Catheter Exit-site Infection Research Articles

Peritonitis in peritoneal dialysis patients in Japan: a 2013 retrospective questionnaire survey of Japanese Society for Peritoneal Dialysis member institutions

Peritonitis is the main cause of withdrawal from peritoneal dialysis (PD) therapy in Japan. The precise extent of PD-associated peritonitis in Japan has not been investigated since 2005; we aimed to clarify the recent incidence and prognosis of PD peritonitis. The 248 institutional members of the Japanese Society for Peritoneal Dialysis were surveyed by questionnaire regarding peritonitis episodes during January 1 to December 31, 2013. Replies from 114 members were received regarding 3042 PD patients, including 516 peritonitis patients, covering a total observation period of 31,686 patient months. The incidence of peritonitis in this study was 0.195 episodes per year. Detailed data on 544 peritonitis episodes in 466 patients was obtained. The causes, in ranked order, were unknown reason, contamination at peritoneal fluid exchange, and extension of intra-abdominal cavity infection. Effluent culture methods included using a blood culture bottle (50.9 %), large-volume culture (culturing sediment after centrifuging effluent) (31.7 %), and direct culture of effluent using a culture dish (12.7 %). The rank order of microbes identified in peritoneal effluent cultures was culture-negative, Streptococcus sp. and Staphylococcus aureus. Empiric therapy with two kinds of antibiotics was administered to 406 cases (75.2 %), most commonly cefazolin + ceftazidime. Antibiotic administration methods included intraperitoneal (51.4 %), intravenous (46.4 %), and oral (2.2 %). After a peritonitis episode, 461 patients (84.7 %) continued PD therapy, 80 (14.7 %) withdrew from PD treatment, and 6 (1.1 %) died. Prognosis among patients grouped by antibiotic administration method was statistically significantly different; in the oral administration group, the rates of mortality and catheter replacement were higher. Logistic regression analysis showed that catheter exit-site infection and frequency of past peritonitis episodes were independent factors associated with PD treatment withdrawal. Although the overall incidence of PD peritonitis in Japan was relatively low, several areas for future improvement were identified: unknown reason and culture-negative were the most frequently cited causes of peritonitis; 1.1 % of patients died, and 13.6 % discontinued PD therapy. Improvements in effluent culture techniques, antibiotic administration methods, etiology determination, and patient education could help. A more effective protocol must be established to further improve the treatment of PD peritonitis in Japan.

Peritoneal Dialysis Registry With 2012 Survey Report.

Since 2009, the peritoneal dialysis (PD) registry survey has been carried out as part of the annual nationwide survey conducted by the Statistical Survey Committee of the Japanese Society for Dialysis Therapy with the cooperation of the Japanese Society for Peritoneal Dialysis. In this report, the current status of PD patients is presented on the basis of the results of the survey conducted at the end of 2012. The subjects were PD patients who lived in Japan and participated in the 2012 survey. Descriptive analysis of various items was performed, which included the current status of the combined use of PD and another dialysis method such as hemodialysis (HD) or hemodiafiltration (HDF), the method of exchanging dialysate, the use of an automated peritoneal dialysis (APD) machine, and the rates of peritonitis and catheter exit-site infection. From the results of the facility survey in 2012, the number of PD patients was 9514, a decrease of 128 from 2011. Among the entire dialysis patient population, 3.1% were PD patients, a decrease of 0.1%. Among the studied patients, 347 had a peritoneal catheter and underwent peritoneal lavage, 175 were started on PD in 2012 but introduced to other blood purification methods in the same year, and 1932 underwent both PD and another dialysis method such as HD or HDF. The percentage of patients who underwent PD and another dialysis method increased with PD vintage: <1 year, 4.8%; 1 to <2 years, 9.2%; 2 to <4 years, 16.3%; 4 to <8 years, 32.0%; and ≥8 years, 47.5%. The percentage of PD patients who completely manually exchanged the dialysate was 29.8%. The percentages of PD patients who used a double-bag exchange system with ultraviolet-light irradiation and those who used the same system but with a sterile connecting device were 54.7 and 13.9%, respectively. The percentage of patients on PD for <1 year using an APD machine was 43.4%, and it decreased with a PD vintage of ≥2 years. The mean rate of peritonitis was 0.22 per patient per year. The mean rate of catheter exit-site infections was 0.36 per patient per year.

