Capnocytophaga canimorsus peritonitis in a pediatric peritoneal dialysis patient

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     

ku Pasteurella multocida peritonitis in patients undergoing peritoneal dialysis

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     

Lactobacillus Peritonitis: A Rare Cause of Peritonitis in Peritoneal Dialysis Patients

Lactobacilli are part of the normal gastrointestinal and female genitourinary flora in humans and they are seldom pathogenic and rarely cause human disease. In the literature, Lactobacillus peritonitis was most common in immunocompromised patients, including patients under chronic peritoneal dialysis. We also suspect that the presence of Lactobacillus spp. in the peritoneal fluid might indicate the leakage of normal flora from a perforated intraabdominal hollow organ. To access the versatile clinical pictures of Lactobacillus peritonitis, this investigation retrospectively reviewed the medical records for Lactobacillus spp. isolated from peritoneal fluid from July 1998 to January 2002 at Chang‐Gung Memorial Hospital, Taipei, Taiwan. A total of 10 patients were enrolled in the study. Six of these 10 patients had concomitant intraabdominal hollow organ perforation, and peritoneal fluid cultures in these six patients also contained bacteria other than Lactobacillus spp. All six patients had recently experienced either abdominal surgery or blunt abdominal trauma. The remaining four patients who had not undergone surgery had decompensated liver cirrhosis with ascites and spontaneous bacterial peritonitis. The results suggested that the presence of Lactobacillus spp. in the peritoneal fluid other than immunocompromised patients should raise the suspicion of hollow organ perforation in patients with recent abdominal surgery or blunt abdominal trauma.     

Cat-bite peritonitis: Pasteurella multocida peritonitis following feline contamination of peritoneal dialysis tubing

We report a case of a 55-year-old woman with end-stage renal disease undergoing intermittent peritoneal dialysis who developed peritonitis secondary to an infection with Pasteurella multocida resulting from a cat bite or cat scratch penetrating her peritoneal dialysis tubing. This case points out the potential importance of household pets as a source of peritoneal contamination.     

Peritonitis associated with Pasteurella multocida in peritoneal dialysis patients--case report and review of the literature

Pasteurella multocida is a zoonotic pathogen found in the oral cavities of domestic dogs and cats and other wild and domestic animals. 14 cases ofperitoneal dialysis-associated Pasteurella multocida peritonitis linked to animal contact have been reported in the literature to date. In each case, the source of infection was believed to be a domestic cat or cats. One case of spontaneous bacterial peritonitis has been reported in a cirrhotic patient and was not linked to animal contact. Poor hygiene in relation to pets was considered the source of infection. We describe the first case of Pasteurella multocida peritonitis in a patient undergoing continuous ambulatory peritoneal dialysis (CAPD) believed to be caused by contact with dogs and discuss the relevant literature.     

Fungal peritonitis in children on peritoneal dialysis

Fungal peritonitis is a rare but serious complication in children on peritoneal dialysis (PD). In this study, risk factors were evaluated, and therapeutic measures were reviewed. A retrospective, multi-centre study was performed in 159 Dutch paediatric PD patients, between 1980 and 2005 (3,573 months). All peritonitis episodes were reviewed. Fungal peritonitis episodes were evaluated based on possible risk factors and treatment strategy. A total of 321 episodes of peritonitis occurred, with 9 cases of fungal peritonitis (2.9%). Candida peritonitis occurred most frequently (78%). Seven patients (78%) had used antibiotics in the prior month. Fungal peritonitis patients had a higher previous bacterial peritonitis rate compared to the total study population (0.13 versus 0.09 episodes/patient*month), with twice as many gram negative organisms. In all fungal peritonitis patients, the PD catheter was removed. In four patients restart on PD was possible. Fungal peritonitis is a rare complication of PD in children, but is associated with high technique failure. The most important risk factors are a high bacterial peritonitis rate, prior use of antibiotics, and previous bacterial peritonitis with gram negative organisms. The PD catheter should be removed early, but in children, peritoneal lavage with fluconazole before removal may be useful to prevent technique failure.     

