Peritonitis

Fried, Linda F.; Piraino, Beth

doi:10.1007/978-94-017-3225-3_17

Cited by 26 publications

(21 citation statements)

References 197 publications

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“…The morphometry was performed on four samples in each group, with a mean of 10 fields analyzed per sample. #P Ͻ 0.05 versus eNOS WT; *P Ͻ 0.05 versus eNOS KO; §P Ͻ 0.05 versus eNOS WT-p. related peritonitis, the catheter contamination from skin flora was completed by an inoculum of coagulase-negative Staphylococci-the most common organism responsible for peritonitis in PD patients (14,21). As compared with controls, mice with peritonitis showed cloudy dialysates with positive cultures and high WBC counts in the dialysate with a majority of polymorphonuclear leukocytes at day 1 followed by a progressive increase in macrophages and lymphocytes; mononuclear cells infiltrates and vascular proliferation in the peritoneum at day 7 ( Figures 3 through 5); upregulation of eNOS and iNOS ( Figures 4 and 6); increased permeability for urea and glucose, with a loss of sodium sieving ( Figure 2); and a combination of decreased UF and increased protein loss in the dialysate (Table 3).…”

Section: Discussionmentioning

confidence: 99%

Mice that Lack Endothelial Nitric Oxide Synthase Are Protected against Functional and Structural Modifications Induced by Acute Peritonitis

Ni¹,

Moulin²,

Gianello³

et al. 2003

Journal of the American Society of Nephrology

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Abstract. Pharmacologic studies suggest that the release of nitric oxide (NO) by endothelial NO synthase (eNOS) contributes to functional alterations of the peritoneal membrane (PM) induced by acute peritonitis. In this study, peritoneal permeability parameters in a mouse model of peritoneal dialysis were characterized, and the effects of eNOS deletion on the PM structure and permeability at baseline and after catheter-induced bacterial peritonitis were examined. Exposure of C57BL/6 mice to standard dialysate yielded a transport of urea and glucose, a sodium sieving, and a net ultrafiltration that were remarkably similar to the values obtained in rats. In comparison with controls, mice with catheter-induced peritonitis were characterized by structural changes in the PM (mononuclear cells infiltrate, vascular proliferation), upregulation of endothelial and inducible NOS, increased permeability for urea and glucose, decreased ultrafiltration, and increased protein loss in the dialysate. Comparison of eNOS wild-type and knockout mice revealed that the permeability modifications and structural changes induced by acute peritonitis were significantly reversed in eNOS knockout mice, resulting in a net increase in ultrafiltration. In contrast, the deletion of eNOS in mouse peritoneum was not reflected by permeability modifications or structural changes at baseline. These results are the first to take advantage of a knockout mouse model to demonstrate directly the crucial importance of eNOS in the permeability and structural modifications caused by acute peritonitis. The characterization of this mouse model suggests that genetically modified mice represent useful tools to investigate the molecular bases of the peritoneal changes during peritoneal dialysis.Despite technological advances and accumulating clinical experience, acute peritonitis remains the most frequent and serious complication of peritoneal dialysis (PD) (1). Understanding the molecular mechanisms that operate in acute peritonitis thus is an essential goal to reduce the functional and structural changes associated with the condition. Studies in rat and rabbit models of PD have demonstrated that transport across the peritoneal membrane (PM) depends on (1) the intrinsic permeability to each solute and (2) the effective peritoneal surface area (EPSA) reflecting the number of perfused capillaries within the peritoneum (2). The capillary endothelium, which expresses both the endothelial nitric oxide (NO) synthase (eNOS) and the water channel aquaporin-1 (AQP1), constitutes the major barrier for solutes and water transport during PD (3,4). Acute peritonitis is characterized by an increased EPSA, with increased permeability for small solutes and glucose, a faster-than-normal dissipation of the osmotic gradient, a decrease of free-water permeability, and a loss of ultrafiltration (UF) (5,6). These modifications are associated with mononuclear cell infiltrate and vascular proliferation within the PM (6).During the past decade, NO has emerged as a crucial mediator in...

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Section: Discussionmentioning

confidence: 99%

Mice that Lack Endothelial Nitric Oxide Synthase Are Protected against Functional and Structural Modifications Induced by Acute Peritonitis

Ni¹,

Moulin²,

Gianello³

et al. 2003

Journal of the American Society of Nephrology

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“…The most common cause of treatment-resistant peritonitis is a catheter tunnel-related infection, usually due to a S. aureus or P. aeruginosa infection of the subcutaneous tissue around the catheter cuffs [ 11 , 115 ]. The confirmation of a tunnel infection in therapy-resistant peritonitis necessitates immediate removal of the catheter, followed by 2–3 weeks of temporary hemodialysis and intravenous antibiotic therapy before a new catheter can be inserted, preferably on the contralateral side [ 11 ].…”

