (in nasal Staphylococcus aureus carriers only) plus usual exit-site care (control, N = 185). Groups were compared on rates of organism-specific ESI and peritonitis, peritonitis-and infection-associated hospitalization, and technique failure (PD withdrawal). Results The mean peritonitis rates in the honey and control groups were 0.41 (95% confidence interval [CI] 0.32 – 0.50) and 0.41 (95% CI 0.33 – 0.49) episodes per patient-year, respectively (incidence rate ratio [IRR] 1.01, 95% CI 0.75 – 1.35). When specific causative organisms were examined, no differences were observed between the groups for gram-positive (IRR 0.99, 95% CI 0.66 – 1.49), gram-negative (IRR 0.71, 95% CI 0.39 – 1.29), culture-negative (IRR 2.01, 95% CI 0.91 – 4.42), or polymicrobial peritonitis (IRR 1.08, 95% CI 0.36 – 3.20). Exit-site infection rates were 0.37 (95% CI 0.28 – 0.45) and 0.33 (95% CI 0.26 – 0.40) episodes per patient-year for the honey and control groups, respectively (IRR 1.12, 95% CI 0.81 – 1.53). No significant differences were observed between the groups for gram-positive (IRR 1.10, 95% CI 0.70 – 1.72), gram-negative (IRR: 0.85, 95% CI 0.46 – 1.58), culture-negative (IRR 1.88, 95% CI 0.67 – 5.29), or polymicrobial ESI (IRR 1.00, 95% CI 0.40 – 2.54). Times to first peritonitis-associated and first infection-associated hospitalization were similar in the honey and control groups. The rates of technique failure (PD withdrawal) due to PD-related infection were not significantly different between the groups. Conclusion Compared with standard nasal mupirocin prophylaxis, daily topical exit-site application of antibacterial honey resulted in comparable rates of organism-specific peritonitis and ESI, infection-associated hospitalization, and infection-associated technique failure in PD patients.

scholarly journals Chemical peritonitis associated with intraperitoneal vancomycin: A case series

2021 ◽  
Vol 35 (2) ◽  
Author(s):  
José Silvano ◽  
◽  
Luciano Pereira ◽  
Ana Oliveira ◽  
Ana Beco ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Drug Withdrawal ◽  
Clinical Course ◽  
Leukocyte Count ◽  
Case Series ◽  
Aseptic Technique ◽  
Drug Challenge ◽  
Chemical Peritonitis ◽  
Culture Negative

Peritonitis is a serious complication in peritoneal dialysis, usually secondary to an infectious cause. Chemical peritonitis is rarer. No case exclusively attributed to vancomycin has been reported in the last 20 years. Data from 4 consecutive patients diagnosed with culture -negative peritonitis following administration of intraperitoneal vancomycin between May and June 2019 were retrospectively recorded. All patients were treated with 2 grams of intraperitoneal vancomycin after a break in aseptic technique and developed a cloudy effluent. No patient was previously known to be allergic to vancomycin. All had a clear dialysate before vancomycin. All developed an elevated leukocyte count in the dialysate. All had sterile cultures. All resumed a clear effluent with less <100 cells/μL after vancomycin cessation, and in two there were no further administrations. In one, a new drug challenge led to recrudescence of abdominal pain and reappearance of a cloudy sterile effluent. In another, vancomycin from a different lot was administrated 3 days after, no symptoms developed and dialysate cell count remained normal. The pathogenic mechanisms underlying chemical peritonitis are not fully known. The clinical course is typically benign. Management seems to be limited to drug withdrawal. If unrecognized, chemical peritonitis may ultimately lead to unnecessary catheter removal.

