Peritonitis is a critical complication of peritoneal dialysis (PD). Investigators have reported the risk of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) versus automated peritoneal dialysis (APD), but the available evidence is predominantly based on observational studies which failed to report on the connection type. Our understanding of the relationship between peritonitis risk and PD modality thus remained insufficient. We studied 285 participants who began PD treatment between 1997 and 2014 at three hospitals in Nara Prefecture in Japan. We matched 106 APD patients with 106 CAPD patients based on their propensity scores. The primary outcome was time to first episode of peritonitis within 3 years after PD commencement. In total, PD peritonitis occurred in 64 patients during the study period. Patients initiated on APD had a lower risk of peritonitis than did those initiated on CAPD in both the unadjusted and adjusted models. The hazard ratio (HR) and 95% confidence interval (CI) for the primary endpoint were 0.30 (0.17–0.53) in the fully adjusted model including connection type. In the matched cohort, APD patients had a significantly lower risk of peritonitis than did CAPD patients (log-rank: p < 0.001, HR 0.32, 95% CI 0.16–0.59). The weighting-adjusted analysis of the inverse probability of treatment yielded a similar result (HR 0.35, 95% CI 0.18–0.67). In conclusion, patients initiated on APD at PD commencement had a reduced risk of peritonitis compared with those initiated on CAPD, suggesting APD may be preferable for prevention of peritonitis among PD patients.
Streptococcus agalactiae, also known as group B Streptococcus (GBS), is a Gram-positive coccus that frequently colonizes the human genital and gastrointestinal tracts. Colonization in the genital tract of pregnant women is of particular importance because it can lead to serious infections in neonates. Recently, an increasing number of GBS cases causing invasive disease in non-pregnant adults have been reported. We herein report a case of infective endocarditis complicated by intraventricular abscess, pericarditis, and mycotic aneurysms due to GBS belonging to ST681, an emerging strain with capsular serotype VI.A 52-year-old woman was admitted to our hospital with generalized pain and muscle weakness over the prior week. Informed consent to publish this paper was obtained from the patient. Her medical history included hypertension, diabetes, hyperlipidemia, and alcoholic liver cirrhosis-all of which were untreated. Her vital signs were as follows: blood pressure, 94 40 mmHg; pulse, irregular and ranging between 30 and 170 beats per minute; temperature, 37.3 C; and respiratory rate, 16 breaths per minute. On physical examination, multiple dental caries and Levine grade 2 systolic murmur at the left apex were noted.Laboratory findings on admission were as follows: white blood cell count, 36 10 9 L; C-reactive protein, 147 mg L; creatinine, 123.8 µmol L; blood urea nitrogen, 12.9 mmol L; aspartate aminotransferase, 61 The transthoracic echocardiography revealed a large mass in the right atrium and a massive pericardial effusion. Coronary angiography revealed severe stenosis in the proximal left anterior descending (LAD) and total occlusion in the distal LAD. Balloon dilatation was performed in the proximal LAD. We performed pericardiocentesis and started empiric intravenous meropenem and vancomycin. The pericardial fluid and 2 sets of blood culture were positive for S. agalactiae. The penicillin G minimum inhibitory concentration was 0.06 µg mL using the broth microdilution method according to the Clinical Laboratory Standards Institute guidelines. We then switched to continuous infusion of penicillin G (24 million units every 24 hours) with gentamicin (60 mg every 8 hours). On day 10, a contrast-enhanced abdominal computed tomography (CT) scan was performed, on which low-density areas indicative of abscesses in the ventricular septum and free wall were incidentally identified (Fig. 1). We considered surgical treatment; however, the patient and her family refused surgery. On day 11, diffusion magnetic resonance imaging of the brain showed multiple high-intensity areas, suggesting multiple cerebral infarctions. According to the modified Duke criteria, we diagnosed definite infective endocarditis. Antimicrobial therapy was continued for a total of 6 weeks. The complete AV block resolved by day 10 and the low-density areas diminished on the CT scan by day 157; however, at this time, a new aneurysm was detected in the descending aorta. The patient was finally discharged from the hospital on day 189. There was no recurre...
Right atrial thrombi may be detected in patients with either atrial fibrillation or patent foramen ovale (PFO). We herein describe a rare case of right atrial thrombus which occurred on an apparently intact intra-atrial septum.A 48-year old woman was admitted to our hospital because of septic multiple systemic (coronary and cerebral) emboli. ECG revealed ST elevation and a Q wave in V2-6. Brain CT showed multiple cerebral emboli. Transthoracic echocardiography revealed hypokinesis of the ventricular septum. The right atrium was not dilated. Transesophageal echocardiography revealed a low echoic mass attached to the right atrial side of the inter-atrial septum (Picture 1A). After anticoagulation therapy (intravenous heparin 10,000 IU/day for 20 days), the size of the mass gradually decreased (Picture 1B) and it finally disappeared (Picture 1C). Neither PFO nor an atrial septal aneurysm was thereafter detected (Picture 2).Right atrial endothelial damage as a result of bacteremia and/or a hypercoagulable status might have contributed to thrombus formation in this case. The authors state that they have no Conflict of Interest (COI).
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