Peritonitis In Adults Research Articles

Bacteriological profile of community peritonitis in adults at Mohammed VI university hospital

A good analysis of intraperitoneal bacteriological results constitutes the basis of therapeutic consideration. The objective of this work is to report the main epidemiological and bacteriological characteristics of community-acquired peritonitis in adults at the Mohammed VI University Hospital of Marrakech. This is a retrospective descriptive study carried out in the microbiology laboratory of Arrazi hospital at Mohammed VI University Hospital in Marrakech over a period of seven years from January 1, 2017 to December 31, 2023 including all community peritonitis documented in our hospital. The cytobacteriological study was carried out according to conventional methods. During the study period (2017-2023), 503 documented peritonitis were collected, The profile of the incriminated germs was dominated by Escherichia coli (48.9%) followed by Streptococci (18.3%), 8% of Pseudomonas aeruginosa and 18.5% for other Enterobacteria. Our results showed that E coli becomes increasingly resistant to the combination of amoxicillin acid clavulanic which is the antibiotic commonly used in our context, this leads us to review the antibiotics prescribed probabilistically in our context for the management of peritonitis community.

MO707: Efficacy and Safety of ‘Helping Hands’: A 3D-Printed Device of Peritoneal Dialysis Adopted in Continuous Ambulatory Peritoneal Dialysis: A Randomized Controlled Trial

Abstract BACKGROUND AND AIMS Touch contamination during bag exchange in continuous ambulatory peritoneal dialysis (CAPD) is a common cause of peritonitis, especially for renal failure patients with fair eye–hand coordination plus and minus poor vision who fail to do the aseptic technique in connecting tubing (Hsieh et al. The negative impact of early peritonitis on continuous ambulatory peritoneal dialysis patients. Perit Dial Int. 2014;34(6):627–35; Woten and Cabrera. Peritonitis: prevention of peritoneal dialysis-induced peritonitis in adults. CINAHL Nursing Guide EBSCO Publishing, 16 November 2018). Those who are unable to execute CAPD by themselves resulted in high restriction in independent living where support from helper or institutional care is required. Up till now, no commercially available CAPD device could be utilized to solve this issue. ‘Helping Hands’ is a device designed with distinctive features including tunnel container for catheter fixation and comfortable handle and clips for parallel point-to-point movement with embedded magnets, and the use of this device might enable those CAPD patients with poor vision and/or eye–hand coordination to perform bag exchange procedure safely and independently. In this study, we hypothesized the use of ‘Helping Hands’ device could reduce the risk of CAPD related peritonitis by allowing CAPD users to work through a safer connection process without direct touch on tubing during bag exchange procedures. METHOD This is a randomized, paralleled, controlled pilot trial in public hospital setting. An interdisciplinary collaboration workgroup was established at Queen Elizabeth Hospital in May 2019. The Renal Unit of Department of Medicine together with the Multi-disciplinary Simulation and Skill Centre designed, prototyped, and then fabricated a CAPD device named ‘Helping Hands’ using 3D-printing technology. All new CAPD patients using ultra-bag peritoneal dialysis (PD) system and attaining ‘high to moderate readiness’ in assessment with occupational therapists were invited to participate in this program. All consented participants were randomly assigned to either intervention group (training + ‘Helping Hands’ provided for CAPD bag exchange) or control group (training alone + CAPD bag exchange without ‘Helping Hands’) using computer-generated numbers. RESULTS From December 2020 to November 2021, 17 patients, with their demographic shown in Fig. 1 were recruited into the study. Nine (53%) and eight (47%) were assigned to intervention group and control group, respectively. Within comparable study period (41 patient-month for both groups), peritonitis rate of intervention group was significantly lower than that of control group, 0.29 versus 1.18/patient-year (P < .01). The peritonitis rate in the intervention group was also lower than the overall peritonitis rate in the Queen Elizabeth Hospital within the same study period, which was 0.31/patient-year (4193 patient-month; peritonitis episode = 108). Investigation report found that the episode of peritonitis identified in intervention group was due to patient not clamping the transfer set before disconnection in performing the bag exchange as opposed to device safety issues. CONCLUSION The use of ‘Helping Hands’ device is safe and can significantly reduce the risk of CAPD-related peritonitis by no direct touching on tubing during bag exchange procedures. The distinctive features of ‘Helping Hands’ might enable those PD patients with poor vision and/or eye–hand coordination to perform bag exchange procedure safely and independently.

Rothia dentocariosa bacteremia in the newborn: causative pathogen or contaminant?