Epidemiology of haemodialysis catheter complications: a survey of 865 dialysis patients from 14 haemodialysis centres in Henan province in China

ObjectivesTo investigate the incidence rates and risk factors for catheter-related complications in different districts and populations in Henan Province in China.DesignCross-sectional.SettingFourteen hospitals in Henan Province.Participants865 patients with renal dysfunction undergoing...

Peritonitis and catheter exit-site infection in patients on peritoneal dialysis at home.

Objective: to analyze the complications related to peritonitis and catheter exit-site infections, in patients on peritoneal dialysis at home. Method: quantitative and cross-sectional study, carried out with 90 patients on peritoneal dialysis at home, in a municipality in the Northeast region of Brazil. For data collection, it was used two structured scripts and consultation on medical records. Descriptive analysis and comparison tests among independent groups were used, considering p<0.05 as level of statistical significance. Results: by comparing the frequency of peritonitis and the length of treatment, it was found that patients over two years of peritoneal dialysis were more likely to develop peritonitis (X²=6.39; p=0.01). The number of episodes of peritoneal catheter exit-site infection showed association with the length of treatment (U=224,000; p=0.015). Conclusion: peritonitis and catheter exit-site infection are associated with the length of treatment.

Application of a Physical Antimicrobial Spray Dressing for Reducing Postoperative Peritoneal Dialysis Catheter Exit Site Infection in End-stage Renal Failure Patients: A Prospective Cohort Study

Application of a Physical Antimicrobial Spray Dressing for Reducing Postoperative Peritoneal Dialysis Catheter Exit Site Infection in End-stage Renal Failure Patients: A Prospective Cohort Study

Peritoneal ultrafiltration in end-stage congestive heart failure

Congestive heart failure (CHF) refractory to pharmacological therapy is a growing medical problem. Renal sodium and water retention remains a key event in the pathogenesis of the disease progression and episodes of severe cardiac decompensation, being also the leading cause of high hospitalization rates and an important risk factor for worsening kidney function and chronic kidney disease (CKD). The two conditions: CHF and CKD form a vicious circle, with a tremendous escalation of complications and mortality. In this clinical situation, peritoneal ultrafiltration (PUF) may be a reasonable choice for long-term treatment of selected patients with end-stage CHF, especially for those with contradictions to heart transplantation. Several observational studies have demonstrated its efficacy and safety in this population. Fluid and sodium removal via peritoneal cavity resulted in significant plasma volume reduction, normalization of serum sodium and restoration of diuretic responsiveness, as well as an improvement in New York Heart Association functional class, reduction of hospitalization and readmission rates. The complications are typical for peritoneal dialysis (catheter exit site infections, peritonitis and fluid leaks) but they are much more rare with 1 instead of 4 exchanges per day,and it seems that at least in case of PUF with 1-2 peritoneal exchanges a day, the benefits of the therapy outweigh the risks. However, as the studied groups were small, larger multicenter randomized trials are necessary to develop precise recommendations regarding clinical aspects of PUF in severe CHF and indications for its use.

Long-Term Central Venous Access in Pediatric Patients at High Risk: Conventional versus Antibiotic–Impregnated Catheters

PurposeTo study selective use of antibiotic–impregnated catheters in children at increased risk of venous catheter–related infections (CRIs). Materials and MethodsFrom December 2008 to June 2009, 428 peripherally inserted central catheters (PICCs) were placed by the interventional radiology service of a large metropolitan children’s hospital. This retrospective study analyzed demographic and outcome data for the 125 patients in this group at high risk for venous CRI. Patients at high risk were those with active systemic infection, previous complicated central venous access, intensive care unit (ICU) admission, intestinal failure, transplantation, complex congenital heart disease, or renal failure. Patients (age, 7.6 y ± 7.0; 73 male and 52 female) received a conventional or antibiotic-impregnated PICC, with 17 receiving more than one catheter. ResultsOf the 146 of 428 qualifying patient encounters (34%), 53 patients received an antibiotic-impregnated PICC and 93 received a conventional PICC, representing 5,080 total catheter-days (CDs). The rates of CRIs per 1,000 CDs, including catheter exit site infections and catheter-related bloodstream infections, were 0.86 for antibiotic-impregnated PICCs and 5.5 for conventional PICCs (P = .036). A propensity-based model predicts 15-fold greater infection-free survival over the lifetime of the catheter in patients who receive an antibiotic-impregnated PICC (P < .001). Antibiotic-impregnated PICC recipients with active infection or ICU admission at the time of insertion had no catheter-associated infections, compared with 3.42 and 9.46 infections per 1,000 CDs, respectively, for patients who received conventional PICCs. Patients with intestinal failure had 1.49 and 10 infections per 1,000 CDs with antibiotic-impregnated versus conventional PICCs, respectively. ConclusionsAntibiotic-impregnated long-term PICCs significantly improve infection-free catheter survival in pediatric patients at high risk.

