Identification of Targets for Prevention of Peritoneal Catheter Tunnel and Exit-Site Infections in Low Incidence Settings

Santos, Clara; Pérez‐Fontán, Miguel; Rodríguez‐Carmona, Ana; Calvo-Rodríguez, María; López-Muñiz, Andrés; López‐Calviño, Beatriz; García-Falcón, Teresa

doi:10.3747/pdi.2014.00131

Cited by 5 publications

(4 citation statements)

References 28 publications

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“…In the current literature, most studies focused on the evaluation of the presence of ESI as a predictor of peritonitis 2,4,14 or studied the risk factors that predispose to the occurrence of the ESI. 4,15,16 Only two studies of our knowledge evaluated the ES score proposed by Schaefer and its association with ESI.…”

Section: Discussionmentioning

confidence: 99%

Clinical utility of a traditional score system for the evaluation of the peritoneal dialysis exit-site infection in a national multicentric cohort study

et al. 2020

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Introduction: Exit-site infection (ESI) is an important risk factor for peritonitis in patients under chronic peritoneal dialysis (PD). The International Society for Peritoneal Dialysis (ISPD) recommend its diagnosis as the presence of purulent drainage in the exit site (ES) but time-consuming scores using others skin signs are routinely used. Objective: To investigate the correlation between the diagnosis of ESI with a score based on five clinical signs obtained from ES inspection, and also if there are interaction with patient’s race. Methods: Multicenter and prospective cohort. We included adult patients from 122 clinics, incident on PD and with a 12-month stay in therapy. The event of interest was ESI, defined as purulent drainage. The clinical score used was composed of hyperemia, edema, pain, scab, and granuloma. Statistical analysis was performed using multilevel logistic regression model, likelihood test, and Cohen concordance analysis. Results: A total of 35,354 ES assessments were performed during the first year of dialysis in 3297 patients. There was a rate of 10.1 (9.1–11.2) episodes of ESI per 1000 patients/month. In patients with ESI, the prevalence of hyperemia was 55.9%, edema 67.3%, pain 31.8%, and scab 23.2%. The agreement with the score was 60.6% and showed differences according to the patient’s race, being 53.2% for African Americans descendants and 65.4% for others. The use of scales for the diagnosis of ESI does not add much information in addition to the presence of purulent secretion as currently recommended by the ISPD.

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Section: Discussionmentioning

confidence: 99%

Clinical utility of a traditional score system for the evaluation of the peritoneal dialysis exit-site infection in a national multicentric cohort study

et al. 2020

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“…This finding should not be completely unexpected. First, catheter-related streptococcal PDrP is an infrequent event ( Table 5 ) [ 23 , 24 ], downplaying the capacity of catheter care to prevent this complication. Touch contamination is a potential source of streptococcal infection, but the ubiquity (skin, mouth, upper respiratory tract, upper and lower gastrointestinal tract) of this genus of bacteria [ 17 ] entails more potential foci of contamination and, probably, a higher capacity for hematogenous spread than CNSt.…”

Section: Discussionmentioning

confidence: 99%

Long-term trends in the incidence of peritoneal dialysis-related peritonitis disclose an increasing relevance of streptococcal infections: A longitudinal study

et al. 2020

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Background The selective impact of strategies for prevention of PD-related peritonitis (PDrP) may have modified, in the long term, the causal spectrum, clinical presentation and outcomes of these infections. Objectives To compare trends in the incidence of PDrP by different microorganisms during a 30-year period, with a particular focus on streptococcal infections. To analyze the clinical presentation and outcomes of these infections. Secondarily, to investigate how the isolation of different species of streptococci can influence the clinical course of PDrP by this genus of bacteria. Method Following a retrospective, observational design we investigated 1061 PDrP (1990–2019). We used joinpoint regression analysis to explore trends in the incidence of PDrP by different microorganisms, and compared the risk profile (Cox), clinical presentation and outcomes (logistic regression) of these infections. Main results Our data showed a progressive decline in the incidence of PDrP by staphylococci and Gram negative bacteria, while the absolute rates of streptococcal (average annual percent change +1.6%, 95% CI -0.1/+3.2) and polymicrobial (+1.8%, +0.1/+3.5) infections tended to increase, during the same period. Remarkably, streptococci were isolated in 58.6% of polymicrobial infections, and patients who suffered a streptococcal PDrP had a 35.8% chance of presenting at least one other infection by the same genus. The risk profile for streptococcal infections was comparable to that observed for PDrP overall. Streptococcal PDrP were associated with a severe initial inflammatory response, but their clinical course was generally nonaggressive thereafter. We did not observe a differential effect of different groups of streptococci on the clinical presentation or outcome of PDrP. Conclusions Time trends in the incidence of PDrP by different microorganisms have granted streptococci an increasing relevance as causative agents of these infections, during the last three decades. This behaviour suggests that current measures of prevention of PDrP may not be sufficiently effective, in the case of this genus of microorganisms.

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“…The current studies indicate, in contrast, that blood-borne ehrlichiae neither gain access to the omentum nor elicit a B-1 cell response, unless delivered via the intraperitoneal route. Notwithstanding, our findings are of wider relevance for our knowledge of B cell responses that occur independently of secondary lymphoid tissues but are also relevant to host immunity to infectious agents that access the peritoneal cavity, via natural or hospital-acquired infections (39)(40)(41)(42). Rangel-Moreno et al previously demonstrated the ability of the omentum to collect peritoneal antigens and support TD immune responses, in the absence of secondary lymphoid organs (21).…”

Section: Discussionmentioning

confidence: 99%

The Omentum Is a Site of Protective IgM Production during Intracellular Bacterial Infection

et al. 2015

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Infection of mice with the bacterium Ehrlichia muris elicits a protective T cell-independent (TI) IgM response mediated primarily by a population of CD11c-expressing plasmablasts in the spleen. Although splenic marginal zone (MZ) B cells are considered to be important for TI responses to blood-borne pathogens, MZ B cells were not responsible for generating plasmablasts in response to Ehrlichia muris. Moreover, antigen-specific serum IgM was decreased only modestly in splenectomized mice and in mice that lacked spleen, lymph nodes, and Peyer's patches (SLP mice). Both splenectomized and SLP mice were protected against lethal ehrlichial challenge infection. Moreover, we found a high frequency of Ehrlichia-specific plasmablasts in the omentum of both conventional and SLP mice. Omental plasmablasts elicited during Ehrlichia infection lacked expression of CD138 but expressed CD11c in a manner similar to that of their splenic counterparts. Selective ablation of CD11c-expressing B cells nearly eliminated the omental Ehrlichia-specific plasmablasts and reduced antigen-specific serum IgM, identifying the omental B cells as a source of IgM production in the SLP mice. Generation of the omental plasmablasts was route dependent, as they were detected following peritoneal infection but not following intravenous infection. Our data identify the omentum as an important auxiliary site of IgM production during intracellular bacterial infection.

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Identification of Targets for Prevention of Peritoneal Catheter Tunnel and Exit-Site Infections in Low Incidence Settings

Cited by 5 publications

References 28 publications

Clinical utility of a traditional score system for the evaluation of the peritoneal dialysis exit-site infection in a national multicentric cohort study

Clinical utility of a traditional score system for the evaluation of the peritoneal dialysis exit-site infection in a national multicentric cohort study

Long-term trends in the incidence of peritoneal dialysis-related peritonitis disclose an increasing relevance of streptococcal infections: A longitudinal study

The Omentum Is a Site of Protective IgM Production during Intracellular Bacterial Infection

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