Recurrent Bacterial Peritonitis Research Articles

High Peritoneal Glucose Exposure Is Associated with Increased Incidence of Relapsing and Recurrent Bacterial Peritonitis in Patients Undergoing Peritoneal Dialysis

Aim: We investigated the association of peritoneal glucose exposure and dialysis exchange number with peritonitis outcome in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods: The first episodes of bacterial peritonitis were retrospectively analyzed in 187 CAPD patients. Peritoneal glucose exposure was calculated based on PD prescription at the onset of peritonitis. Results: Patients with peritoneal glucose exposure ≤140 g/day showed a higher and complete cure rate of peritonitis (66 vs. 51.7%, p = 0.047), lower occurrence of relapsing/recurrent peritonitis (10.0 vs. 21.8%, p = 0.026) and catheter removal (14.0 vs. 26.4%, p = 0.033). Patients who exchanged more than three times every day demonstrated marginally higher catheter removal rate (24.1 vs. 13.0%, p = 0.085). Logistic analysis indicated that peritoneal glucose exposure >140 g/day was an independent predictor for relapsing/recurrent peritonitis (RR: 1.959, p = 0.042). Conclusion: High peritoneal glucose exposure is associated with increased incidence of relapsing/recurrent peritonitis in CAPD patients.

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.

Dynamic Component Chemiluminescent Sensor for Assessing Circulating Polymorphonuclear Leukocyte Activity of Peritoneal Dialysis Patients

Recurrent bacterial peritonitis is a major complication in peritoneal dialysis (PD) patients, which is associated with polymorphonuclear leukocyte (PMN) functional changes and can be assessed by a chemiluminescent (CL) reaction. We applied a new approach of a dynamic component chemiluminescence sensor for the assessment of functional states of PMNs in a luminol-amplified whole-blood system. This method is based on the evaluation of CL kinetic patterns of stimulated PMNs, while the parallel measurements of intracellular and extracellular production of reactive oxygen species (ROS) from the same sample can be conducted. Blood was drawn from diabetic and nondiabetic patients during follow-up, and during peritonitis. Healthy medical personnel served as the control group. Chemiluminescence curves were recorded and presented as a sum of three biological components. CL kinetic parameters were calculated, and functional states of PMNs were assessed. Data mining algorithms were used to build decision tree models that can distinguish between different clinical groups. The induced classification models were used afterward for differentiating and classifying new blind cases and demonstrated good correlation with medical diagnosis (84.6% predictive accuracy). In conclusion, this novel method shows a high predictive diagnostic value and may assist in detection of PD-associated clinical states.

Peritoneal fibrosis and its prevention

SUMMARY: Peritoneal fibrosing syndrome (PFS) is composed of a wide spectrum of peritoneal alterations observed in patients under peritoneal dialysis (PD). Long‐term peritoneal exposure to unphysiological PD solutions and recurrent bacterial peritonitis had been claimed as the most common causes predisposing to the development of PFS in a PD population. With the advances in molecular research, physicians and pathologists recognized that peritoneal injury and the accompanied accumulation of extracellular matrix (ECM) within the peritoneum are key events leading to PFS. Bioincompatible solution and it's related products, inflammatory mediators, growth factors as well as cytokines in the peritoneal cavity are contributing factors. Therapeutic strategies antagonizing these mediators and/or their downstream intracellular signalling pathways with either drug molecules or gene transfer may have potential for the prevention or treatment of PFS.

Recurrent bacterial peritonitis caused by Neisseria cinerea in a chronic ambulatory peritoneal dialysis (CAPD) patient

We present an unusual case of recurrent (chronic ambulatory peritoneal dialysis) CAPD-associated peritonitis caused by Neisseria cinerea. Using DNA restriction fragment length polymorphism (RFLP) analysis, we determined that the recurrent infection was caused by reinfection with a different N. cinerea strain rather than relapse with the index strain and that the probable origin of the reinfecting organism was the patient's upper respiratory tract.