Microbiology and Outcomes of Peritonitis in Australian Peritoneal Dialysis Patients

2011 ◽  
Vol 31 (6) ◽  
pp. 651-662 ◽  
Author(s):  
Joanna R. Ghali ◽  
Kym M. Bannister ◽  
Fiona G. Brown ◽  
Johan B. Rosman ◽  
Kathryn J. Wiggins ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Single Agent ◽  
Catheter Removal ◽  
Fungal Peritonitis ◽  
Gram Negative ◽  
Single Organism ◽  
Transplant Registry ◽  
Anaerobic Infections ◽  
Gram Negative Organisms ◽  
Culture Negative

We analyzed data from the Australia and New Zealand Dialysis and Transplant Registry for 1 October 2003 to 31 December 2008 with the aim of describing the nature of peritonitis, therapies, and outcomes in patients on peritoneal dialysis (PD) in Australia.At least 1 episode of PD was observed in 6639 patients. The overall peritonitis rate was 0.60 episodes per patient–year (95% confidence interval: 0.59 to 0.62 episodes), with 6229 peritonitis episodes occurring in 3136 patients. Of those episodes, 13% were culture-negative, and 11% were polymicrobial. Gram-positive organisms were isolated in 53.4% of single-organism peritonitis episodes, and gram-negative organisms, in 23.6%. Mycobacterial and fungal peritonitis episodes were rare. Initial antibiotic therapy for most peritonitis episodes used 2 agents (most commonly vancomycin and an aminoglycoside); in 77.2% of episodes, therapy was subsequently changed to a single agent. Tenckhoff catheter removal was required in 20.4% of cases at a median of 6 days, and catheter removal was more common in fungal, mycobacterial, and anaerobic infections, with a median time to removal of 4 – 5 days. Peritonitis was the cause of death in 2.6% of patients. Transfer to hemodialysis and hospitalization were frequent outcomes of peritonitis. There was no relationship between center size and peritonitis rate. The peritonitis rate in Australia between 2003 and 2008 was higher than that reported in many other countries, with a particularly higher rate of gram-negative peritonitis.

Factors Contributing to the Differences in Peritonitis Rates between Centers and Regions

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 281-285 ◽  
Author(s):  
Andrea E. Stinghen ◽  
Pasqual Barretti ◽  
Roberto Pecoits–Filho
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Selection ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Gram Negative ◽  
Significant Percentage ◽  
Technological Advances ◽  
The World ◽  
Culture Negative

Despite improvements in connectology, peritoneal dialysis (PD)–associated peritonitis contributes significantly to morbidity and modality failure in patients maintained on PD therapy. A broad spectrum of organisms—gram-positive, gram-negative, fungal, anaerobic—are involved in this complication. In addition, a significant percentage of episodes involve polymicrobial and culture-negative infection. Technological advances are being developed to minimize the incidence of access-related complications such as peritonitis. Many traditional factors such as exit-site infection and poor technique have been already identified. In the present review, we discuss the geographic, patient selection, and clinical issues that can affect peritonitis rates in different areas of the world and in different centers in the same area.

scholarly journals Retrospective single-center analysis of the reasons and serious complications of peritoneal-related peritonitis in patients with end-stage renal disease undergoing peritoneal dialysis treatment

2018 ◽  
Vol 128 (3) ◽  
pp. 103-106
Author(s):  
Agnieszka M. Grzebalska ◽  
Anna Steć ◽  
Izabela Ławnicka ◽  
Anna Bednarek-Skublewska ◽  
Andrzej Książek
Keyword(s):  
Peritoneal Dialysis ◽  
Medical Center ◽  
Gram Positive ◽  
Dialysis Treatment ◽  
Gram Negative ◽  
Antibiotics Use ◽  
Stage Renal Disease ◽  
End Stage ◽  
Culture Negative ◽  
Dialysis Discontinuation

Abstract Introduction. Peritonitis is still a serious complication of peritoneal dialysis (PD). Consequences of peritonitis can be severe. The most severe are peritoneal dialysis discontinuation and patient’s death. In majority, peritonitis is bacterial in the origin. Mainly there is a gram-positive infection, less commonly gram-negative one. Some peritonitis are culture-negative, because of former antibiotics use. In minority, fungal, tuberculous or even viral peritonitis are observed. Aim. The aim of the present study is to analyze the number, origin and serious complications of peritoneal-related peritonitis cases found in our PD center. Material and methods. We performed a retrospective five-years evaluation of medical records. The total number of peritonitis episodes was 56 cases, underwent by 30 adult patients on chronic peritoneal dialysis. Peritonitis was diagnosed according to ISPD recommendations. Causes and serious complications of peritoneal-related peritonitis were analyzed in every single year. Etiology of peritonitis was classified on the basis of the result of effluent dialysate culture as: gram-positive, gram-negative and culture negative. Peritoneal dialysis discontinuation or patient’s death were defined as serious complications. Results. Among 56 cases of peritoneal-related peritonitis 44.6% were gram-positive, 26.8% gram-negative and 28.6% culture-negative. No fungal or tuberculosis peritonitis were found. Because of the peritonitis complications in the evaluated period, six patients discontinued peritoneal dialysis and were switched to hemodialysis (20%), two others died (6.7%). Conclusion. The further improvement in peritonitis’ causes identification and treatment is needed in order to reduce number of serious complications in our medical center.

