Peritonitis in Continuous Ambulatory Peritoneal Dialysis Patients

Rubin, Jack; Ray, Ricé; Barnes, Tom; Teal, Nancy; Hellems, Eric; Humphries, Joe; Bower, John D.

doi:10.1016/s0272-6386(83)80039-0

Cited by 33 publications

(26 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The mean and median intervals are not significantly different between episodes (115), and, with the possible exception of corynebacteria (1,74,94,107), bacteria (but not fungi) do not show any preference for any episode (131,136). Multiple episodes are observed in more than 50% of all patients who have gone through one episode (47,115,134); in one series, two-thirds of the episodes were relapses, i.e., infections with the same microorganisms (47). Exit site infections have occurred at a mean rate of 0.7 per patient per year (83); this value, of course, would increase with an increased incidence of peritonitis caused by S. aureus and P. aeruginosa, the main agents of exit site infections.…”

Section: Microbiological Findingsmentioning

confidence: 87%

“…Wu et al have shown that the most likely source of an intestinal leak is through a preexisting diverticulosis in these patients (157). Some studies indicate that transmural migration of Escherichia coli from the gastrointestinal tract into the peritoneal cavity does occur (115,143). Other contributing endogenous routes of infection have included vaginal leaks of peritoneal dialysis fluid (135).…”

Section: Portals Of Entry and Microbial Pathogenicity Factorsmentioning

confidence: 99%

“…There is unanimity that the sensitivity of the Gram stain (even on centrifuged samples) and the acridine orange stain (139) is low. Because of the low concentration of microorganisms in the dialysate, tinctorial sensitivity compared with that of culture results has been reported to range only between 10 and 50% (36,68,90,115,116). Gram-positive organisms may have a higher chance of being detected on Gram stain than gram-negative ones (82).…”

Section: Microbiological Findingsmentioning

confidence: 99%

“…Approximately 60% of patients on CAPD will have developed at least one episode of peritonitis during the first year of dialysis (97,134). The mean and median intervals are not significantly different between episodes (115), and, with the possible exception of corynebacteria (1,74,94,107), bacteria (but not fungi) do not show any preference for any episode (131,136). Multiple episodes are observed in more than 50% of all patients who have gone through one episode (47,115,134); in one series, two-thirds of the episodes were relapses, i.e., infections with the same microorganisms (47).…”

Section: Microbiological Findingsmentioning

confidence: 99%

“…The presence of members of the Enterobacteriaceae in dialysis fluid most often indicates fecal contamination due to bowel perforation (e.g., in diverticulitis) or possible migration through the bowel wall (115,143,157). In an occasional hospitalized patient, organisms may migrate into the lumen from the skin or the patient's feces (2).…”

Section: Enterobacteriaceaementioning

confidence: 99%

See 4 more Smart Citations

Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis

1992

View full text Add to dashboard Cite

The process of continuous ambulatory peritoneal dialysis has provided a useful, relatively inexpensive, and safe alternative for patients with end-stage renal disease. Infectious peritonitis, however, has limited a more widespread acceptance of this technique. The definition of peritonitis in this patient population is not universally accepted and does not always include the laboratory support of a positive culture (or Gram stain). In part, the omission of clinical microbiological findings stems from the lack of sensitivity of earlier microbiological efforts. Peritonitis results from decreased host phagocytic efficiency with depressed phagocytosis and bactericidal capacity of peritoneal macrophages. During episodes of peritonitis, fluid movement is reversed, away from the lymphatics and peritoneal membrane and toward the cavity. As a result, bloodstream infections are rare. Most peritonitis episodes are caused by bacteria. Coagulase-negative staphylococci are the most frequently isolated organisms, usually originating from the skin flora, but a wide array of microbial species have been documented as agents of peritonitis. Clinical microbiology laboratories need to be cognizant of the diverse agents so that appropriate primary media can be used. The quantity of dialysate fluid that is prepared for culture is critical and should constitute at least 10 ml. The sensitivity of the cultural approach depends on the volume of dialysate, its pretreatment (lysis or centrifugation), the media used, and the mode of incubation. The low concentration of microorganisms in dialysate fluids accounts for negative Gram stain results. Prevention of infection in continuous ambulatory peritoneal dialysis patients is associated with the socioeconomic status of the patient, advances in equipment (catheter) technology, and, probably least important, the application of prophylactic antimicrobial agents.

show abstract