Treatment Of Bacterial Peritonitis Research Articles

Ceftriaxone pharmacokinetics by new simple and sensitive ultra-high-performance liquid chromatography method

Ceftriaxone is a cephalosporin antibiotic with a potent antimicrobial activity and excellent penetration in most body fluids such as pleural, peritoneal, spinal and brain. These facts contribute to the application of ceftriaxone in the treatment of bacterial peritonitis, an abdominal disorder in veterinary medicine, with potential risk of death. The determination of ceftriaxone levels in plasma and peritoneal fluid may be used to assess the pharmacokinetic profile at various instances of administration and allows observing if the concentrations needed are being achieved. Therefore a method was developed and validated for the determination of ceftriaxone in plasma and peritoneal fluid which after was applied in a pharmacokinetic profile study. The bioanalytical method validation was performed according to widely acceptable experiments. Two horses were used as a model of the method applicability; ceftriaxone was intraperitoneally administered to these animals as a single dose. The plasma and peritoneal fluid analysis were performed using an UHPLC system in reverse phase chromatography mode in fully validated conditions. The methods have shown linearity between 0.49 and 500μg/mL for plasma, and between 0.24 and 500μg/mL for peritoneal fluid. The quantitative analysis of ceftriaxone in these matrices allows monitoring of the therapy. This method showed improved sensitivity as well as the quantitation in peritoneal fluid.

190 CHANGES IN THE ETIOLOGIC AND ANTIBIOTIC RESISTANCE PROFILES OF BACTERIA CAUSING SPONTANEOUS PERITONITIS IN EGYPTIAN PATIENTS WITH LIVER CIRRHOSIS

To evaluate the recent changes in bacteria causing spontaneous bacterial peritonitis (SBP) in cirrhotic patients and its clinical significance on treatment, we compared the etiologic agents and their antibiotic resistance profiles over a four year period. In the prospective period of the study, 150 ascitic fluid (AF) samples obtained from SBP patients admitted consecutively to the Hepatology Department of Theodor Bilharz Research Institute during 2006-2007 were examined for polymorphnuclear leukocytes (PMLs) by blood cell counter and by a bedside dipstick test (Multistix SG10, Bayer). Blood and AF cultures were performed using BACTEC blood culture bottles and purified bacterial isolates were identified with a BBL Crystal Id System and software. Antibiotic sensitivity testing and extended-spectrum beta-lactamase (ESBL)- production were determined by disk diffusion and modified double disk synergy tests (MDDST) respectively. Genes encoding ESBLs were detected by PCR and typed by DNA sequencing. In the retrospective period of the study (20042005), the laboratory records of 140 episodes of SBP were examined for the culture positive rate, causes of SBP and their antibiotic resistance patterns recorded. Results showed that the overall culture positivity rate was significantly higher in prospective study period (32%) versus retrospective period (16.4 %) p<0.05 and the main bacterial isolates were E.coli, 47.8% and Klebsiella pneumoniae, 28.1% with no differences in the two study periods. Gram positive bacteria (GPB) were isolated more frequently in the prospective than retrospective period (25% versus 13%). Two opportunistic bacterial species (Staphylococcus haemolyticus and Pantoea agglomerans) were detected as a cause of SBP in the prospective period. Species identification of Pantoea isolate was confirmed by DNA extraction, sequencing of ribosomal RNA and phylogenetic analysis. ESBLs were detected among 17.6% of E. coli and Klebsiella isolates of the prospective period and all were of the CTX-M15 type. The rate of resistance to cefotaxime significantly increased from 45% to 72 % and to ciprofloxacin from 25% to 47% and treatment failure rate was 65% in recent years. No resistance was detected to imipenem over the entire study period. For the GPB, 50% were resistant to ampicilin/sulbactam, cefotaxime and gentamicin and one S. haemolyticus isolate was methicillin resistant. In conclusion the emergence of multidrug resistant opportunistic pathogens and ESBL-producing E. coli and Klebsiellae as causal agents of SBP, together with an increase in resistance to antibiotics commonly used for the empiric treatment of bacterial peritonitis have serious implications on patient management in our region. Rapid diagnosis of SBP by a bedside dipstick test and identification of the causative organism by culture using blood culture bottles and direct sensitivity testing to establish an effective antibiotic therapy is recommended.

Antiseptics in the treatment of bacterial peritonitis in rats.