Predictive value of superficial cultures to anticipate tunneled hemodialysis catheter–related bloodstream infection

We performed a prospective study in patients with tunneled catheters to assess the validity of Gram stain and superficial culture for anticipating catheter exit-site infection and hemodialysis catheter–related bloodstream infection. The sensitivity and negative predictive value were high, and we succeeded in identifying a subpopulation at low risk of infection.

Transient Brugada electrocardiogram pattern associated with Tenchkoff catheter exit site infection

Transient <scp>B</scp>rugada electrocardiogram pattern associated with <scp>T</scp>enchkoff catheter exit site infection

The Efficacy of Prophylactic Antibiotics Administration prior to Insertion of Tunneled Catheter in Hemodialysis Patients

Aim and background: Central venous catheter (CVC)-related blood stream infection is a major cause of morbidity and mortality in patients with end-stage renal diseases. However, CVCs are quite frequently required for vascular access in hemodialysis (HD) patients. Tunneled catheters (TCs) are widely used when a catheter is needed for a long period. However, long-term catheter survival is limited by TC-related infections. The purpose of this prospective study was to assess clinical outcomes of prophylactic antibiotics administration prior to insertion of TCs in HD patients. Material and methods: Sixty uremic patients who required TC insertion due to vascular access failure were included in our study between April 2009 and April 2010. Patients were randomized into two groups: group I and group II. Group I received 1 g of cefazolin sodium intravenously 1 h prior to catheter insertion. Group II received equal amount of saline intravenously 1 h prior to catheter insertion. The primary end points of the study were catheter loss, hospitalization, or mortality due to catheter-related infections (CRIs). The secondary end points included exit-site infection (not requiring hospitalization), tunnel infections (not requiring catheter removal), and bacteremia. Results: During the follow-up period, one patient in group I and three patients in group II reached primary end point (p < 0.05). Catheter loss due to infection was higher in group II than in group I as 6 versus 3, respectively (p < 0.05). Catheter exit-site infections, which does not require hospitalization, have been considered as secondary end points and have been detected in four patients for 7 times in group I and in six patients for 10 times in group II (p < 0.05). Tunnel infection, which does not require removal of the catheter, has been detected in two patients for 3 times in group I and in five patients for 6 times in group II (p < 0.05). Conclusion: The prophylactic antibiotic use prior to TC insertion significantly reduced CRIs, bacteremia, and catheter loss.

Do topical antibiotics reduce exit site infection rates and peritonitis episodes in peritoneal dialysis patients? The Pan Thames Renal Audit

Peritonitis is the major cause of peritoneal dialysis (PD) technique failure. Prophylactic topical antibiotics have been reported to reduce peritoneal dialysis catheter exit site infections (ESI) and peritonitis rates. We audited the effect of different exit site practices in the 12 Pan Thames and South East England PD centres, on ESIs and peritonitis between 2005 and 2008. PD patients used prophylactic mupirocin (n=1,270), gentamicin (n=502) and no prophylactic antibiotics (n=1,203); annualised ESI rates were reduced with mupirocin (median 0.18, interquartile range [IQR] 0.13-0.23, patient episodes per year, vs. median 0.32, IQR 0.24-0.69, for no antibiotic prophylaxis, p<0.01). Gentamicin treatment was not significantly lower (median 0.29, IQR 0.21-0.47). Staphylococcal ESIs accounted for 39.6% in the no antibiotic group and fell to 25.7% with mupirocin and 28.2% with gentamicin. Despite the reduction in ESIs, there was no significant reduction in peritonitis rates (no antibiotics: median 0.56, IQR 0.5-0.65; mupirocin: median 0.55, IQR 0.53-0.75; and gentamicin: median 0.47, IQR 0.32-0.65). In particular, mupirocin did not reduce Staphylococcus aureus peritonitis rates. Topical antibiotics have been reported to reduce both ESI and peritonitis rates in controlled trials, and although in this audit of routine clinical practice, topical mupirocin did reduce overall ESI rates and both mupirocin and gentamicin reduced S. aureus ESIs, neither reduced overall peritonitis rates.

