Case Of Bacterial Peritonitis Research Articles

TUNNELED LAPAROSCOPIC PERITONEAL DIALYSIS CATHETER AS A RESOURCE TECHNIQUE IN PERITONEAL DIALYSIS

Abstract INTRODUCTION Surgical approach to peritoneal dialysis (PD) catheters is the main step in achieving successful PD therapy. It is important to conduct a simple and safe procedure, with adequate visualization of the path and location of the catheter, to avoid discontinuation of PD. The tunneled laparoscopic PD catheter (TLPDC) is a reliable surgical alternative in patients who are candidates for PD. MATERIAL AND METHODS This is a retrospective and descriptive study that includes all the patients in whom TLPDC was placed from October 2019 to January 2021. The objective is to know the rate of functioning and evaluate the complications derived from the procedure. RESULTS TLPDC was placed in 7 patients with a mean age of 51.4 (7.7) years and a mean BMI of 26.6 (8.0) kg/m2. Rescue therapy was considered in 6 (85.7%) patients, after removal of a previous PD catheter. There was no case (0.0%) of displacement, being the adequate functioning rate of 85.7%. One (14.3%) case of bacterial peritonitis was diagnosed, resolved with conservative management, and early TLPDC dysfunction in another (14.3%) case, requiring laparoscopic revision on the eleventh postoperative day and its repositioning, with current suspicion of encapsulating peritonitis. CONCLUSIONS The TLPDC approach is a safe and simple technique, avoiding displacement of the catheter and, thus, a higher success rate. However, as a counterpoint, it requires general anesthesia to be performed. Furthermore, an adequate selection of a suitable candidate for PD is necessary to ensure the success of the procedure.

A Case Report of Bacterial Peritonitis Caused by MBL-Producing Citrobacter werkmanii in Peritoneal Dialysis

Infections caused by Enterobacterales have become more difficult to treat due to increasing antibiotic resistance, in particular, in the case of production of carbapenemases. Bacterial peritonitis is a common complication of peritoneal dialysis, being Citrobacter spp., an uncommon cause of this syndrome. We report the first case of bacterial peritonitis in continuous ambulatory peritoneal dialysis (CAPD) caused by Citrobacter werkmanii resistant to all beta-lactams, gentamicin, and cotrimoxazole, and also the new anti-gram-negative molecules ceftazidime/avibactam and ceftolozane/tazobactam. The molecular analysis of the strain demonstrated the presence of blaVIM metallo-β-lactamase gene. The patient was effectively cured with a course of systemic tigecycline, colistin, and meropenem.

膵管ステントが著効した細菌性腹膜炎を伴った膵性腹水の1例

膵管ステントが著効した細菌性腹膜炎を伴った膵性腹水の1例

A case of bacterial peritonitis caused by Roseomonas mucosa in a patient undergoing continuous ambulatory peritoneal dialysis.

Bacterial peritonitis remains a life-threatening complication of peritoneal dialysis (PD). Roseomonas is a bacterial genus of pink-pigmented, oxidized, gram-negative coccobacilli that was first named in 1993. Importantly, Roseomonas mucosa exhibits antibiotic resistance, with significant resistance to cephalosporin, which is often selected as an empirical antibiotic regimen for peritonitis in PD patients. We herein report the case of a PD patient with bacterial peritonitis caused by Roseomonas mucosa that was fortunately identified using 16S rRNA gene sequencing and successfully treated with ciprofloxacin. Given that Roseomonas demonstrates resistance to a variety of antibiotics. The administration of empiric antibiotic therapy based on the recommendation of the International Society of Peritoneal Dialysis guidelines occasionally fails, leading to the aggravation of bacterial peritonitis. Hence, nephrologists should consider Roseomonas as one of the potential causative organisms of peritonitis, especially when gram-negative bacilli are resistant to cephalosporin and cannot be identified using standard laboratory methods.

Infección de herida traumática por Cedecea lapagei: Comunicación de un caso y revisión de la literatura

Cedecea lapagei is a gram-negative, facultative anaerobic, non-spore-forming bacteria, belonging to the family Enterobacteriaceae. It has been reported as a pathogen in few cases of bacterial peritonitis, wound infection, chemicals burns and pneumonia. We report a case of traumatic wound infection by this pathogen with a pertinent review.

