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1.
Peritonitis is a common problem in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and represents the most frequent cause of peritoneal catheter loss and discontinuation of CAPD. The incidence of peritonitis remains less than one episode per patient year of treatment. Common bacteria, particularly staphyloccal species, are the usual causative agents. Fungi and higher bacteria such as Nocardia as aetiological agents have been infrequent in patients undergoing CAPD. We report a case of Nocardia nova peritonitis complicated by an intra‐abdominal abscess requiring surgical drainage and a protracted course of antibiotics. 相似文献
2.
Fungal peritonitis is a serious complication of chronic peritoneal dialysis (CPD) and is frequently associated with CPD drop-out.
Paecilomyces variotii, a common saprophytic fungus, rarely causes human infection. To date, only nine adult or adolescent patients with P. variotii peritonitis during continuous ambulatory peritoneal dialysis have been reported. In all patients, successful treatment required
antifungal therapy and removal of the peritoneal catheter. We report the first case of P. variotii peritonitis in an infant on automated peritoneal dialysis successfully treated with combined intraperitoneal and oral fluconazole,
without removal of the peritoneal catheter.
Received: 10 March 1999 / Revised: 7 July 1999 / Accepted: 8 July 1999 相似文献
3.
Nithin Karakala Lisa L. Steed Michael E. Ullian 《International urology and nephrology》2013,45(1):289-291
We report the case of acute peritonitis caused by a rapidly growing mycobacterium in a chronic peritoneal dialysis patient, whose renal failure had been caused by diabetic glomerulosclerosis. The organism cultured from the peritoneal dialysis fluid was Mycobacterium wolinskyi. Peritonitis caused by M. wolinskyi in a chronic peritoneal dialysis patient has never been reported before. 相似文献
4.
Capnocytophaga canimorsus, a bacterium rarely encountered by clinicians, was responsible for the development of peritonitis in an 18-year-old white
male on automated peritoneal dialysis following the puncture of his dialysis tubing by a domestic cat. Although more than
100 cases of septicemia caused by C. canimorsus have been reported, this is the first report of the organism causing peritonitis in a patient receiving peritoneal dialysis.
Of interest, the patient had a prior episode of peritonitis secondary to Pasteurella multocida, also following transmission from the same cat.
Received: 20 November 1998 / Revised: 13 January 1999 / Accepted: 13 January 1999 相似文献
5.
Sharon P. Andreoli Carl D. Langefeld Sally Stadler Paula Smith Allison Sears Karen West 《Pediatric nephrology (Berlin, Germany)》1993,7(5):543-547
Children undergoing long-term peritoneal dialysis are at risk for membrane injury, necessitating conversion to hemodialysis. We analyzed the incidence and risk factors for membrane failure (inadequate ultrafiltration with or without peritoneal adhesions and decreased peritoneal surface area) in 68 children maintained with peritoneal dialysis for more than 3 months at our institution. The overall incidence of membrane failure was 16.2% (11/68). Kaplan-Meier estimates of peritoneal membrane survival were 88% at 24 months, 72% at 36 months, 65% at 48 months, and 52% at 60 months. Logistic regression analysis demonstrated that the risk of membrane failure increased with the number of episodes of peritonitis (odds ratio 1.61). The rate of peritonitis was 1 per 7.02 patient months in children who developed membrane failure compared with 1 per 9.18 patient months in children without membrane failures but the rate of peritonitis was not predictive of membrane failure (P=0.09). Multiple logistic regression analysis demonstrated that peritonitis caused byPseudomonas aeruginosa or alpha streptococcal organisms were independent predictors of membrane failure. We conclude that peritoneal membrane survival declines substantially with time on peritoneal dialysis and that membrane failure is associated with peritonitis, particularly peritonitis caused byPseudomonas aeruginosa and alpha streptococcal organisms. The mechanism(s) of membrane injury are unknown but may be related to the inflammatory response initiated during peritonitis. 相似文献
6.
