Outcome of polymicrobial peritonitis in continuous ambulatory peritoneal dialysis patients

Kiernan, L.; Finkelstein, Frederic O.; Kliger, Alan S.; Gorban-Brennan, Nancy; Juergensen, Peter H.; Mobed, Ahmad; Brown, Eric

doi:10.1016/0272-6386(95)90109-4

Cited by 38 publications

(26 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although the majority of polymicrobial peritonitis can be successfully treated without catheter removal, the long-term prognosis is poor (26,27). Although traditionally thought to be secondary to underlying bowel pathology, no consistent risk factors have been identified in previous studies (28)(29)(30). In the PTP group, six of 11 patients developed polymicrobial peritonitis within 2 weeks of catheter insertion.…”

Section: Discussionmentioning

confidence: 99%

Peritonitis before Peritoneal Dialysis Training: Analysis of Causative Organisms, Clinical Outcomes, Risk Factors, and Long-Term Consequences

King-Wing

Chow

Kwan

et al. 2016

CJASN

View full text Add to dashboard Cite

Background and objectives Peritonitis before peritoneal dialysis (PD) training (pretraining peritonitis [PTP]) is an uncommon event. The study aim was to examine the causative organisms, clinical outcomes, risk factors, and long-term consequences of PTP.Design, setting, participants, & measurements In this single-center, retrospective, observational study involving all incident patients on PD who developed PTP between 1998 and 2012, we examined the causative organisms, primary response rate, complete cure rate, risk factors, and associations of PTP with peritoneal equilibration test (PET) and patient survival. For each patient in the PTP group, the patients who underwent catheter insertion immediately before and after the index case were identified as controls.Results Among 1252 incident patients on PD, 52 (4.2%) patients developed PTP, and 104 patients were identified as controls. The two groups were similar in age, sex distribution, comorbidities, and residual renal function, but the PTP group had significantly lower hemoglobin and serum albumin. Patients were followed up for a median of 37.5 months (interquartile range [IQR], 16.3-62.2 months). The most common causative organisms of PTP were Staphylococcus aureus (30.8%) and polymicrobial (21.2%); 25% had negative growth. The primary response and complete cure rates were 82.7% and 78.8%, respectively. In the PTP group, 7.7% of patients died, 9.6% of patients required catheter removal, and PD training was significantly delayed (median =42.0; IQR, 26.0-65.8 days versus 27.5; IQR, 23.0-35.0 days; P=0.01). Multivariate logistic regression analysis showed that serum albumin was the only predictor of PTP (adjusted odds ratio, 0.89 per 1-g/dl increase; 95% confidence interval, 0.82 to 0.97). There were no differences in PET results and dialysis adequacy (measured around 1 month after PD training). The PTP group had significantly worse patient survival (median =41.2; IQR, 21.8-60.5 months versus 55.8; IQR, 40.4-71.2 months; P=0.02). Technique failure occurred in 11.5% and 10.6% of patients in the PTP and control groups, respectively.Conclusions S. aureus is the most common causative organism of PTP. Nutritional interventions in patients who are hypoalbuminemic before catheter insertion deserve additional study.

show abstract

Section: Discussionmentioning

confidence: 99%

Peritonitis before Peritoneal Dialysis Training: Analysis of Causative Organisms, Clinical Outcomes, Risk Factors, and Long-Term Consequences

King-Wing

Chow

Kwan

et al. 2016

CJASN

View full text Add to dashboard Cite

show abstract

“…Peritonitis is an inflammatory disease of the lining of the abdominal wall and organs and is most frequently caused by infectious processes resulting from bowel perforation, laparotomy surgery, intestinal hernias, and, most commonly, insertion of medical devices, such as peritoneal dialysis (PD) catheters (8). Crucially, it has been documented that PD-mediated polymicrobial peritonitis results in higher incidences of relapsing infection, catheter loss, a permanent switch to hemodialysis (HD), and mortality than monomicrobial peritonitis, especially peritonitis involving fungi (9)(10)(11). Indeed, peritoneal infections involving fungi, namely, the Candida species, are becoming increasingly common in the hospital setting (12).…”

mentioning

confidence: 99%

Candida albicans-Staphylococcus aureus Polymicrobial Peritonitis Modulates Host Innate Immunity

2013

View full text Add to dashboard Cite

bDespite advances in medical device fabrication and antimicrobial treatment therapies, fungal-bacterial polymicrobial peritonitis remains a serious complication for surgery patients, those on peritoneal dialysis, and the critically ill. Using a murine model of peritonitis, we have demonstrated that monomicrobial infection with Candida albicans or Staphylococcus aureus is nonlethal. However, coinfection with these same doses leads to a 40% mortality rate and increased microbial burden in the spleen and kidney by day 1 postinfection. Using a multiplex enzyme-linked immunosorbent assay, we have also identified a unique subset of innate proinflammatory cytokines (interleukin-6, granulocyte colony-stimulating factor, keratinocyte chemoattractant, monocyte chemoattractant protein-1, and macrophage inflammatory protein-1␣) that are significantly increased during polymicrobial versus monomicrobial peritonitis, leading to increased inflammatory infiltrate into the peritoneum and target organs. Treatment of coinfected mice with the cyclooxygenase (COX) inhibitor indomethacin reduces the infectious burden, proinflammatory cytokine production, and inflammatory infiltrate while simultaneously preventing any mortality. Further experiments demonstrated that the immunomodulatory eicosanoid prostaglandin E 2 (PGE 2 ) is synergistically increased during coinfection compared to monomicrobial infection; indomethacin treatment also decreased elevated PGE 2 levels. Furthermore, addition of exogenous PGE 2 into the peritoneal cavity during infection overrode the protection provided by indomethacin and restored the increased mortality and microbial burden. Importantly, these studies highlight the ability of fungal-bacterial coinfection to modulate innate inflammatory events with devastating consequences to the host.