A controlled mixed peritoneal infection was produced by inoculation of bacteria into the peritoneum and peritonitis was allowed to become established. A laparotomy was performed and peritoneal toilet with a variety of agents was carried out. Local povidone-iodine in the inflamed peritoneum proved to be not only of no benefit but, in fact, to be toxic. In the standard concentrations recommended it proved lethal. Noxythiolin 2.5 per cent also had no beneficial effect. There was a significant difference between the effect of povidone-iodine when instilled into an inflamed peritoneum and instillation into the intact peritoneal cavity. We would advise caution in the use of these antiseptics in any situation in which local defence mechanisms have been compromised as a result of established infection.

Neonatal Peritoneal Dialysis

After completing this article, readers should be able to: 1. List the indications for peritoneal dialysis (PD) in neonates. 2. Delineate neonates who are poor candidates for PD. 3. Review the parameters of the PD prescription. 4. Review special nutrition considerations for neonates who are undergoing PD. 5. Review potential complications of PD in neonates. Peritoneal dialysis (PD) is generally considered the optimal dialysis modality for neonates. PD allows for the slow removal of fluid and solutes while avoiding hemodynamic instability. It is technically simple and, when necessary, can be performed continuously in the neonate hospitalized in the neonatal intensive care unit. In this review, we discuss the salient features of neonatal PD, including the rationale and indications for PD, its advantages and disadvantages, the PD prescription, nutritional considerations for the neonate undergoing PD, and the management of peritonitis. ### Rationale and Indications for Dialysis in Neonates Acute renal failure is common, occurring in as many as 23% of neonates hospitalized in neonatal intensive care units. There are excellent reviews in the literature that discuss the causes, pathophysiology, and medical management of acute renal failure in the neonate (see Acute Renal Failure Management in the Neonate in this issue of NeoReviews ). A partial list of the causes of acute renal failure in neonates is provided in Table 1. | Prerenal | || | | | Intrinsic | | | | Postrenal | | | Table 1. Causes of Acute Renal Failure The decision to initiate dialysis typically is necessitated by recalcitrant electrolyte abnormalities, worsening uremia, fluid overload, persistent acid-base abnormalities, …

Pharmacokinetic Study of Antimicrobial Agents in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

A pharmacokinetic study was done in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) to establish an appropriate treatment for bacterial peritonitis. Twenty-nine CAPD patients were randomized to receive either oral ofloxacin (OFLX) 300mg, followed by 200mg once a day; intraperitoneal vancomycin (VCM) 30mg/kg once a week; or intravenous imipenem/cilastatin (IPM/CS) 1000mg once a day. Pharmacokinetic simulation models were determined according to changes of doses and duration. The time to reach the maximum plasma concentration (<i>t</i>_max), the maximum plasma concentration (<i>C</i>_max), the plasma elimination half-life (<i>t</i>_1/2), and area under the curve (AUC) were, respectively, 5.2 hours, 4.7 μg/mL, 20.4 hours and 80.5 μg/mL/h (AUC_0–24) for OFLX, 7.0 h, 26.4 μg/mL, 92.0 hours, and 1641 μg/mL/h (AUC_0–120) for VCM, 1.1 hour, 62.3 μg/ml, 3.76 hours, and 229.3 μg/mL/h (AUC₀₋₁) for IPM/CS. Twenty-three of 27 (85%) strains of clinical isolates were gram-positive cocci; 20 strains (74%) consisted of staphylococci or streptococci. The MIC₉₀ of OFLX, VCM, and IPM was 3.13, 1.56, and 0.78 μg/mL, respectively. When the minimum concentration in the dialysate during the initial 5 days was higher than the MIC, all the isolates (7 out of 7) were eradicated, when it was lower, only half of the isolates (3 out of 6) were eradicated. The simulation study suggested a significant drug accumulation in response to shortening the dosing duration. J Infect Chemother 1996;2:167–178

Effect of recombinant interleukin-2 on course of experimental staphylococcal peritonitis in mice

The effect of RIL-2 on the survival of mice with S. aureus--induced peritonitis was studied. Animals received bacterial suspension and RIL-2 as following: bacteria--on days 0, +2, RIL-2--day 0 (group 1); bacteria--days 0, +4, RIL-2--days 0, +2 (group 2); bacteria--days 0, +6, RIL-2--days 0, +2, +4 (group 3). RIL-2 exerted no protective effect in group 1. However, in groups 2 and 3, where the control animals survival was, resp., 56% and 38%, the RIL-2 treatment increased survival up to, resp., 84% and 70%. Antibiotics given instead of RIL-2 in analogous regimen decreased the survival in group 3 to the level of 25%. Thus, RIL-2 proved to be a potent therapeutic agent in the 2nd of 3d studied models of S. aureus--induced peritonitis in mice. The perspectives of RIL-2 use in the treatment of bacterial peritonitis, including porous ones, and of the immunodepression--aggravated conditions are discussed.