Adverse effect of peritonitis on peritoneal membrane function in children on dialysis

 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     

Comparing long-term outcomes between early and delayed initiation of peritoneal dialysis following catheter implantation

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.     

Risk factors for peritoneal dialysis withdrawal due to peritoneal dialysis-related peritonitis

BackgroundPeritoneal dialysis has become commonly used for renal replacement therapy; however, some patients withdraw from peritoneal dialysis due to complications, including peritoneal dialysis-related peritonitis, resulting in the low number of patients on peritoneal dialysis. Risk factors for peritoneal dialysis withdrawal due to peritoneal dialysis-related peritonitis are less certain. This retrospective study aimed to investigate these risk factors.MethodsWe retrospectively analyzed clinical characteristics, laboratory data, and causative microorganisms of 204 episodes of peritoneal dialysis-related peritonitis between 2007 and 2018 at our institution.ResultsOf the 204 episodes, 38 resulted in withdrawal from peritoneal dialysis due to peritoneal dialysis-related peritonitis. The number of peritonitis episodes per patient-year and the incidence of cardiovascular disease were significantly higher in the withdrawal group. Similarly, this group had low levels of serum creatinine, urea nitrogen, serum albumin, alanine aminotransferase, cholinesterase and high C-reactive protein, and second dialysate cell counts after antibiotic administration. Multivariate logistic regression analysis revealed that serum albumin (odds ratio: 0.465; 95% confidence interval: 0.249–0.868; P = 0.016) and cardiovascular disease (odds ratio: 2.508; 95% confidence interval: 1.184–5.315; P = 0.016) exhibited significant differences.ConclusionsThe results of this study suggest that hypoalbuminemia and the presence of cardiovascular disease were independent risk factors for withdrawal from peritoneal dialysis due to peritoneal dialysis-related peritonitis.     

Video-assisted laparoscopic procedures in peritoneal dialysis

Background Although laparoscopy is commonly adopted for the diagnosis and management of various medical or surgical problems, its use for patients with peritoneal dialysis has seldom been addressed. This retrospective study analyzes the indications and clinical effects of this procedure. Methods: A retrospective chart was drawn up and a videotape review performed for 18 laparoscopic procedures involving 198 patients receiving peritoneal dialysis on a long-term basis at our dialysis unit from May 1992 to June 2002. The clinical and demographic parameters in this study included gender, age, underlying renal diseases, duration of peritoneal dialysis before laparoscopy, indications of laparoscopic intervention, laparoscopic findings, time of operation, laparoscopic procedures, postoperative complications, mortality, and catheter results. Results: A total of 18 laparoscopic procedures were performed in 17 uremia patients, with indications including catheter malfunction in five cases, preimplantation evaluation of peritoneal space in three cases, evaluation of the etiology underlying intractable peritonitis in nine cases, and verification of the cause for dialysate leakage in one case. Four (80%) of the five catheter malfunctions were successfully corrected, including one case of catheter migration and three cases of omental wrapping, whereas correction failed in the remaining case because of severe bowel adhesion. New catheter placement after adhesiolysis was successful in all three cases of preimplantation peritoneal evaluation (100%). Of the nine patients whose peritonitis episodes were evaluated, two were found to have secondary peritonitis, two had fungal peritonitis; one had tuberculous peritonitis and four had bacterial peritonitis. In the case of persistent exit-site dialysate leakage, laparoscopy showed a penetrating injury of the abdominal wall, raising a strong suspicion of iatrogenic injury during the tunneling maneuvers in initial catheter placement. Two conversions to laparotomy were performed: one to repair the penetrating injury and the other to save the life of a patient threatened by severe fungal peritonitis with abdominal cocoon formation. The laparoscopic procedures lasted 20 to 150 min (average, 50 min). Despite one instance of postoperative hydrocele, there was no operative mortality. Conclusions: The analytical results of this study demonstrate that the current video-assisted laparoscopic technique is an effective means for managing several problems related to peritoneal dialysis such as catheter malfunction, preimplantation evaluation, location of the source of the dialysate leak, and assessment of the causes for peritonitis. Thus, this technique should always be considered when the these problems arise.     