Abstract Objectives To describe an infrequent case of bacteremia by Rothia dentocariosa in a newborn and to discuss its potential pathogenicity. Case presentation R. dentocariosa is an aerobic or facultative anaerobic gram-positive bacillus, common in the human oral cavity that has been isolated in cases of endocarditis, pneumonia, endophthalmitis and peritonitis in adults. Infections in the fetus and newborn have been scarcely reported. We present a full-term newborn with prolonged rupture of membranes, acute elevation of C-reactive protein, and isolation of R. dentocariosa in the blood culture. Endocarditis was ruled out and the patient did well with five days of intravenous broad spectrum antibiotics. To date, only a previous case of sepsis by R. dentocariosa in a neonate with meconium aspiration syndrome and an antenatal death of a full-term fetus with hemorrhagic brain lesions probably related to R. dentocariosa have been reported. Conclusions Until more information about the pathogenicity of this germ in the newborn is available, an individualized approach and a close clinical control of the patient with infectious risk factors and bacteremia by R. dentocariosa seem to be prudent.

Elizabethkingia meningoseptica: An Uncommon Cause of Peritonitis In Continuous Ambulatory Peritoneal Dialysis: A Case Report and Review of Literature

Peritonitis is a major complication of peritoneal dialysis (PD) and due to its gravity, it remains the primary reason to switch from PD to hemodialysis. Elizabethkingia meningoseptica, a non-fermentative Gram-negative bacillus, is rarely encountered as a pathogen causing peritonitis in adults. We present here a case report of an acquired infection with this organism in adult on PD. To the best of our knowledge, this is the first report of infection with this organism in a continuous ambulatory PD patient in Tunisia.

Ascitic calprotectin as a useful marker in the diagnosis of spontaneous bacterial peritonitis in adults

BackgroundAscitic fluid polymorphonuclear leucocyte count (PMN) is known to be the gold standard for spontaneous bacterial peritonitis (SBP) diagnosis. The aim of this work was to assess ascitic calprotectin for SBP diagnosis. Serum C-reactive protein (CRP), high sensitivity C-reactive protein (hsCRP), nitrous oxide, ascitic PMN, ascitic leucocyte esterase and ascitic calprotectin were measured.ResultsThe average age of our patients was 55.25 ± 7.89 years, mostly males (n = 51, 63.8%), anti-HCV antibodies were positive in (n = 61, 76.3%). Sixty-four patients (80%) were Child-Pugh C and their average MELD was 24.29 ± 8.06. Patients with SBP had statistically significant higher median MELD score (26.5 vs. 19) and higher average Child-Pugh score (12.18 ± 1.74 vs. 10.5 ± 1.97). Forty patients had SBP and 40 patients were without SBP. Both the serum and ascitic nitrous oxide did not differ statistically between patients with and without SBP. In contrast, patients with SBP had higher median serum CRP (49 vs. 12 mg/dL), hsCRP (58,000 vs. 23,750 ng/dL) and ascitic calprotectin (7.57 vs. 1.1 ng/mL). The ascitic leucocyte esterase test was positive in 95% of SBP patients in contrast to 2.5% patients without SBP. Ascitic calprotectin >2 ng/mL had 90% sensitivity, 92.5% specificity, 92.3% positive predictive value and 90.2% negative predictive value. MELD, CRP, hsCRP and ascitic calprotectin are independent predictors of SBP.ConclusionAscitic calprotectin is a useful marker for SBP diagnosis.

Diagnostic significance of ascites adenosine deaminase levels in suspected tuberculous peritonitis in adults

Amac: Tuberkuloz peritonit hastalarinda adenozin deaminaz’in (ADA) tanisal belirtec olarak kullanimi hakkinda celiskili raporlar vardir. Nepal’de eriskinlerde tuberkuloz peritonit tanisinda ADA aktivitesinin degerini arastiran bir calisma bulunmamaktadir. Bu nedenle supheli tuberkuloz peritonit hastalarinda asit sivida ADA duzeylerini arastirmak ve istatistiksel olarak bu testin tanisal onemini belirlemek icin yola ciktik.Yontemler: Calismaya alinan hastalar iki farkli eriskin hasta grubundan olusmaktaydi. Grup I; 35 supheli tuberkuloz peritonit olgusu, ve Grup II; transudatif asitli 35 hastanin olusturdugu kontrol grubu (transuda oldugu biyokimyasal olarak kanitlanmis veya hipoproteinemisi olan hastalar) calismaya dahil edildi ve periton sivilari alindi. ADA olcumu spektrofotometri ile yapildi.Bulgular: ADA duzeyleri (ortalama ± SS)supheli tuberkuloz peritonit ve transudatif asit olgularinda, sirasiyla, 48,5 ± 17,9 U/L ve 19,8 ± 7,7 U/L idi (P<0,001). Asit degerleri icin “alici isletim karakteristik” (ROC) egrisinde, ADA kesme seviyesi 41,5 U/L alindiginda en iyi ayirici tani degerleri bulundu ve tuberkuloz peritonit olgularinda testin duyarlilik, ozgulluk, pozitif prediktif deger, negatif prediktif deger ve dogruluk duzeyleri, sirasiyla, % 80,0,% 97,2,% 96,6,% 82,9,% 88,6 idi.Sonuc: Supheli tuberkuloz peritonit olgularinda ADA duzeyleri yukselmektedir ve bu basit, hizli, ucuz ve en az invaziv testtir. Mikobakteri kulturleri veya biyopsi sonuclarini beklerken tuberkuloz peritonit erken tanisi icin bu en kullanisli bir biyokimyasal belirtectir