show abstract

“…Two recent studies using Pasteurella multocida and Borrelia burgdorferi have provided a more comprehensive view of in vivo bacterial gene expression by using DNA microarrays (3, 4, 33). These studies illustrate that a significant number of genes (2 to 8% of all the genes in the genomes) are differentially regulated in vivo, suggesting that the in vivo environment is distinct from normal in vitro culture conditions.Although evaluation of the transcriptomes of in vivo-grown bacteria provides a snapshot of transcription under monoculture growth conditions, it is clear that many infections are not simply the result of colonization by one bacterium but rather the pathogenic contributions of several bacteria (10,19,20,22,46). Such is the case for P. aeruginosa infections, particularly in the CF lung, which often consist of a consortium of pathogenic bacteria, including Staphylococcus aureus and Streptococcus pneumoniae (19,23).…”

mentioning

confidence: 99%

“…Although evaluation of the transcriptomes of in vivo-grown bacteria provides a snapshot of transcription under monoculture growth conditions, it is clear that many infections are not simply the result of colonization by one bacterium but rather the pathogenic contributions of several bacteria (10,19,20,22,46). Such is the case for P. aeruginosa infections, particularly in the CF lung, which often consist of a consortium of pathogenic bacteria, including Staphylococcus aureus and Streptococcus pneumoniae (19,23).…”

mentioning

confidence: 99%

Staphylococcus aureus Serves as an Iron Source for Pseudomonas aeruginosa during In Vivo Coculture

et al. 2005

View full text Add to dashboard Cite

Pseudomonas aeruginosa is a gram-negative opportunistic human pathogen often infecting the lungs of individuals with the heritable disease cystic fibrosis and the peritoneum of individuals undergoing continuous ambulatory peritoneal dialysis. Often these infections are not caused by colonization with P. aeruginosa alone but instead by a consortium of pathogenic bacteria. Little is known about growth and persistence of P. aeruginosa in vivo, and less is known about the impact of coinfecting bacteria on P. aeruginosa pathogenesis and physiology. In this study, a rat dialysis membrane peritoneal model was used to evaluate the in vivo transcriptome of P. aeruginosa in monoculture and in coculture with Staphylococcus aureus. Monoculture results indicate that approximately 5% of all P. aeruginosa genes are differentially regulated during growth in vivo compared to in vitro controls. Included in this analysis are genes important for iron acquisition and growth in low-oxygen environments. The presence of S. aureus caused decreased transcription of P. aeruginosa ironregulated genes during in vivo coculture, indicating that the presence of S. aureus increases usable iron for P. aeruginosa in this environment. We propose a model where P. aeruginosa lyses S. aureus and uses released iron for growth in low-iron environments.Pseudomonas aeruginosa is a gram-negative opportunistic human pathogen commonly found in water and soil. P. aeruginosa causes a number of chronic and acute infections and is noted for its inherent resistance to many clinically relevant antibiotics. Two of the most common infections caused by P. aeruginosa are chronic colonization of the lungs of individuals with the genetic disease cystic fibrosis (CF) (19) and peritonitis in individuals undergoing continuous ambulatory peritoneal dialysis (CAPD) (25). The lungs of CF patients are commonly colonized before the age of 8, and most individuals maintain these infections throughout their lifetimes. High infection rates are also associated with CAPD, which is often used to treat end-stage renal disease.P. aeruginosa physiology and gene expression during in vivo growth is largely unknown. Using in vivo expression technology (IVET), Wang et al. identified 19 P. aeruginosa genes inducible during growth in a neutropenic mouse (40). Although that study identified several new genes important for virulence in P. aeruginosa, it did not provide a comprehensive analysis of in vivo gene expression. Two recent studies using Pasteurella multocida and Borrelia burgdorferi have provided a more comprehensive view of in vivo bacterial gene expression by using DNA microarrays (3, 4, 33). These studies illustrate that a significant number of genes (2 to 8% of all the genes in the genomes) are differentially regulated in vivo, suggesting that the in vivo environment is distinct from normal in vitro culture conditions.Although evaluation of the transcriptomes of in vivo-grown bacteria provides a snapshot of transcription under monoculture growth conditions, it is clear that many in...

show abstract

Outcome of polymicrobial peritonitis in continuous ambulatory peritoneal dialysis patients

Cited by 38 publications

References 8 publications

Peritonitis before Peritoneal Dialysis Training: Analysis of Causative Organisms, Clinical Outcomes, Risk Factors, and Long-Term Consequences

Peritonitis before Peritoneal Dialysis Training: Analysis of Causative Organisms, Clinical Outcomes, Risk Factors, and Long-Term Consequences

Candida albicans-Staphylococcus aureus Polymicrobial Peritonitis Modulates Host Innate Immunity

Staphylococcus aureus Serves as an Iron Source for Pseudomonas aeruginosa during In Vivo Coculture

Contact Info

Product

Resources

About