Matsumoto N Shiraga H Takahashi K Kikuchi K Ito K 《Pediatric nephrology (Berlin, Germany)》2002,17(4):243-245
Aspergillus peritonitis is a rare, potentially fatal complication of continuous ambulatory peritoneal dialysis (CAPD). We report the
successful treatment of refractory fungal peritonitis in an 8-year-old girl treated by peritoneal dialysis for 3.3 years.
This is the second report of Aspergillus thermomutatus (telemorph: Neosartorya pseudofischeri) in humans. Comprehensive treatment included early removal of the CAPD catheter, the use of liposomal amphotericin B, and
the use of itraconazole.
Received: 21 August 2001 / Revised: 17 December 2001 / Accepted: 18 December 2001 相似文献
7.
《American journal of kidney diseases》1999,33(3):e5.1-e5.5
Fungal peritonitis is an uncommon, serious complication of peritoneal dialysis, usually caused by Candida sp . Asymptomatic fungal colonization of the peritoneal catheter is less frequent. Penicillium sp have only rarely been reported as a cause of peritoneal complications in peritoneal dialysis. We report a case of fever and peritoneal catheter malfunction associated with catheter colonization by Penicillium sp , in the absence of signs or symptoms of acute peritonitis. Cultures of the dialysate grew Penicillium sp, and histological examination showed penetration of the catheter by hyphae. The peritoneal catheter was removed, and the patient was maintained on hemodialysis and oral itraconazole for 6 weeks before successfully returning to continuous cycling peritoneal dialysis (CCPD). One case of Penicillium catheter colonization and seven of Penicillium peritonitis in peritoneal dialysis patients have been previously published in the English literature. Detailed data were provided in five reports. Delayed diagnosis was frequent (mean ± SD 31 ± 24 days after the onset of symptoms). Peritonitis cases were treated with catheter removal and antifungal medications, and the outcome was always satisfactory. We conclude that Penicillium should be considered a pathogenic fungus, not a contaminant, when isolated from peritoneal dialysis specimens, and should be treated accordingly. However, Penicillium may colonize the peritoneal catheter in the absence of peritonitis, and the prognosis of Penicillium peritonitis is good despite a frequent delay in diagnosis. 相似文献
8.
We report the first case of peritonitis caused by Curvularia species in a child undergoing peritoneal dialysis. He presented with gray-black proteinaceous material obstructing the lumen
of his Tenckhoff catheter. Although the peritoneal fluid was cloudy, the patient suffered neither significant abdominal tenderness
nor systemic symptoms. Catheter removal and treatment with amphotericin B allowed complete recovery and return to peritoneal
dialysis within 7 days. Outdoor play in a wooded environment may have allowed contact of this saprophytic fungus with the
child’s indwelling catheter transfer set.
Received: 6 March 2000 / Revised: 7 June 2000 / Accepted: 11 August 2000 相似文献
9.
Schafer K; Schumann R; Stoteknuel S; Schollmeyer P; Dobos G 《Nephrology, dialysis, transplantation》1998,13(4):969-974
Background: Bacterial peritonitis is a frequent
complication during treatment of end-stage renal failure by continuous
ambulatory peritoneal dialysis. Local host defence mechanisms including the
secretion of proinflammatory cytokines by peritoneal macrophage are of
particular importance in the pathogenesis of infectious complications.
LPS-binding protein (LBP) and soluble CD14 (sCD14) are serum factors known
to regulate the endotoxin-induced cellular immune response. However, it is
still unknown whether LBP and sCD14 are also present in the peritoneal
effluent of CAPD patients. Methods: Using specific
immunoassays, we examined the concentration of LBP, sCD14 and the
proinflammatory cytokines TNF=&agr;, IL-1{beta} and IL-6 in the
dialysis effluents of 31 patients with CAPD-associated peritonitis. Twenty
patients without peritonitis served as controls. Intraperitoneal LPS
concentrations were determined using the limulus amebocyte lysate assay.
Results: Bacterial lipopolysaccharide could be
detected in 42% of the infected dialysis effluents. In comparison to
controls (0.2±0.05 &mgr;g/ml), LBP was significantly
elevated in both Gram-negative/LPS-positive (1.03±0.3
&mgr;g/ml) and Gram-positive infections (0.5±0.14
&mgr;g/ml) (P<0.05). No significant differences were detected
concerning the intraperitoneal sCD14 levels in the three patient groups.