Preditores de peritonite em pacientes em um programa de diálise peritoneal

INTRODUÇÃO: Peritonite é a principal complicação relacionada com a diálise peritoneal (DP). OBJETIVO: Avaliar possíveis preditores para o seu desenvolvimento em pacientes em programa crônico na modalidade. MÉTODO: Realizou-se estudo de coorte retrospectivo em 330 pacientes (média de idade 53 ± 19 anos) em programa de DP na Clínica de Nefrologia de Sergipe (Clinese), em Aracaju/ SE, Brasil, entre 1.º de janeiro de 2003 e 31 de dezembro de 2007. Variáveis sociodemográficas e clínicas foram avaliadas comparativamente entre pacientes que apresentaram (141% - 42,7%) ou não (189% - 57,3%) peritonite. Na análise estatística, utilizaramse teste t de Student, qui-quadrado e modelo de regressão com múltiplas variáveis. RESULTADOS : Ocorreu um episódio de peritoniteacada28,4pacientes/mês(0,42episódio/ paciente/ano). O Staphylococcus aureus foi o agente etiológico mais frequente (27,8%). Não se utilizava antibioticoterapia profilática e 136 pacientes (41,2%) haviam apresentado previamente infecção de sítio de saída do cateter peritoneal (ISSCP). Identificou-se maior risco de peritonite nos pacientes com albuminemia < 3,0 g/dL no início do tratamento [risco relativo (RR) = 2,0; intervalo de confiança (IC) de 95% = 1,21 - 3,43; p < 0,01], escolaridade < 4 anos (RR = 2,15; IC = 1,09 - 4,24; p = 0,03) e com histórico de ISSCP (RR = 2,63; IC = 1,57 - 4,41; p < 0,01). Não houve diferença significante entre os grupos no tocante a gênero, idade, renda familiar, procedência, presença ou não de diabetes, forma de início do tratamento (se eletiva ou emergencial), tipo de cateter e tipo de implante. CONCLUSÕES: Hipoalbuminemia, menor escolaridade e ISSCP mostraram-se como fatores preditores independentes de peritonite. Embora os índices de peritonite observados sigam os padrões internacionais, recomendam-se estratégias profiláticas para ISSCP.

Topical Mupirocin/Sodium Hypochlorite Reduces Peritonitis and Exit-Site Infection Rates in Children

Peritoneal dialysis (PD) is a common maintenance renal replacement modality for children with ESRD frequently compromised by infectious peritonitis and catheter exit site and tunnel infections (ESI/TI). The effect of topical mupirocin (Mup) and sodium hypochlorite (NaOCl) solution was evaluated as part of routine daily exit site care on peritonitis and ESI/TI rates, causative microorganisms, and catheter survival rates. Retrospective chart review of children on home continuous cycling PD between April 1, 2001 and June 30, 2007 was performed. Infection rates were examined based on exit site protocol used in two different periods: Mup alone, April 1, 2001 to November 17, 2004; and Mup and NaOCl (Mup+NaOCl), November 18, 2004 to June 30, 2007. Eighty-three patients (mean PD initiation age: 12.1 +/- 5.8 yr) received home PD over 2009 patient months. Annualized rates (ARs) for peritonitis decreased from 1.2 in the Mup period to 0.26 in the Mup+NaOCl period (P < 0.0001). ARs for ESI/TI decreased from 1.36 in the Mup period to 0.33 in the Mup+NaOCl period (P < 0.0001). No infections with Mup-resistant organisms were observed when either Mup or Mup+NaOCl was used for prophylaxis. Gram-negative-organism associated peritonitis decreased from an AR of 0.31 in the Mup period to 0.07 in the Mup+NaOCl period (P < 0.001). Infection-related catheter removal rates decreased from 1 in 38.9 catheter-months in the Mup period to 1 in 94.2 in the Mup+NaOCl period (P = 0.01). Catheter survival rates were longer in the Mup+NaOCl period (Kaplan-Meier, P < 0.009). The combination Mup+NaOCl in daily exit site care was very effective to reduce PD catheter-associated infections and prolong catheter survival in pediatric patients.