Peritoneal taurolidine lavage in children with localised peritonitis due to appendicitis

Despite aggressive surgical treatment, rational antibiotic therapy, and modern intensive care, generalised peritonitis remains a major threat in the paediatric age group. Several adjuvant strategies such as peritoneal saline lavage and peritoneal drainage have been utilised. Taurolidine, derived from the amino acid taurine, has bactericidic, antiendotoxic, and antiinflammatory properties. It has been introduced previously for intraoperative peritoneal lavage in treating peritonitis in adults. The aim of our study was to evaluate the effect of peritoneal taurolidine lavage on the clinical course and serological inflammation markers in children with perforated appendicitis and localised peritonitis. A series of 27 children presenting with appendicitis between January 1999 and July 2001 were included in the study after parental informed consent. All patients underwent open appendectomy. Taurolidine peritoneal lavage was applied in 15 randomly selected children (eight girls and seven boys; mean age 10 years and 10 months). Twelve children received saline peritoneal lavage and served as the control group (six girls and six boys; mean age 9 years and 7 months). Blood was taken preoperatively and on postoperative days 1, 3, 7, and 14. Full blood cell count, C-reactive protein, endotoxin, interleukin-1, interleukin-6, soluble interleukin-2 receptor, tumour necrosis factor alpha, and procalcitonin were investigated to evaluate the serological course of inflammation. Both groups initially presented with severe inflammation as evidenced clinically and serologically. The clinical postoperative course was uneventful in 13/15 patients in the treatment group and 10/12 patients in the control group. The remaining patients presented complications: intraperitoneal abscess or early postoperative bowel obstruction. With regard to the serological inflammatory parameters, no significant differences were found between the two groups except for the soluble interleukin-2-receptor on the 7th postoperative day. In conclusion, the expected reduction of endotoxin levels and inflammatory activity in the treatment group was not evident. A significant advantage of adjuvant peritoneal taurolidine lavage in the surgical therapy of children with localised peritonitis due to appendicitis could not be shown in our study.

Antibiotic regimens for secondary peritonitis of gastrointestinal origin in adults.

Secondary peritonitis is associated with a high mortality rate and if not treated successfully leads to development of abscesses, severe sepsis and multi-organ failure. Source control and adjunctive antibiotics are the mainstay of treatment. However, no conclusive evidence suggest that one antibiotic regimen is better than any other but at the same time have a lower toxicity. To ascertain the efficacy and adverse effects of different antibiotic regimens in treating intra-abdominal infections in adults. Outcomes were divided into primary (clinical success and effectiveness in reducing mortality) and secondary (microbiological success, preventing wound infection, intra-abdominal abscess, clinical sepsis, remote infection, superinfection, adverse reactions, duration of treatment required, effectiveness in reducing hospitalised stay, and time to defervescence). We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library, Issue 4, 2004), MEDLINE (from 1966 to November 2004), EMBASE (from 1980 to November 2004) and Cochrane Colorectal Cancer Group specialised register SR-COLOCA. Bibliographies of identified studies were screened for further relevant trials. Randomised and quasi-randomised controlled trials comparing different antibiotic regimens in the treatment of secondary peritonitis in adults were selected. Trials reporting gynaecological or traumatic peritonitis were excluded from this review. Ambiguity regarding suitability of trials were discussed among the review team. Six reviewers independently assessed trial quality and extracted data. Data collection was standardised using data collection form to ensure uniformity among reviewers. Statistical analyses were performed using the random effects model and the results expressed as odds ratio for dichotomous outcomes, or weight mean difference for continuous data with 95% confidence intervals. Fourty studies with 5094 patients met the inclusion criteria. Sixteen different comparative antibiotic regimens were reported. All antibiotics showed equivocal comparability in terms of clinical success. Mortality did not differ between the regimens. Despite the potential high toxicity profile of regimens using aminoglycosides, this was not demonstrated in this review. The reason for this could be the inherent bias within clinical trials in the form of patient selection and stringency in monitoring drug levels. No specific recommendations can be made for the first line treatment of secondary peritonitis in adults with antibiotics, as all regimens showed equivocal efficacy. Other factors such as local guidelines and preferences, ease of administration, costs and availability must therefore be taken into consideration in deciding the antibiotic regimen of choice. Future trials should attempt to stratify patients and perform intention-to-treat analysis to allow better external validity.