Levels of TNF-&agr;, IL-1{beta} and IL-6 were significantly
increased in the effluents of patients with bacterial peritonitis compared
to non-infected controls. Moreover the respective cytokine concentrations
were significantly higher in the Gram-negative/LPS-positive compared to the
gram-positive bacterial infections (P<0.01).
Conclusion: Our data demonstrate that LBP is
significantly elevated in the dialysis effluents of patients with
CAPD-associated peritonitis caused by both Gram-negative and Gram-positive
bacteria and might be used as a marker of intraperitoneal infection.
Moreover, our findings support the concept that LBP enhances the effects of
LPS on cytokine production by peritoneal macrophages. The function of LBP
in Gram-positive infection remains to be further elucidated. Key
words: CAPD-associated peritonitis; cytokines;
lipopolysaccharide-binding protein; macrophages; peritoneal dialysis;
soluble CD14
相似文献
10.
Mahmoud Loghman-Adham 《Pediatric nephrology (Berlin, Germany)》1997,11(3):353-354
A 12-year-old girl on peritoneal dialysis developed sub-clinical peritonitis due to Pasteurella multocida, following puncture of her dialysis tubing by a domestic cat. Only four other similar cases of P. multocida peritonitis have been reported in adults. This unusual form of peritonitis could be easily prevented by not allowing domestic
animals to come into contact with dialysis tubings in patients undergoing peritoneal dialysis.
Received June 10, 1996; received in revised form and accepted October 1, 1996 相似文献
11.
Mei-Fen Pai Ju-Yeh Yang Hung-Yuan Chen Shih-Ping Hsu Yen-Ling Chiu Hon-Yen Wu 《Renal failure》2016,38(6):875-881
Aim: The aim of this study was to compare peritonitis rates, peritoneal dialysis technique survival and patient survival between patients who started peritoneal dialysis earlier than 14 days (early starters) and 14 days or more (delayed starters) after insertion of a Tenckhoff catheter. Methods: Observational analysis was performed for all patients who underwent insertion of a Tenckhoff catheter at Far Eastern Memorial Hospital between 1 January 2006 and 31 December 2012. The patients were divided into two groups: early and delayed starters. The rate and outcomes of peritonitis were recorded. Peritoneal dialysis technique survival and patient survival were analyzed using the Kaplan–Meier method. Cox regression analysis was performed for peritoneal dialysis technique failure and patient mortality. Results: There were 80 early starters and 69 delayed starters. The peritonitis rate was 0.18 episodes per year in early starters and 0.13 episodes per year in delayed starters. There was no significant difference of peritonitis free survival (p?=?0.146), peritoneal dialysis technique survival (p?=?0.273) and patient survival (p?=?0.739) at 1, 3, 5 years between early starters and delayed starters. After adjustment with age, albumin and diabetes, early starters did not have an increased risk of peritonitis, technique failure and mortality compared to delayed starters. Conclusion: Compared to the patients who started peritoneal dialysis 14 days or more after catheter implantation, the patients who started earlier did not have an increased risk of peritonitis, peritoneal dialysis technique failure and mortality. 相似文献
12.
Bakir N; Surachno S; Sluiter W; Struijk D 《Nephrology, dialysis, transplantation》1998,13(12):3178-3183
Background. The occurrence of peritonitis in
peritoneal dialysis patients after renal transplantation during
immunosuppression might increase morbidity and mortality. Hence the timing
of catheter removal is still controversial. The associated risk factors of
this complication have not been analyzed. Methods. We
analyzed, retrospectively, the incidence of peritonitis within 90 days
after transplantation, its associated morbidity and mortality, as well as
risk factors. From 1980 until March 1995, 238 consecutive kidney
transplants in peritoneal dialysis patients were performed. Univariate and
multivariate logistic regression analysis were used to identify risk
factors for the development of peritonitis. Results.