A Randomized Trial Comparing Conventional Swan-Neck Straight-Tip Catheters to Straight-Tip Catheters with An Artificial Subcutaneous Swan Neck

To evaluate the safety and efficacy of inserting a straight-tip Tenckhoff catheter configured with a subcutaneous artificial swan neck. Clinical outcomes of conventional swan-neck straight-tip catheters and Tenckhoff straight-tip catheters implanted with an artificial subcutaneous swan neck were compared in a prospective randomized controlled trial in a single-center setting. Patients undergoing peritoneal dialysis catheter insertion were randomized to receive either a double-cuff straight-tip Tenckhoff catheter with an artificial subcutaneous swan-neck (TC) or a conventional double-cuff straight-tip swan-neck catheter (SN). The primary outcome was catheter exit-site infection rate; the secondary outcomes were catheter-related mechanical events and surgery-related bleeding. A total of 39 consecutive patients were enrolled: 20 into the TC group and 19 into the SN group. More exit-site infections were observed in the SN group than in the TC group, although the difference was not statistically significant (0.97 vs 0.51 episodes per patient-year, p = 0.0657). However, there were more peritonitis episodes in the TC group than in the SN group (0.35 vs 0.15 episodes per patient-year, p = 0.0256). Exit-site and main wound bleeding post surgery were generally mild and similar in the 2 groups. No events of dialysate leakage, catheter tip migration, or subcutaneous cuff protrusion were observed in patients of either group. Outflow failure due to mechanical causes occurred in 2 patients in the TC group and in 1 patient in the SN group during the intermittent peritoneal dialysis period; all were corrected successfully by laparoscopic omentectomy. Placement of the double-cuff straight-tip Tenckhoff catheter configured with an artificial subcutaneous swan neck appears to be an effective and safe procedure. It may be a good alternative to the conventional swan-neck catheter.

Dialysis-associated peritonitis in children.

Peritonitis remains a frequent complication of peritoneal dialysis in children and is the most common reason for technique failure. The microbiology is characterized by a predominance of Gram-positive organisms, with fungi responsible for less than 5% of episodes. Data collected by the International Pediatric Peritonitis Registry have revealed a worldwide variation in the bacterial etiology of peritonitis, as well as in the rate of culture-negative peritonitis. Risk factors for infection include young age, the absence of prophylactic antibiotics at catheter placement, spiking of dialysis bags, and the presence of a catheter exit-site or tunnel infection. Clinical symptoms at presentation are somewhat organism specific and can be objectively assessed with a Disease Severity Score. Whereas recommendations for empiric antibiotic therapy in children have been published by the International Society of Peritoneal Dialysis, epidemiologic data and antibiotic susceptibility data suggest that it may be desirable to take the patient- and center-specific history of microorganisms and their sensitivity patterns into account when prescribing initial therapy. The vast majority of patients are treated successfully and continue peritoneal dialysis, with the poorest outcome noted in patients with peritonitis secondary to Gram-negative organisms or fungi and in those with a relapsing infection.

Actualités en dialyse péritonéale

Peritoneal dialysis, like hemodialysis, is a first-line therapy for patients with end-stage renal disease. Progress in medical devices and materials has reduced infectious complications such as peritonitis and catheter exit-site infections and thus decreased morbidity. Peritoneal dialysis fluids are increasingly biocompatible, result in fewer glucose degradation products, protect the peritoneal membrane better and thus improve tolerance. The maintenance of residual renal function, together with better comfort and no pain, help control the fluid and sodium balance. Automated peritoneal dialysis can be performed each night, either autonomously or assisted by a visiting nurse twice a day (to prepare, connect, and disconnect the machine). This treatment can thus be provided to most patients, regardless of their age. Peritoneal dialysis is indicated principally for young people waiting for a kidney transplantation (to preserve their vascular network), elderly patients who wish to remain either at home or in an institution, and patients with cardiac insufficiency, because of the better hemodynamic tolerance. Numerous obstacles, mainly nonmedical, still impede the development of peritoneal dialysis. Patients seen in emergencies start hemodialysis without necessarily receiving any information about peritoneal dialysis. Indeed, neither physicians nor patients receive adequate information.

Microbial Etiology of Hemodialysis Related Central Venous Catheter Exit Site Infections Following Use of Triple Antibiotic Ointment to Insertion Site