scholarly journals Comparison between unilateral PNIF and rhinomanometry in healthy and obstructed noses

2014 ◽  
Vol 52 (1) ◽  
pp. 25-30
Author(s):  
G. Ottaviano ◽  
V. Lund ◽  
E. Nardello ◽  
B. Scarpa ◽  
G. Frasson ◽  
...  
Keyword(s):  
Nasal Obstruction ◽  
Healthy Subjects ◽  
Roc Analysis ◽  
Operating Characteristic ◽  
The Other ◽  
Nasal Patency ◽  
Easy Method ◽  
Nasal Blockage ◽  
Nasal Symptoms ◽  
Peak Nasal Inspiratory Flow

Aims: Peak Nasal Inspiratory Flow (PNIF) is an easy method to assess nasal patency. Normative unilateral PNIF data in adults have been proposed. The study purpose was to compare PNIF and unilateral PNIF values to total and unilateral nasal resistances measured by anterior active rhinomanometry (AAR) in subjects with and without nasal obstruction to see whether unilateral PNIFis sensitive to detect nasal obstruction. Methods and results: Measurements of PNIF, unilateral PNIF and AAR were performed in 125 volunteers. Seventy of them were healthy subjects not complaining of nasal symptoms and entered into the study as the'normal' group. The other group consisted of fifty-five symptomatic subjects.Data were analysed to show the correlation between PNIF, unilateral PNIF and nasal resistances. The ability of PNIF and AAR in predicting pathologies were compared by receiver operating characteristic (ROC) analysis indicating that PNIF and AAR have a similar and significant power to discriminate pathologic from healthy subjects. Conclusion: The measurement of unilateral PNIF could be a helpful method to support the diagnosis of nasal blockage also in those cases with single nostril obstruction, but, in cases of doubt, AAR should also be performed to improve diagnostic accuracy.

scholarly journals The Effects of Biocompatible Compared with Standard Peritoneal Dialysis Solutions on Peritonitis Microbiology, Treatment, and Outcomes: TheBalanz Trial

2012 ◽  
Vol 32 (5) ◽  
pp. 497-506 ◽  
Author(s):  
◽  
David W. Johnson ◽  
Fiona G. Brown ◽  
Margaret Clarke ◽  
Neil Boudville ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Controlled Trial ◽  
Statistical Significance ◽  
Geometric Mean ◽  
Secondary Outcome ◽  
Outcome Analysis ◽  
Control Group ◽  
Gram Positive ◽  
Gram Negative ◽  
Culture Negative