Hamster bite peritonitis: Pasteurella pneumotropica peritonitis in a dialysis patient

We report the first case of Pasteurella pneumotropica peritonitis in a peritoneal dialysis patient. This rare infection was the result of contamination of the dialysis tubing by a pet hamster. We stress the importance of household pets as a source of infection in the peritoneal dialysis population. Received: 17 March 2000 / Revised: 19 May 2000 / Accepted: 19 May 2000     

Acinetobacter co-infection and coagulase-negative Staphylococcus: case report and literature review

Continuous ambulatory peritoneal dialysis (CAPD) is a safe, convenient, and cost-effective therapy in end-stage renal disease. The major complication of peritoneal dialysis (PD) is peritonitis. Gram-positive cocci are isolated in majority of the episodes. Among gram-negative bacteria, Acinetobacter species have been reported in peritonitis, sometimes as a concomitant that may be asymptomatic and require no treatment. Little has been written about the clinical features and outcome of PD-related peritonitis caused by co-infection of Acinetobacter species with other pathogens. We herein present a case of peritonitis caused by co-infection with Acinetobacter species and coagulase-negative staphylococci, which resulted in patient dropout and mortality. We review the literature about Acinetobacter peritonitis and current treatment protocols.     

Peritonitis in continuous ambulatory peritoneal dialysis in children living in Saudi Arabia

The clinical aspects of peritonitis and catheter infections were reviewed in 64 children on continuous ambulatory peritoneal dialysis living in Saudi Arabia over a period of 6 years. Peritonitis occurred in 41 children (64%). The mean time from starting dialysis to the first episode of peritonitis was 7.2 months. The incidence of peritonitis was 1 episode in 9 treatment months. Gram-negative organisms were responsible for the majority of episodes (42%), followed by Gram-positive organisms (20%), and Candida albicans (6%); 32% were culture negative. Recurrent peritonitis was present in 20 cases. Catheter was replaced in 24 patients: 44% due to recurrent peritonitis. Peritoneal membrane loss occurred in 7 patients, 3 had Candida peritonitis and 3 had recurrent peritonitis due to Pseudomonas. The mortality rate was 4.6% but none of the deaths were related to peritonitis or dialysis. Received August 23, 1995; received in revised form October 2, 1996; accepted October 18, 1996     

Case Report: Peritonitis by <Emphasis Type="Italic">Penicillium</Emphasis> spp. in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis

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.     

Peritonitis in peritoneal dialysis patients after renal transplantation

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      

Lactobacillus peritonitis: a rare cause of peritonitis in peritoneal dialysis patients

Lactobacilli are part of the normal gastrointestinal and female genitourinary flora in humans and they are seldom pathogenic and rarely cause human disease. In the literature, Lactobacillus peritonitis was most common in immunocompromised patients, including patients under chronic peritoneal dialysis. We also suspect that the presence of Lactobacillus spp. in the peritoneal fluid might indicate the leakage of normal flora from a perforated intraabdominal hollow organ. To access the versatile clinical pictures of Lactobacillus peritonitis, this investigation retrospectively reviewed the medical records for Lactobacillus spp. isolated from peritoneal fluid from July 1998 to January 2002 at Chang-Gung Memorial Hospital, Taipei, Taiwan. A total of 10 patients were enrolled in the study. Six of these 10 patients had concomitant intraabdominal hollow organ perforation, and peritoneal fluid cultures in these six patients also contained bacteria other than Lactobacillus spp. All six patients had recently experienced either abdominal surgery or blunt abdominal trauma. The remaining four patients who had not undergone surgery had decompensated liver cirrhosis with ascites and spontaneous bacterial peritonitis. The results suggested that the presence of Lactobacillus spp. in the peritoneal fluid other than immunocompromised patients should raise the suspicion of hollow organ perforation in patients with recent abdominal surgery or blunt abdominal trauma.     

Risks of peritoneal membrane failure in children undergoing long-term peritoneal dialysis

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.     