BACKGROUND/OBJECTIVES: Catheter related infections are a serious and common complication in Hemodialysis (HD) patients who are dependent on central venous catheters (CVC) for their access. Applying Triple Antibiotic Ointment a broad spectrum topical antibacterial ointment containing Polymyxin B Sulfate, Bacitracin Zinc and Gramicidin to the CVC insertion site has been found to reduce the incidence of catheter related infections. OBJECTIVE: To assess the frequency of exit site infections and the proportion due to Candida sp after instituting a practice of applying Triple Antibiotic Ointment to the insertion site of CVC catheters. METHODS: The patient population included in this project was a convenience subset of a Regional Dialysis population. All HD patients in 4 of 17 HD units within our Renal Program using a permanent tunneled and cuffed CVC for their HD access were included. Patients were surveyed from January 1 to March 31 2005. During this period a thin film of Triple Antibiotic Ointment was applied by dialysis nurses 3 times /week before each HD episode. Patient dialysis charts and culture reports from swabs of CVC sites were regularly reviewed. The Canadian definition for exit site infections was used to determine the presence or absence of infection. RESULTS: There were 306 HD patients and 147 patients used a permanent tunneled and cuffed CVC for their HD access. There were fifteen exit site infections in 15 patients during the 3 month survey, 2.7 per 1000 patient runs, 1.16 per 1000 catheter days. Of the 15 infections five (33%) were yeast infections. Other identified pathogens were Coagulase-negative Staphylococcus, Staphylococcus aureus, Enterococcus sp, Pseudomonas aeruginosa and Diphtheriods . CONCLUSIONS: Following implementation of topical antibacterial prophylaxis of CVC exit sites, there has been an apparent increase in Candida sp as a cause of CVC site infections. A longer term study is warranted to confirm these results.

CHAPTER 4

CHAPTER 4

Clinical outcomes of systemic lupus erythematosus patients undergoing continuous ambulatory peritoneal dialysis

The purpose of this study was to evaluate the outcome of systemic lupus erythematosus (SLE) patients on continuous ambulatory peritoneal dialysis (CAPD). Eighteen SLE patients who had been undergoing CAPD for at least 3 months in our unit were compared with 36 other age- and gender-matched non-diabetic CAPD patients with an underlying primary chronic glomerulonephritis (CGn). The clinical outcome, infective complications, lupus activities, biochemical parameters, haemoglobin level and the use of erythropoietin were reviewed. The duration of dialysis of the two studied groups was not different, with a mean of 35.4 months for the SLE group and 36.7 months for the CGn group. Before dialysis, SLE patients had a significantly lower albumin level (30.4+/-6.6 vs 35.4+/-5.59 g/dl, P<0.01), while the mean haemoglobin levels of the two groups were similar (8.5+/-1.8 g/dl for SLE vs 9.0+/-1.9 g/dl for the control group). However, the weekly dose of erythropoietin (EPO) used was significantly higher in the SLE group (6000 vs 3818 U/week, P<0.01) to maintain a similar haemoglobin level during dialysis. Regarding the infective complications, the SLE group had a higher peritonitis rate (5.7 episodes/100 patient-months vs 2.4 episodes/100 patient-months, P<0.05), and an increase in the non catheter related infection rate (6.67 episodes/100 patient-months vs 1.1 episodes/100 patient-months, P<0.001). However, no significant difference could be demonstrated in the Tenckhoff catheter exit site infection rate (2 episodes/100 vs 1.7 episode/100 patient-months). The number of patients who received a kidney transplant or required a change of mode to haemodialysis was similar among the two groups. Seven patients died during the follow-up period, and the overall mortality rate was much higher in the SLE group than in the control group (0.83/100 vs 0.15/100 patient-months, P<0.05). SLE patients on CAPD have a significantly lower pre-dialysis serum albumin level and use a higher dose of Epo to achieve a comparable haemoglobin level than other non-diabetic CGn CAPD patients. They also have a poorer prognosis in terms of infective complications and mortality rate.

Peritonitis Due to Neisseria mucosa in an Adolescent Receiving Peritoneal Dialysis

Neisseria mucosa is part of the normal nasopharyngeal flora and rarely pathogenic in humans. Reports of serious infections associated with this pathogen are very unusual. A 17-year-old boy with end-stage renal disease due to IgA nephropathy presented with acute, spontaneous, symptomatic peritoneal dialysis-associated peritonitis without reported break in sterility or PD catheter exit site infection. beta-lactamase-negative N. mucosa was isolated from the dialysate effluent. Intraperitoneal antibiotic treatment with cephalothin/gentamicin for 5 days and subsequent ceftriaxone led to complete resolution of the infection. This case demonstrates that "non-pathogenic" Neisseria species can cause clinically severe peritonitis with high intraperitoneal neutrophil counts, elevated C-reactive protein levels in the peritoneal effluent (in the presented case, 27,600/mul and 3.6 mg/l, respectively) and impaired peritoneal membrane transport function. To our knowledge, this is the first case of N. mucosa peritonitis complicating chronic peritoneal dialysis in an adolescent patient.