BackgroundA multicenter, multi-country randomized controlled trial (the balANZ study) recently reported that peritonitis rates significantly improved with the use of neutral-pH peritoneal dialysis (PD) solutions low in glucose degradation products (“biocompatible”) compared with standard solutions. The present paper reports a secondary outcome analysis of the balANZ trial with respect to peritonitis microbiology, treatment, and outcomes.MethodsAdult incident PD patients with residual renal function were randomized to receive either biocompatible or conventional (control) PD solutions for 2 years.ResultsThe safety population analysis for peritonitis included 91 patients in each group. The unadjusted geometric mean peritonitis rates in those groups were 0.30 [95% confidence interval (CI): 0.22 to 0.41] episodes per patient–year for the biocompatible group and 0.49 (95% CI: 0.39 to 0.62) episodes per patient–year for the control group [incidence rate ratio (IRR): 0.61; 95% CI: 0.41 to 0.90; p = 0.01]. When specific causative organisms were examined, the rates of culture-negative, gram-positive, gram-negative, and polymicrobial peritonitis episodes were not significantly different between the biocompatible and control groups, although the biocompatible group did experience a significantly lower rate of non-pseudomonal gram-negative peritonitis (IRR: 0.41; 95% CI: 0.18 to 0.92; p = 0.03). Initial empiric antibiotic regimens were comparable between the groups. Biocompatible fluid use did not significantly reduce the risk of peritonitis-associated hospitalization (adjusted odds ratio: 0.80; 95% CI: 0.48 to 1.34), but did result in a shorter median duration of peritonitis-associated hospitalization (6 days vs 11 days, p = 0.05). Peritonitis severity was more likely to be rated as mild in the biocompatible group (37% vs 10%, p = 0.001). Overall peritonitis-associated technique failures and peritonitis-related deaths were comparable in the two groups.ConclusionsBiocompatible PD fluid use was associated with a broad reduction in gram-positive, gram-negative, and culture-negative peritonitis that reached statistical significance for non-pseudomonal gram-negative organisms. Peritonitis hospitalization duration was shorter, and peritonitis severity was more commonly rated as mild in patients receiving biocompatible PD fluids, although other peritonitis outcomes were comparable between the groups.

scholarly journals Brevundimonas vesicularis Peritonitis in a Chronic Peritoneal Dialysis Patient

2021 ◽  
pp. 314-320
Author(s):  
Vijayakumar Paramasivam ◽  
Armando Paez ◽  
Ashish Verma ◽  
Daniel Landry ◽  
Gregory L. Braden
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Dialysis Patient ◽  
Chronic Peritoneal Dialysis ◽  
Peritoneal Catheter ◽  
Gram Negative ◽  
Initial Symptoms ◽  
Continuous Cycling ◽  
Amoxicillin Clavulanate ◽  
Brevundimonas Vesicularis ◽  
Culture Negative

Gram-negative peritonitis in chronic peritoneal dialysis patients is difficult to treat and may result in catheter loss. <i>Brevundimonas vesicularis</i> is a Gram-negative rod bacterium which rarely causes infections in humans. A 41-year-old male receiving continuous cycling peritoneal dialysis for 5 months developed culture-negative peritonitis. He failed initial empiric treatment with intraperitoneal vancomycin and levofloxacin and thereafter intravenous gentamicin. <i>B. vesicularis</i> resistant to levofloxacin was isolated from the peritoneal fluid 21 days after his initial symptoms. Despite treatment with intravenous ceftriaxone and oral amoxicillin-clavulanate, the infection persisted, which required removal of the peritoneal catheter in order to cure this infection. We describe the features of <i>B. vesicularis</i> infection in our patient and the rarely reported additional cases.

scholarly journals Value of gamma interferon enzyme-linked immunospot assay in the diagnosis of peritoneal dialysis-associated tuberculous peritonitis

2021 ◽  
Author(s):  
Qiuxia Fan ◽  
Xiaoyan Huang ◽  
Jieyun Zhang ◽  
Yinan Sun ◽  
Zuying Xiong ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Peripheral Blood ◽  
Peritoneal Fluid ◽  
Elispot Assay ◽  
Operating Characteristic ◽  
Mononuclear Cells ◽  
Tuberculous Peritonitis ◽  
Diagnostic Efficiency ◽  
Cutoff Value ◽  
Ifn Γ