Peritoneal dialysis in the nursing home

Background: During the past few decades, the demographics of end stage renal disease have been changed significantly with the emerging predominance of elderly patients. Elderly dialysis patients are usually more dependent and may need long-term placement in a long-term care facility. Failure to meet the needs of these patients may have a significant impact on the peritoneal dialysis program. We report our experience of starting peritoneal dialysis program in a community-based Long Term Care Facility (LTCF).Methods: During the period of 2000–2001, after appropriate training of nursing home personnel, we admitted 8 peritoneal dialysis patients to one community-based nursing home. All information presented here has been collected through chart review.Results: At the time of admission the average age of the 8 patients was 77.3 ± 7.2 years (range 69 to 91 years). All patients had several comorbid diseases and six of the eight were bed-ridden. The patients stayed in the facility for a total of 29.57 patient months. One patient had three episodes of peritonitis within three months (all culture negative) and has been excluded from the analysis of the overall peritonitis rate. The peritonitis rate for the other seven patients was 1 per 7.54 patient month. Six patients were readmitted to hospital because of peritonitis [4], severe malnutrition [1] and hip fracture [1]. Four of them died in the hospital. One died in the nursing home. One patient remains in the nursing home at the present time.Conclusions: Our experience suggests that peritoneal dialysis can be achieved in a community-based nursing home. This requires a systematic training program for the LTCF personnel and the availability of a ``dedicated' nephrology dialysis staff. This is crucial to the success of the program. It is important that patients, their families and ESRD care professionals are informed of the limited survival expectation particularly for very old and severely impaired patients.     

The changing trends of peritoneal dialysis related peritonitis and novel risk factors

Abstract

Aim: Continuous ambulatory peritoneal dialysis (PD) has become a treatment modality for end stage renal disease with a peak of its use in 1990s. The aim of this study was to examine the peritonitis rates, causative organisms and the risk factors of peritonitis in a large group of patients in our center. Methods: The study was conducted in the Nephrology Department of a University Hospital in Turkey. Patients in the PD programme between January 2000 and January 2006 were included. Cohort-specific and subject specific peritonitis incidence, and peritonitis-free survival were calculated. Causative organisms and risk factors were evaluated. Results: Totally 620 episodes of peritonitis occurred in 440 patients over the six years period. Peritonitis rates showed a decreasing trend through the years (0.79 episodes/patient-year 2000–2003 and 0.46 episodes/patient-year 2003–2006). Cohort-specific peritonitis incidence was 0.62 episodes/patient-years and median subject-specific peritonitis incidence was 0.44 episodes/patient-years. The median peritonitis-free survival was 15.25 months (%95 CI, 9.45–21.06 months). The proportion of gram-negative organisms has increased from 9.8% to 17.3%. There was a significant difference in the percentage of culture negative peritonitis between the first three and the last three years (53.1% vs. 43.2%, respectively). Peritonitis incidence was higher in patients who had been transferred from HD, who had catheter related infection and who had HCV infection without cirrhosis. Conclusions: Our study showed significant trends in the peritonitis rates, causative organisms and antibiotic resistance. Prior HD therapy, catheter related infections and HCV infection were found to be risk factors for peritonitis.     

Recent peritonitis associates with mortality among patients treated with peritoneal dialysis

Peritonitis is a major complication of peritoneal dialysis, but the relationship between peritonitis and mortality among these patients is not well understood. In this case-crossover study, we included the 1316 patients who received peritoneal dialysis in Australia and New Zealand from May 2004 through December 2009 and either died on peritoneal dialysis or within 30 days of transfer to hemodialysis. Each patient served as his or her own control. The mean age was 70 years, and the mean time receiving peritoneal dialysis was 3 years. In total, there were 1446 reported episodes of peritonitis with 27% of patients having ≥ 2 episodes. Compared with the rest of the year, there were significantly increased odds of peritonitis during the 120 days before death, although the magnitude of this association was much greater during the 30 days before death. Compared with a 30-day window 6 months before death, the odds for peritonitis was six-fold higher during the 30 days immediately before death (odds ratio, 6.2; 95% confidence interval, 4.4-8.7). In conclusion, peritonitis significantly associates with mortality in peritoneal dialysis patients. The increased odds extend up to 120 days after an episode of peritonitis but the magnitude is greater during the initial 30 days.