232 cases (141 men, 91 women) were available for analysis. In
191 patients, the catheter was removed with a mean interval after
transplantation of 122 days (range 0-573). Thirty peritonitis episodes with
predominantly Staphylococcus aureus (10/30) or
Gram-negative bacteria (12/30) were observed. Independent risk factors
before transplantation were the total number of peritonitis episodes
(P<10-5), previous
peritonitis with S. aureus bacteria
(P<10-5), and male sex
(P<0.004). Risk factors after transplantation
were technical surgical problems
(P<10-5), more than two
rejection episodes (P<0.02), permanent graft
non-function (P<0.026), and urinary leakage
(P<0.035). Conclusions.
Transplantation without simultaneous peritoneal catheter removal
is feasible. However, this increases the risk of peritonitis after
transplantation. Early catheter removal should be considered seriously in
those patients at risk. When peritonitis develops, antibiotic treatment
should be directed against Gram-positive as well as Gram-negative bacteria
until culture results are available. Keywords:
catheter; peritoneal dialysis; peritonitis; risk factors;
transplantation
相似文献
13.
Keceli S Yegenaga I Dagdelen N Mutlu B Uckardes H Willke A 《International urology and nephrology》2005,37(1):129-131
Even though prominent technical improvements in continuous ambulatory peritoneal dialysis (CAPD) treatments during the last decade, peritonitis keeps its place as an important cause of morbidity and mortality in these patients. Among them fungal peritonitis is happened to be the most difficult one to deal with and comes out serious clinical presentation. It is presented here a case of CAPD related fungal peritonitis caused by Penicillium spp. This case experienced recently relapsing bacterial episodes of peritonitis and received long term antibiotics intraperitoneally and systemically. Eventually, Penicillium spp. was detected in several cultures of peritoneal effluent and also tip of Tenckhoff catheter, therefore it was considered as a causative agent. Then, the catheter was removed and amphotericin B therapy was performed. But the general condition of the patient did not improve till surgically drainage of peritoneal collection which was determined by MR (Magnetic Resonance) examination of abdomen after antifungal treatment was completed and Penicillium spp. in the drainage samples was not determined anymore. 相似文献
14.
Adverse effect of peritonitis on peritoneal membrane function in children on dialysis 总被引:1,自引:0,他引:1
Andreoli SP Leiser J Warady BA Schlichting L Brewer ED Watkins SL 《Pediatric nephrology (Berlin, Germany)》1999,13(1):1-6
The effect of peritonitis on peritoneal membrane solute transport characteristics was determined as part of a multicenter
study in children on continuous ambulatory/cycling peritoneal dialysis. Ninety-three children each underwent a 4-h peritoneal
equilibration test (PET) with 1,100 ml/m2 2.5% Dianeal for determination of mass transfer area coefficients (MTAC), dialysate to plasma ratios (D/P) for creatinine
and urea at 0, 30, 60, 120, 180, and 240 min and dialysate glucose levels at 0, 30, 60, 120, 180, and 240 min for calculation
of D/Do. The mean age of the study cohort was 10.1±5.6 years (range 0.1–19 years). There were 162 historical episodes of peritonitis;
at the time of the PET tests, 36 children had never had an episode of peritonitis (group I) while 57 children had a history
of one or more episodes of peritonitis (group II). In group II children, the 4-h glucose D/Do was significantly lower and
the 4-h D/P creatinine ratio, the creatinine MTAC, and the glucose MTAC were significantly higher (each P<0.05) than in group I. In children with a history of peritonitis caused by Gram-negative organisms, the 4-h glucose D/Do
(P<0.05) and the creatinine MTAC (P<0.05) were significantly lower and the glucose MTAC (P=0.07) nearly significantly lower than in children without a history of peritonitis. Linear regression analysis did not demonstrate
a correlation between any of the variables and duration of peritoneal dialysis, while the rate of peritonitis was weakly correlated
with glucose MTAC (r=0.34, P<0.05) and with 4-h glucose D/Do (r=–0.222, P<0.01). We conclude that children with a history of peritonitis have peritoneal membranes that are more permeable to glucose
and creatinine than children without a history of peritonitis, and that the peritoneal membranes of children who have had
peritonitis caused by Gram-negative organisms are also more permeable to creatinine and glucose. Such changes are likely to
have an adverse effect on membrane function and could eventually contribute to ultrafiltration failure.