Polymicrobial Multiple Intraabdominal Infections - A Rare Complication of Colonoscopy in a Cirrhotic Patient

Case Description: A 58-year-old male with a history of HCV and alcohol related advanced cirrhosis, presented with altered mental status and right upper quadrant pain, three days following upper and lower endoscopy. The endoscopy showed hemorrhoids and minimal gastritis and no interventions were performed. Diagnostic work-up upon admission showed elevated white blood cell count. CT abdomen showed multiple liver abscesses, which were partially drained and grew Streptococcus anginosus and Staphylococcus epidermidis. There were no other intra-abdominal fluid collections or abscesses, no features suggestive of bowel perforation on imaging. Blood cultures grew E. coli. His condition gradually deteriorated despite treatment with appropriate antibiotics. Repeat CT scan 10 days later showed right upper lobe pneumonia, bilateral pleural effusion along with persistent liver abscesses and new ascites. Paracentesis revealed an exudate with WBC count of 8125 with 94% neutrophils and grew Klebsiella pneumoniae. Antibiotics were adjusted according to sensitivities. However, his condition continued to deteriorate and he finally died of severe sepsis and multi-organ dysfunction. Discussion: There is a wide variation in the rate of bacteremia after various endoscopic procedures ranging from 2 to 45% based on type of procedure performed. They occur predominantly following interventional procedures. To our knowledge, there have only been two cases of bacterial peritonitis following colonoscopy in patients undergoing continuous ambulatory peritoneal dialysis and 2 other instances in patients with cirrhosis and ascites. Septicemia has been reported in only 4 cases after colonoscopy. These include 2 patients with cirrhosis and ulcerative colitis who developed gram negative septicemia; a patient who underwent splenectomy and was taking corticosteroids developed septicemia with Flavobacterium meningosepticum and Escherichia coli; and Listeria in a patient being treated with ACTH for ulcerative colitis. Conclusions: Patients with cirrhosis have a higher rate of infectious complications, likely due to decreased compliment levels, impaired neutrophil chemotaxis, lymphocyte dysfunction and immunoglobulin dysfunction, combined with portal hypertensive colopathy due to venous congestion. In summary, infectious complications following diagnostic endoscopies in cirrhotics are rare but can be severe and life threatening, even without obvious signs of bowel perforation.

Recurrent Peritonitis in Peritoneal Dialysis Patients During Antibiotic Therapy: Is Catheter Removal Always Reasonable?

AbstractInternational Society of Peritoneal Dialysis (ISPD) guidelines suggest that in case of bacterial peritonitis in peritoneal dialysis patients, antibiotic therapy failure, and/or the absence of clinical improvement after 4‐7 days should induce catheter removal. We present an atypical case of recurrent bacterial peritonitis, 2 episodes, during a 35‐day treatment. The second episode occurred after therapy modifi cation. In addition to having constant abnormal laboratory (increased C‐reactive protein values, leukocyte cell count, serum ferritin, etc.) and clinical (fever) findings, patients' subjective well‐being and fulfi lled dialysis effi ciency remained unchanged during the treatment period; these data induced further therapy modifi cation without catheter removal. One month later laboratory parameters returned to normal, whereas echotomography control revealed the absence of the previously observed infl ammatory signs. In conclusion, our case provides evidence that patients' clinical conditions may be more predictive than laboratory findings of outcome following bacterial peritonitis.

Use of Subcutaneous Venous Access Ports to Treat Refractory Ascites

To assess the feasibility of peritoneal ports for management of patients with cirrhotic refractory ascites, 10 ports were placed in nine patients for frequent outpatient paracentesis. Retrospective review and telephone interviews were used to assess port performance. Kaplan-Meier analysis revealed a median duration of port patency of 255 days. In 1,557 port days, four access problems prompted further interventional evaluation. Three cases of bacterial peritonitis and one catheter obstruction developed. The use of subcutaneous venous access ports to allow control of ascites by nursing personnel is a promising alternative for management of patients with refractory ascites. Additional studies are needed to determine long-term effectiveness and safety.

Secondary Bacterial Peritonitis Due to Listeria monocytogenes After Paracentesis

Although it is a relatively rare cause of peritonitis, Listeria monocytogenes must be considered in cirrhotic patients with ascites and a suggestive clinical presentation. We believe this is the first report of a case of peritonitis due to L monocytogenes in a patient without sepsis, and the sixth reported case of bacterial peritonitis in a patient with cirrhosis.