Section: Management Of Refractory Peritonitismentioning

confidence: 99%

Dialysis-associated peritonitis in children

2009

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Peritonitis remains a frequent complication of peritoneal dialysis in children and is the most common reason for technique failure. The microbiology is characterized by a predominance of Gram-positive organisms, with fungi responsible for less than 5% of episodes. Data collected by the International Pediatric Peritonitis Registry have revealed a worldwide variation in the bacterial etiology of peritonitis, as well as in the rate of culture-negative peritonitis. Risk factors for infection include young age, the absence of prophylactic antibiotics at catheter placement, spiking of dialysis bags, and the presence of a catheter exit-site or tunnel infection. Clinical symptoms at presentation are somewhat organism specific and can be objectively assessed with a Disease Severity Score. Whereas recommendations for empiric antibiotic therapy in children have been published by the International Society of Peritoneal Dialysis, epidemiologic data and antibiotic susceptibility data suggest that it may be desirable to take the patient- and center-specific history of microorganisms and their sensitivity patterns into account when prescribing initial therapy. The vast majority of patients are treated successfully and continue peritoneal dialysis, with the poorest outcome noted in patients with peritonitis secondary to Gram-negative organisms or fungi and in those with a relapsing infection.

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“…Resistance to Cpx and other quinolones is being increasingly reported in infections affecting the population at large, especially among aggressive bacteria such as MRSA, Enterococcus spp, and Acinetobacter spp, as also with ESBL-producing and non-fermenting gram-negative bacteria (31). Infections by these microbes demand individualized antimicrobial approaches and are not adequately covered by most regimes commonly used for initial treatment of PD-related peritonitis (4,5). Resistance to quinolones is known to occur by at least three mechanisms (31).…”

Section: Discussionmentioning

confidence: 99%

“…There are some accepted general premises, including the convenience of empiric coverage of both gram-positive and gram-negative bacteria until an isolation is obtained (4) but, beyond these, there is a remarkable lack of unanimity concerning decisions such as the preferable antibiotic administration route, the use of continuous versus intermittent treatment schedules, and the duration of therapy. The spectrum of antibiotic regimes applied for the primary treatment of PD-related peritonitis is endless (5). Local differences in the epidemiology of these infections and a relative paucity of quality evidence to clarify the question (6) are two of the main factors favoring such heterogeneity of approaches.…”

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confidence: 99%

Treatment of Peritoneal Dialysis-Related Peritonitis with Ciprofloxacin Monotherapy: Clinical Outcomes and Bacterial Susceptibility over Two Decades

et al. 2009

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Background There is controversy about the preferred initial antibiotic therapy for peritoneal dialysis (PD)-related peritonitis. Quinolones have been used extensively in this setting, yet their long-term effectiveness is unknown. Aim To analyze the results of a protocol of treatment of PD-related peritonitis with ciprofloxacin, maintained over two decades. Method We analyzed the clinical outcome of 682 episodes of bacterial peritonitis treated with intraperitoneal ciprofloxacin monotherapy, and the time course of bacterial susceptibility to this antimicrobial, in a historical cohort of 641 PD patients (1988-2007). Main outcome variables included changes to initial therapy and rates of hospital admission, catheter removal, relapse, reinfection, PD dropout, and mortality. For comparisons we divided the study period into phases A (1988-1994), B (1995-2000), and C (2001-2007). Results The incidence of Staphylococcus aureus peritonitis decreased, while the incidences of polymicrobial and negative-culture peritonitis increased after phase A. In vitro susceptibility to ciprofloxacin decreased significantly only among coagulase-negative staphylococci (87.0% susceptible strains in phase A vs 70.0% in B and 70.1% in C, p = 0.006). Overall success rates (catheter not removed and ongoing PD after the episode) remained stable, at over 85%. However, the proportion of patients treated solely with ciprofloxacin declined from 75.7% (A) to 47.3% (B) to 32.4% (C) ( p < 0.0005) and admission rates increased from 12.7% to 16.8% to 24.9% respectively ( p = 0.001). These changes affected all the etiologic groups except culture-negative peritonitis. In vitro resistance to ciprofloxacin was a marker of multiresistance and correlated strongly with clinical outcome of peritonitis. Among isolates susceptible to ciprofloxacin, changing initial therapy for any reason also predicted a poor outcome. Conclusions Following satisfactory early results, the effectiveness of ciprofloxacin as monotherapy for PD-related peritonitis has declined markedly in the long term. This decline cannot be explained solely by a decrease of in vitro susceptibility to this antimicrobial, which was significant only among coagulase-negative staphylococci. Resistance to ciprofloxacin is a strong marker of in vitro multiresistance and poor clinical outcome of peritonitis.

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Peritonitis

Cited by 26 publications

References 197 publications

Mice that Lack Endothelial Nitric Oxide Synthase Are Protected against Functional and Structural Modifications Induced by Acute Peritonitis

Mice that Lack Endothelial Nitric Oxide Synthase Are Protected against Functional and Structural Modifications Induced by Acute Peritonitis

Dialysis-associated peritonitis in children

Treatment of Peritoneal Dialysis-Related Peritonitis with Ciprofloxacin Monotherapy: Clinical Outcomes and Bacterial Susceptibility over Two Decades

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