Cloudy Dialysate and Pseudomembranous Colitis in a Patient on CAPD

Sakao, Yukitoshi; Kato, Akira; Sugiura, T.; Fujikura, Tomoyuki; Murakami, Takashi; Tsuji, Tetsuya; Sakakima, Masanori; Yasuda, H; Fujigaki, Yoshihide; Hishida, Akira

doi:10.1177/089686080802800528

Cited by 2 publications

(2 citation statements)

References 8 publications

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“…1). On one hand these patients may have a non-infectious neutrophilic reaction due to the presence of peri-peritoneal inflammation/colitis while on the other, the possibilities exist for a true bacterial peritonitis either with C. difficile itself or related to the other more conventional bacteria [4,17,18,23]. Findings of cloudy effluent in these situations do not assist in establishing the diagnosis of either, and the current guidelines trigger empiric initiation of broad-spectrum antimicrobials, including third generation cephalosporins for the management of PD peritonitis.…”

Section: Discussionmentioning

confidence: 99%

Clostridioides difficile associated peritonitis in peritoneal dialysis patients – a case series based review of an under-recognized entity with therapeutic challenges

et al. 2020

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Background: Initial presentation of peritoneal dialysis associated infectious peritonitis can be clinically indistinguishable from Clostridioides difficile infection (CDI) and both may demonstrate a cloudy dialysate. Empiric treatment of the former entails use of 3rd-generation cephalosporins, which could worsen CDI. We present a logical management approach of this clinical scenario providing examples of two cases with CDI associated peritonitis of varying severity where the initial picture was concerning for peritonitis and treatment for CDI resulted in successful cure. Case presentation: A 73-year-old male with ESRD managed with PD presented with fever, abdominal pain, leukocytosis and significant diarrhea. Cell count of the peritoneal dialysis effluent revealed 1050 WBCs/mm 3 with 71% neutrophils. C. difficile PCR on the stool was positive. Patient was started on intra-peritoneal (IP) cefepime and vancomycin for treatment of the peritonitis and intravenous (IV) metronidazole and oral vancomycin for treatment of the C. difficile colitis but worsened. PD fluid culture showed no growth. He responded well to IV tigecycline, oral vancomycin and vancomycin enemas. Similarly, a 55-year-old male with ESRD with PD developed acute diarrhea and on the third day noted a cloudy effluent from his dialysis catheter. PD fluid analysis showed 1450 WBCs/mm 3 with 49% neutrophils. IP cefepime and vancomycin were initiated. CT of the abdomen showed rectosigmoid colitis. C. difficile PCR on the stool was positive. IP cefepime and vancomycin were promptly discontinued. Treatment with oral vancomycin 125 mg every six hours and IV Tigecycline was initiated. PD fluid culture produced no growth. PD catheter was retained. Conclusions: In patients presenting with diarrhea with risk factors for CDI, traditional empiric treatment of PD peritonitis may need to be reexamined as they could have detrimental effects on CDI course and patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Clostridioides difficile associated peritonitis in peritoneal dialysis patients – a case series based review of an under-recognized entity with therapeutic challenges

et al. 2020

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“…Peritoneal dialysis-induced changes in the gut's permeability can result in translocation of bacteria and endotoxins from the intestines into the blood vessels and dialysate. [1][2][3] Both effects can result in stimulation of the systemic inflammatory reaction and intraperitoneal inflammationcausing long-term peritoneal damage. Szeto et al found in peritoneal dialysis patients that plasma levels of endotoxins correlate with serum C-reactive protein level and with the carotid intima-media thickness.…”

Section: Introductionmentioning

confidence: 99%

Hyaluronan reduces colitis-induced intraperitoneal inflammation during peritoneal dialysis

Jasiński

Bręborowicz

2021

Perit Dial Int

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Background: Peritoneal dialysis induces the inflammatory response within the peritoneal cavity, which contributes to the progressive damage of the peritoneum. Due to close contact of the peritoneal cavity and the intestines, there is the possibility that the visceral disorders can affect the intraperitoneal inflammation during peritoneal dialysis. Objectives: Study of the effect of acute colitis on the intraperitoneal inflammation in conditions of peritoneal dialysis and evaluation of the protective effect of hyaluronan in that scenario. Methods: In rats with the dextran sulphate-induced colitis, 6-h peritoneal dialysis was performed with dianeal 2.5% +/− hyaluronan 10 mg/dL. In the control group, rats without colitis were studied. Peritoneal permeability and dialysate inflammation were studied at the end of the dialysate exchange. Results: In rats with colitis, intraperitoneal inflammatory reaction was increased as compared with the control group and reflected by the following studied parameters: dialysate cell count (+26%, p < 0.01), number of neutrophils (+75%, p < 0.01), generation of free radicals in the leukocytes (+70%, p < 0.05), dialysate level of elastase (+102%, p < 0.01), tumor necrosis factor α (+48%, p < 0.01) and monocyte chemoattractant protein-1 (+42%, p < 0.01). Drained dialysate volume was lower (−21%, p < 0.01) and peritoneal permeability increased in rats with colitis (+55%, p < 0.01). In animals with the hyaluronan supplemented dialysis fluids, the intensity of the intraperitoneal inflammation was reduced. Conclusions: Visceral inflammation during colitis induces the inflammatory reaction within the peritoneal cavity that may accelerate damage to the peritoneum. Supplementation of the dialysis fluid with hyaluronan reduces the intensity of that effect.

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Cloudy Dialysate and Pseudomembranous Colitis in a Patient on CAPD

Cited by 2 publications

References 8 publications

Clostridioides difficile associated peritonitis in peritoneal dialysis patients – a case series based review of an under-recognized entity with therapeutic challenges

Clostridioides difficile associated peritonitis in peritoneal dialysis patients – a case series based review of an under-recognized entity with therapeutic challenges

Hyaluronan reduces colitis-induced intraperitoneal inflammation during peritoneal dialysis

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