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Flynn JT, Meislich D, Kaiser BA, Polinsky MS, Baluarte HJ. Fusarium Peritonitis in a Child on Peritoneal Dialysis: Case Report and Review of the Literature. Perit Dial Int 2020. [DOI: 10.1177/089686089601600113] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo review various aspects of the management of peritonitis due to Fusarium, a soil mold which infrequently causes infections in humans.Data SourcesA case of Fusarium peritonitis in a child on chronic peritoneal dialysis (PD) is presented. The child developed Fusarium peritonitis 2 weeks after an episode of bacterial peritonitis. His Tenckhoff catheter was removed, and he was maintained on hemodialysis while receiving intravenous amphotericin. Following 2 weeks of treatment with amphotericin, he was successfully returned to PD. A literature review of all previously reported cases of Fusarium peritonitis was then conducted to determine features common to infections caused by Fusarium. Emphasis was also placed on unique characteristics of the organism that may affect patient management, as well as patient characteristics that may increase the risk for infection by Fusarium.ResultsFusarium may cause infection inimmuno suppressed individuals, such as cancer patients or patients on chronic PD. The organism has a propensity to attach to foreign bodies such as intravascular and intraperitoneal catheters. Therefore, successful treatment of infections caused by Fusarium may require catheter removal in addition to systemic antifungal therapy.ConclusionsThis report presents the first known case of Fusarium peritonitis in a child. In view of the difficulties posed by this unusual organism, optimal therapy of Fusarium peritonitis should consist of immediate catheter removal and treatment with systemic antifungal drugs.
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Affiliation(s)
- Joseph T. Flynn
- Department of Pediatrics, Section of Nephrology, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, U.S.A
| | - Debrah Meislich
- Department of Pediatrics, Albert Einstein Medical Center, Philadelphia, Pennsylvania, U.S.A
| | - Bruce A. Kaiser
- Department of Pediatrics, Section of Nephrology, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, U.S.A
| | - Martin S. Polinsky
- Department of Pediatrics, Section of Nephrology, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, U.S.A
| | - H. Jorge Baluarte
- Department of Pediatrics, Section of Nephrology, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, U.S.A
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Yinnon A, Jain V, Magnussen C. B Streptococcus (Agalactiae) Peritonitis and Bacteremia Associated with Capd. Perit Dial Int 2020. [DOI: 10.1177/089686089301300318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- A.M. Yinnon
- The Infectious Disease Unit University of Rochester Medical Center Rochester, New York, U.S.A
| | - V. Jain
- Nephrology Unit St. Mary's Hospital Rochester, New York, U.S.A
| | - C.R. Magnussen
- Infectious Disease Unit St. Mary's Hospital Rochester, New York, U.S.A
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Nikolaidis P, Walker SE, Dombros N, Tourkantonis A, Paton TW, Oreopoulos DG. Single -Dose Pefloxacin Pharmacokinetics and Metabolism in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD). Perit Dial Int 2020. [DOI: 10.1177/089686089101100112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Seven adult patients on continuous ambulatory peritoneal dialysis (CAPD) received one dose of pefloxacin, a novel quinolone antibiotic, orally and intravenously on two separate occasions to characterize the pharmacokinetics and metabolism of the drug. Concentrations of both pefloxacin and its active metabolite N-desmethylpefloxacin (norfloxacin) were measured in serum and dialysate by HPLC. Half-life, total body clearance and peritoneal clearance were determined. The overall elimination half-life was 19.9h. Relative to the IV dose the bioavailability following oral administration of pefloxacin was 76%. The mean serum and dialysate concentrations were similar up to 24 h after the oral or IV dose. After a 6 h dwell time the dialysate concentration of pefloxacin was 2.24 mg/L which is above the MICgo for most bacteria responsible for peritonitis in CAPD patients. The peritoneal clearance of pefloxacin averaged 2.5 mL/min. Serum concentrations of the metabolite norfloxacin were less than 0.5 mg/L during the 24 h study period.We conclude that pefloxacin might be equally effective in the treatment of peritonitis of CAPD after oral or IV administration. Since the peritoneal clearance contributes insignificantly to the elimination of pefloxacin during CAPD, the proposed maintenance regimen of an oral or IV 400 mg dose/day seems to be a reasonable therapy for infections in CAPD patients.