Received: 29 December 1997 / Revised: 13 April 1998 / Accepted: 14 April 1998 相似文献
15.
Beatriz Kuizon Teresita Lu Melocoton Margaret Holloway Susan Ingles He-Jing Eric W. Fonkalsrud Isidro B. Salusky 《Pediatric nephrology (Berlin, Germany)》1995,9(Z1):S12-S17
Continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) are the predominant dialytic modalities for the majority of children while awaiting transplantation. Wide acceptability of peritoneal dialysis is hindered by infectious complications. A retrospective review of 367 pediatric patients treated with CAPD/CCPD for at least 3 months from September 1980 through December 1994 revealed that the peritonitis incidence ranged from 1.7 to 0.78 episodes per patient-year. No differences in peritonitis rates were observed between patients treated with CAPD or CCPD. Gram-positive organisms were responsible for the majority of peritonitis episodes. Age, sex, race, primary renal disease, presence of nephrotic syndrome, and serum albumin level were not associated risk factors. Longer time on treatment and diminished serum IgG level were associated with increased peritonitis incidence. Treatment was successfully completed at home in most cases. Almost half of the catheter losses were caused byStaphylococcus, Pseudomonas, and fungal peritonitis and tunnel/exit-site infections. Infectious complications are still the major causes of morbidity and treatment failure in patients treated with CAPD/CCPD. Thus, controlled studies are needed to assess methods for prevention or improvement of peritonitis rates in this patient population. 相似文献
16.
Peritoneal nitric oxide is a marker of peritonitis in patients on continuous ambulatory peritoneal dialysis 总被引:3,自引:1,他引:2
Yang C. W.; Hwang T. L.; Wu C. H.; Wu M. S.; Lai P. C.; Huang J. Y.; Yu C. C.; Shyr M. H.; Huang C. C. 《Nephrology, dialysis, transplantation》1996,11(12):2466-2471
Nitric oxide plays an important role in mediating the inflammatoryprocess. The aim of this study was to evaluate if nitric oxideproduction was increased during peritonitis in patients receivingcontinuous ambulatory peritoneal dialysis (CAPD), and the associationwith the prognosis. The study population comprised 21 patientswith 22 episodes of peritonitis. Fifteen patients without peritonitiswere controls. Nitrate was measured by HPLC and nitrite by theGriess method, to reflect nitric oxide production. Peritonealdialysate effluent and plasma were collected from six patientsduring peritonitis and 1 week after treatment to study changesin dialysate:plasma ratio. In 15 patients, nitrite was measuredduring peritonitis and every 3 days for 2 weeks or until normalizedfor evolutional changes. The dialysate plasma ratios of nitrateand nitrite during peritonitis were reduced 26% and 41.5%, respectively,after 1 week of treatment, indicating the peritoneal productionof nitric oxide during peritonitis. In the evolutional study,a 5.1-fold increase of peak nitrite levels in bacterial peritonitis(n=13) and a 2.5-fold increase in fungal peritonitis (n=3) wereobserved compared to controls. Nitrite gradually declined tocontrol levels (9.3±7.2 days) after effective antibiotictreatment, but took longer than to normalize leukocyte countin the peritoneal dialysate effluent (3.9±1.9 days).In four patients with refractory peritonitis (Candida infectionin three, Acinetobacter infection in one), the nitrite levelsremained elevated 2-fold despite treatment, and the catheterswere removed. It is concluded that nitrite levels in peritonealdialysate effluent may serve as a marker to assess treatmentefficacy in CAPD patients with peritonitis. 相似文献
17.