The Epidermo-Peritoneal Potential in Patients Treated with Continuous Ambulatory Peritoneal Dialysis

At physiologic pH, S. epidermidis moves along an electrical potential gradient. We measured the epidermo-peritoneal electrical potential (EPP) in 23 end-stage renal failure patients treated with CAPD. There was a negative correlation between the mean EPP and the patient's age (r = 0.47, p = 0.016), but no correlation between the mean EPP and the duration of treatment (r = 0.003, p = 0.5). The EPP was greater in those patients with a history of recurrent bacterial peritonitis due to S. epidermidis [median EPP 23 mv (95% confidence limits 16-51)] compared to those with only one or no episodes of bacterial peritonitis due to S. epidermidis infection [11 mv (9-17), p < 0.05]. Thus electrical gradients caused by the presence of the CAPD catheter could contribute to colonisation and subsequent infection by skin commensals, by aiding bacterial migration.

‘Tumour’ in the ascending colon in a patient with recurrent bacterial peritonitis

‘Tumour’ in the ascending colon in a patient with recurrent bacterial peritonitis

Effect of monophosphoryl lipid A on the in vitro function of peritoneal leukocytes from uremic patients on continuous ambulatory peritoneal dialysis

We analyzed the effects of monophosphoryl lipid A (MPL), a relatively nontoxic immunostimulant derived from bacterial endotoxin, on the depressed in vitro immune function of leukocytes derived from six patients undergoing continuous ambulatory peritoneal dialysis and who had histories of recurrent bacterial peritonitis. MPL was also tested for its capacity to stimulate the proliferation of peritoneal fibroblasts, as determined by [3H]thymidine incorporation. In vitro incubation of peritoneal lymphocytes and macrophages (PM phi) with increasing amounts of MPL, up to 5 micrograms/ml, resulted in a dose-dependent enhancement of gamma interferon and interleukin-2 production by peritoneal lymphocytes and interleukin-1 release by PM phi. In vitro incubation of PM phi with MPL also resulted in an increase of PM phi bacterial killing and membrane Fc receptor number, although no change in peritoneal fibroblast proliferation was seen with any of the MPL concentrations tested. These results suggest that the peritoneal leukocyte dysfunction observed in patients undergoing continuous ambulatory peritoneal dialysis and who have high rates of peritonitis may be alleviated, to some degree, by MPL, without directly inducing a potentially deleterious fibrotic lesion.

The Use of Intracatheter Instillation of Streptokinase in the Treatment of Recurrent Bacterial Peritonitis in Continuous Ambulatory Peritoneal Dialysis

Recurrent bacterial peritonitis resistant to therapy with antibiotics is seen in a small percentage of patients maintained on continuous ambulatory peritoneal dialysis. In these patients, removal of the Tenckhoff catheter is necessary to achieve a cure. Sequestration of bacteria within fibrin clots located on the catheter has been postulated to contribute to this resistance to standard therapy. We, therefore, examined the efficacy of intraperitoneal streptokinase in combination with antibiotic therapy in the treatment of two patients with recurrent bacterial peritonitis. After addition of streptokinase to the therapeutic regimen, no further episodes of peritonitis were observed after 6 to 8 weeks follow-up. These data suggest that intraperitoneal streptokinase may be useful as adjunctive therapy in the treatment of recurrent bacterial peritonitis.

REMOVAL AND REPLACEMENT OF TENCKHOFF CATHETER AT A SINGLE OPERATION: SUCCESSFUL TREATMENT OF RESISTANT PERITONITIS IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS

8 episodes of persistent and 4 of recurrent bacterial peritonitis in 11 patients on continuous ambulatory peritoneal dialysis (CAPD) were treated successfully by the removal and immediate replacement of the Tenckhoff catheter. Intraperitoneal antibiotics, which had previously failed to produce clinical resolution of the peritonitis, were continued unchanged. Dialysate culture yielded Staphylococcus epidermidis (3 cases), Staphylococcus aureus (1 case), pseudomonas species (5 cases), acinetobacter (1 case), and no growth in 2 cases. Clinical and microbiological resolution was achieved in all 12 cases within 36 h. CAPD continued uninterrupted in 10 cases. 1 patient required temporary haemodialysis for 6 weeks because of dialysate leakage and later restarted CAPD. 1 patient chose haemodialysis as his long-term treatment when his new catheter failed mechanically on the second postoperative day. Replacement of the Tenckhoff catheter at a single operation without interrupting CAPD reduces the demand which temporary haemodialysis of these patients makes on centre dialysis facilities and may preserve the peritoneal cavity for dialysis by preventing the formation of adhesions.