Abstract Background Tuberculous peritonitis is the most common form of extrapulmonary tuberculosis infection in peritoneal dialysis patients. However, diagnosing tuberculous peritonitis quickly and early has always been a challenge for nephrologists. Mycobacterium tuberculosis antigen-specific gamma interferon enzyme-linked immunospot (IFN-γ ELISPOT) assay has been widely used in the clinical diagnosis of tuberculous pleurisy and peritonitis, but its use has not been reported for uremia. Methods This study mainly verified the feasibility of using the M. tuberculosis antigen-specific IFN-γ ELISPOT assay in the diagnosis of continuous ambulatory peritoneal dialysis (CAPD) patients with tuberculous peritonitis. Taking M. tuberculosis culture as the gold standard, the IFN-γ ELISPOT assay was used to analyze peripheral blood and peritoneal dialysis fluid of patients, and the receiver operating characteristic (ROC) curves in patients with tuberculous peritonitis (TBP) or non-tuberculous peritonitis (NTBP) were analyzed. Results The area under the receiver operating characteristic curve (AUC) was 0.927 (95% CI 0.816–1.000, P = 0.001) for the ELISPOT assay with peritoneal fluid mononuclear cells (PFMC), which was higher than that for the ELISPOT assay with peripheral blood mononuclear cells (PBMC) (0.825, 95% CI 0.6490–1.000, P = 0.011). The cutoff value for the diagnosis of TBP was 40 spot-forming cells (SFCs)/2 × 105 for the ELISPOT with PBMC, with a sensitivity of 55.6%, a specificity of 92.3%, and a diagnostic efficiency of 77.3%. The cutoff value for the diagnosis of TBP was 100 SFCs/2 × 105 for the ELISPOT on PFMC, with a sensitivity, specificity, and diagnostic efficiency 77.8%, 84.6%, and 81.8%, respectively. Parallel and serial testing algorithms appeared more accurate than single ELISPOT assays with PBMC, but ELISPOT assays with PFMC. Conclusions The IFN-γ release test can be used for the early diagnosis of CAPD-related TBP; compared with peripheral blood, peritoneal fluid may be a more effective and accurate medium to diagnose CAPD complicated with tuberculous peritonitis.

scholarly journals Coccidioidomycosis Complement Fixation Titer Trends in the Age of Antifungals

2018 ◽  
Vol 56 (12) ◽  
Author(s):  
Ian H. McHardy ◽  
Bao-Tran N. Dinh ◽  
Sarah Waldman ◽  
Ethan Stewart ◽  
Derek Bays ◽  
...  
Keyword(s):  
Roc Analysis ◽  
Operating Characteristic ◽  
Pulmonary Infection ◽  
Complement Fixation ◽  
Area Under The Curve ◽  
Cutoff Value ◽  
Kinetics And Dynamics ◽  
Life Threatening ◽  
Widespread Availability ◽  
Disseminated Disease

ABSTRACTCoccidioidomycosis is associated with a broad spectrum of illness severity, ranging from asymptomatic or self-limited pulmonary infection to life-threatening manifestations of disseminated disease. Serologic studies before the widespread availability of antifungals established current understanding of serologic kinetics and dynamics. Chart histories and complement fixation (CF) titer trends were analyzed for 434 antifungal-treated coccidioidomycosis patients, who were classified by three infectious disease physicians as having either pulmonary uncomplicated coccidioidomycosis (PUC) (n= 248), pulmonary chronic coccidioidomycosis (PCC) (n= 64), disseminated coccidioidomycosis (DC) not including meningitis (n= 86), or coccidioidal meningitis (CM) (n= 36). The median maximal CF titers were 1:4 for PUC patients, 1:24 for PCC patients, 1:128 for DC patients, and 1:32 for CM patients. Approximately 25.4% of PUC patients, 6.2% of PCC patients, 2.3% of DC patients, and 8.3% of CM patients did not develop detectable titers during the study period. Maximal titers developed a mean of 31 days (95% confidence interval [CI], 13 to 50 days) after initial serologic positivity, with no significant differences between groups. Serologic recurrence occurred in 9% of PUC patients, 36% of PCC patients, 50% of DC patients, and 52% of CM patients. Median titer improvement rates were 91 days/dilution for PUC patients, 112 days/dilution for PCC patients, 136 days/dilution for DC patients, and 146 days/dilution for CM patients. Receiver operating characteristic (ROC) analysis revealed that CF testing retains moderate classification value for disseminated infections (area under the curve [AUC], 0.82 [95% CI, 0.78 to 0.87]) and complicated infections (AUC, 0.82 [95% CI, 0.77 to 0.86]). A suitable cutoff value for complicated infections is ≥1:32. Findings update serologic parameters that are relevant for clinical assessment of coccidioidomycosis patients in the triazole era.

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