Peritonitis Associated with Intra-Abdominal Pathology in Continuous Ambulatory Peritoneal Dialysis Patients

Tzamaloukas, Antonios H.; Obermiller, Leo E.; Gibel, Laurence J.; Murata, Glen H.; Wood, Barbara; Simon, Denise; Erickson, Dale G.; Kanig, Steven P.

doi:10.1177/089686089301302s83

Cited by 47 publications

(34 citation statements)

References 4 publications

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“…It is clear that abdominal catastrophes such as cholecystitis, ischemic bowel disease, and infectious diarrhea can lead to peritonitis, but these generally are infrequent events. [114][115][116][117][118] Transmural migration of bacteria due to severe constipation appears to be a cause in some patients. 118 Every effort should be made to avoid constipation in PD patients.…”

Section: Preventing Gastrointestinal Sources Of Peritonitismentioning

confidence: 99%

Prevention of infectious complications in peritoneal dialysis: best demonstrated practices

Bender

Bernardini

Piraino

2006

Kidney International

134

125

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Peritoneal dialysis (PD) related infections continue to be a serious complication for PD patients. Peritonitis can be associated with pain, hospitalization and catheter loss as well as a risk of death. Peritonitis risk is not evenly spread across the PD population or programs. Very low rates of peritonitis in a program are possible if close attention is paid to the causes of peritonitis and protocols implemented to reduce the risk of infection. Protocols to decrease infection risk in PD patients include proper catheter placement, exit-site care that includes Staphylococcus aureus prophylaxis, careful training of patients with periodic retraining, treatment of contamination, and prevention of procedure-related and fungal peritonitis. Extensive data have been published on the use of antibiotic prophylaxis to prevent exit site infections. There are fewer data on training methods of patients to prevent infection risk. Quality improvement programs with continuous monitoring of infections, both of the catheter exit site and peritonitis, are important to decrease the PD related infections in PD programs. Continuous review of every episode of infection to determine the root cause of the event should be routine in PD programs. Further research is needed examining approaches to decrease infection risk.

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Section: Preventing Gastrointestinal Sources Of Peritonitismentioning

confidence: 99%

Prevention of infectious complications in peritoneal dialysis: best demonstrated practices

Bender

Bernardini

Piraino

2006

Kidney International

134

125

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“…This is usually indicative of an infectious aetiology, but other scenarios must be considered – particularly, in the absence of microbial isolates. Intraperitoneal and juxtaperitoneal visceral inflammation is frequently associated with an aseptic and cloudy effluent due to neutrophil translocation from nearby inflamed viscera, sometimes evolving with perforation which may lead to polymicrobial peritonitis 1,2,20 . In these cases, diagnosis is frequently hindered by the absence of the characteristic localizing signs of catastrophic abdominal events, masked by the generalized pain typically found in peritonitis 20 .…”

Section: Discussionmentioning

confidence: 99%

Clearing the clouds: Case‐report and review of the literature

Relvas

Beco

Pereira

et al. 2020

Seminars in Dialysis

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In peritoneal dialysis (PD), a cloudy dialysate is an alarming finding. Bacterial peritonitis is the most common cause, however, atypical infections and non‐infectious causes must be considered. A 46‐year‐old man presented with asthenia, paraesthesia, foamy urine and hypertension. Laboratory testing revealed severe azotaemia, anaemia, hyperkalaemia and nephrotic‐range proteinuria. Haemodialysis was started through a central venous catheter. Later, due to patient preference, a Tenckhoff catheter was inserted. Conversion to PD occurred 3 weeks later, during hospitalization for a presumed central line infection. A month later, the patient was hospitalized for neutropenic fever. He was diagnosed an acute parvovirus infection and was discharged under isoniazid for latent tuberculosis. Four months later, the patient presented with fever and a cloudy effluent. Peritoneal fluid (PF) cytology was suggestive of infectious peritonitis, but the symptoms persisted despite antibiotic therapy. Bacterial and mycological cultures were negative. No neoplastic cells were detected. Mycobacterium tuberculosis eventually grew in PF cultures, despite previous negative molecular tests. Directed therapy was then initiated with excellent response. Thus, facing a cloudy effluent, one must consider multiple aetiologies. Diagnosis of peritoneal tuberculosis is hampered by the lack of highly sensitive and specific exams. Here, diagnosis was only possible due to positive mycobacterial cultures.

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“…Despite a number of technological advances, infection remains the leading complication of PD and contributes significantly to the patient morbidity and mortality. These infections have been associated with translocation of bacteria across the bowel wall , intra‐abdominal pathologies , hypokalemia , contamination , hand hygiene , surgical technique such as tunnel direction and also climate. This effect has been described in various climates around the globe and in the following discussion we will be referring briefly to the main outcomes of these respective studies.…”

Section: Discussionmentioning

confidence: 99%

Seasonal Variation in the Peritoneal Dialysis‐Related Infections: A Single Center Experience in the Mediterranean

et al. 2016

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Seasonal variation in the incidence of peritoneal dialysis-related infections (PDRI) has been sparingly investigated, especially in the Mediterranean. Our aim was to explore this association in Malta. All PDRI occurring between Jan-2008 and Dec-2012 were retrospectively studied.A total of 137 patients were followed-up for a median time of 32.5 months (range: 2-81). During this time, 19% never had PDRI, 11.7% transferred permanently to hemodialysis and 6.6% received a kidney transplant. A total of 279 PDRI were identified, equating to 145 catheter-related infections (CRI) and 144 peritonitis episodes (including 10 catheter related peritonitis). A spring peak in the overall gram positive PDRI (0.61 vs. 0.34/patient-year-at-risk, P=0.05), together with a peak in gram negative peritonitis in the warm period (0.13 vs. 0.07/patient-year at risk, P=0.04) was identified. The incidence rate ratios (Confidence Interval) involving the overall gram positive PDRI, gram positive peritonitis, coagulase-negative Streptococci (CoNS) and Streptococci were 1.82 (1.18-2.82, P=0.007), 2.20 (1.16-4.16, P=0.02), 2.65 (1.17-6.02, P=0.02] and 3.18 (1.03-9.98, P=0.04) in spring when compared to winter. No significant difference in the overall PDRI, peritonitis or CRI rates between seasons or warm/cold period was identified.To our knowledge, this is the first study which examines the effect of seasons on the incidence of PDRI in the Mediterranean basin. Findings suggest that spring confers a higher risk for gram positive PDRIs, gram positive peritonitis, CoNS and Streptococcus, whilst the warm period was associated with a peak in the gram negative peritonitis.

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Peritonitis Associated with Intra-Abdominal Pathology in Continuous Ambulatory Peritoneal Dialysis Patients

Cited by 47 publications

References 4 publications

Prevention of infectious complications in peritoneal dialysis: best demonstrated practices

Prevention of infectious complications in peritoneal dialysis: best demonstrated practices

Clearing the clouds: Case‐report and review of the literature

Seasonal Variation in the Peritoneal Dialysis‐Related Infections: A Single Center Experience in the Mediterranean

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