《Néphrologie & thérapeutique》2021,17(2):128-131
The presence of a biofilm within the peritoneal dialysis catheter where bacteria are encapsulated, protected from the action of antibiotics and insidiously liberated within the dialysate, best explains the relapse of the infectious peritonitis, when antibiotics are withdrawn. We here report a serie of four clinical cases in whom the administration of urokinase within the peritoneal catheter in addition to the current antibiotherapy, has cured relapsing peritonitis due to Staphylococcus epidermidis in two cases, Acinetobacter johnsonii in one case and Staphylococcus haemolyticus in one case, respectively. This approach, safe and easy, allowed the infection eradication and did prevent a catheter removal and a potential transfer of the patients to hemodialysis. 相似文献
18.
Peritoneal Catheters and Related Infections 总被引:1,自引:1,他引:0
Thodis E Passadakis P Lyrantzopooulos N Panagoutsos S Vargemezis V Oreopoulos D 《International urology and nephrology》2005,37(2):379-393
Catheter related infectious complications (exit-site infections, tunnel infections, and peritonitis) remain the major reasons for technique failure during the three decades since, continuous ambulatory peritoneal dialysis (CAPD) treatment has been first established. Despite improvements in catheter’s survival rates, catheter related complications result in an increase in the cumulative patients’ morbidity and often leading to the catheter removal. The ideal catheter provides reliable and rapid dialysate flow rates without leaks or infections. Among several types, the double-cuff straight Tenckhoff catheter, developed in 1968, is still the most widely used, although its use is decreasing in favour of swanneck catheters. Although there are onlu few well-designed trials comparing catheters and catheters related infectious complications, controlling for all other important variables, no difference in these complications among the main types of catheters was seen. The single cuff catheters have been associated with a shorter survival rate and time to the first peritonitis episode than the double-cuff catheters. Also exit-site infections were found to be more frequent and significantly more resistant to treatment with single-cuff compared to double-cuff ones. Finally, better results have been reported with the latest developed presternal peritoneal dialysis catheter both regarding survival rates and exit-site infection and peritonitis rates. Recently a renewed interest in continuous flow peritoneal dialysis stimulated inventions of imaginative, double-lumen catheters since a suitable peritoneal access is a sine qua non condition for the development of this new technique of peritoneal dialysis. 相似文献
19.
K. Hamai Hirokazu Imai Hiroshi Ohtani Atsushi Komatsuda Takahito Kodama Hideki Wakui Akira B. Miura 《Clinical and experimental nephrology》1999,3(1):59-61
A 49-year-old man had three episodes of bacterial peritonitis in the 8 months after he started nocturnal intermittent peritoneal
dialysis (NIPD) at home, using an automated cycler device. When peritonitis was first diagnosed, Enterobacter agglomerance was cultured in his peritoneal fluid. In the second and third episodes, Pasteurella multocida and alpha-Streptococcus were isolated, respectively. These bacteria are unusual pathogens in continuous ambulatory peritoneal dialysis (CAPD) peritonitis.
Detailed questioning revealed that a domestic cat had bitten the dialysis tube before the patient experienced the second episode
of peritonitis. Pasteurella multocida is part of the normal oral flora in cats and dogs. We isolated Pasteurella multocida from the teeth of the patient's cat. Enterobacter agglomerance is part of the common bacterial flora in animal's alimentary tract, and alpha-Streptococcus is commonly found in animal's respiratory tracts. Since the patient removed the cat from his bedroom, he has had no peritonitis.
NIPD is a very convenient sysytem for patients in the final stage of renal failure; however, patients must be aware of the
risks associated with keeping pets in their homes. This case is the first report of cat-associated peritonitis in Japan.
Received: July 9, 1998 / Accepted: September 24, 1998 相似文献
20.
Equils O Deville JG Shapiro AM Sanchez CP 《Pediatric nephrology (Berlin, Germany)》1999,13(9):771-772
A 19-year-old female on chronic peritoneal dialysis developed acute peritonitis; multiple peritoneal fluid and catheter tip
cultures yielded Penicillium species. She promptly responded to catheter removal and intravenous amphotericin B, followed by oral fluconazole, without
further recurrences 1 year later. This is the first reported case of Penicillium peritonitis in the pediatric population. We review the microbiology and clinical spectrum of this disease, as well as the
few previous reported cases in adults.
Received: 2 November 1998 / Revised: 1 February 1999 / Accepted: 4 February 1999 相似文献