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Affiliation(s)
- Paul Nikolaidis
- Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, AHEPA General Hospital, University of Thessaloniki, Thessaloniki, Greece
| | - Scott E. Walker
- Department of Pharmacy, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Dombros
- Department of Medicine, AHEPA General Hospital, University of Thessaloniki, Thessaloniki, Greece
| | - Achilleas Tourkantonis
- Department of Medicine, AHEPA General Hospital, University of Thessaloniki, Thessaloniki, Greece
| | - Tom W. Paton
- Department of Pharmacy, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dimitrios G. Oreopoulos
- Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Fung LCT, Khoury AE, Vas SI, Smith C, Oreopoulos DG, Mittelman MW. Biocompatibility of Silver-Coated Peritoneal Dialysis Catheter in a Porcine Model. Perit Dial Int 2020. [DOI: 10.1177/089686089601600414] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
ObjectivePrevious studies have shown that silver formulations coated onto implantable materials retard bacterial colonization and reduce the incidence of catheter-related infections. The objective of this study was to assess the histologic effects of sputter-coated silverl silicone implants on host tissue.DesignSputter silver-coated silicone peritoneal dialysis catheter segments with and without Dacron cuffs were implanted in the subcutaneous fat and muscle in 4 pigs. Noncoated implants served as controls. The specimens were retrieved at 1,2,3,4,7,8,9,10,12, and 27 weeks.Experimental AnimalsFour 6-week-old male Yorkshire Land race pigs (5–6 kg) were used.Main Outcome MeasuresHistologic parameters evaluated included the degree of inflammation, the number of giant cells, the extent of silver particulate inclusions, and the thickness of the capsules. All specimens were evaluated by a single blinded pathologist. Microbiologic analyses were also performed.ResultsThe silver-coated catheters were associated with less inflammation than were the noncoated catheters, both infatand muscle (p=0.04). The number of giant cells was also lower around the silver-coated than the noncoated catheters, which were implanted in subcutaneous fat (p < 0.05). Particulate inclusions compatible with silver or silver oxide were observed only in tissue around silvercoated implants (p < 0.0001). The thickness of the capsules and the extent of the inflammatory zones were not significantly different. There was no evidence of infection-related changes.ConclusionsThese data suggest that the sputter silver coating does not act as a significant tissue irritant.
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Affiliation(s)
- Leo C. T. Fung
- Departments of Surgery, University of Toronto, Ontario, Canada
| | | | - Stephan I. Vas
- Microbiology, University of Toronto, Ontario, Canada
- Medicine, University of Toronto, Ontario, Canada
| | | | | | - Marc W. Mittelman
- Departments of Surgery, University of Toronto, Ontario, Canada
- Microbiology, University of Toronto, Ontario, Canada
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Mycobacterium fortuitum and Polymicrobial Peritoneal Dialysis-Related Peritonitis: A Case Report and Review of the Literature. Case Rep Nephrol 2014; 2014:323757. [PMID: 25028616 PMCID: PMC4083769 DOI: 10.1155/2014/323757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 05/30/2014] [Indexed: 12/14/2022] Open
Abstract
Mycobacterium fortuitum is a ubiquitous, rapidly growing nontuberculous mycobacterium (NTM). It is the most commonly reported NTM in peritoneal dialysis (PD) associated peritonitis. We report a case of a 52-year-old man on PD, who developed refractory polymicrobial peritonitis necessitating PD catheter removal and shift to hemodialysis. Thereafter, M. fortuitum was identified in the PD catheter culture and in successive cultures of initial peritoneal effluent and patient was treated with amikacin and ciprofloxacin for six months with a good and sustained clinical response. Months after completion of the course of antibiotics, the patient successfully returned to PD. To our knowledge, this is the first reported case of M. fortuitum peritonitis in the field of polymicrobial PD peritonitis. It demonstrates the diagnostic yield of pursuing further investigations in cases of refractory PD peritonitis. In a systematic review of the literature, only 20 reports of M. fortuitum PD peritonitis were identified. Similar to our case, a delay in microbiological diagnosis was frequently noted and the Tenckhoff catheter was commonly removed. However, the type and duration of antibiotic therapy varied widely making the optimal treatment unclear.
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Mawhinney WM, Adair CG, Gorman SP. Development and treatment of peritonitis in continuous ambulatory peritoneal dialysis. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2011. [DOI: 10.1111/j.2042-7174.1991.tb00519.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
The main complication of continuous ambulatory peritoneal dialysis is peritonitis. This paper reviews its causes and treatment.
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Affiliation(s)
- W M Mawhinney
- Pharmacy Department, Belfast City Hospital, Lisburn Road, Belfast BT9 7BL, Northern Ireland
| | - C G Adair
- School of Pharmacy, Queen's University of Belfast, Belfast BT9 7BL, Northern Ireland
| | - S P Gorman
- School of Pharmacy, Queen's University of Belfast, Belfast BT9 7BL, Northern Ireland
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Oreopoulos DG, Tzamaloukas AH. Our war against bacteria in peritoneal dialysis, the last 40 years! Int Urol Nephrol 2009; 40:709-14. [PMID: 18443912 DOI: 10.1007/s11255-008-9392-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Pneumococcal and Gonococcal Peritonitis Due to Vaginitis. Perit Dial Int 2002. [DOI: 10.1177/089686080202200618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Scanziani R, Dozio B, Baragetti I, Grillo P, Colombo L, De Liso S, Surian M. Vaginal colonization with group B Streptococcus (Streptococcus agalactiae) and peritonitis in a woman on CAPD. Nephrol Dial Transplant 1999; 14:2222-4. [PMID: 10489238 DOI: 10.1093/ndt/14.9.2222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Borra SI, Chandarana J, Kleinfeld M. Fatal peritonitis due to group B beta-hemolytic streptococcus in a patient receiving chronic ambulatory peritoneal dialysis. Am J Kidney Dis 1992; 19:375-7. [PMID: 1562028 DOI: 10.1016/s0272-6386(12)80457-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients is rarely caused by group B beta-hemolytic streptococcus species. We describe a 52-year-old man with chronic glomerulonephritis who developed a fatal peritonitis due to streptococcus group B in the absence of predisposing factors such as diabetes mellitus, malignancy, human immunodeficiency virus (HIV) infection, or liver disease. This report suggests that although beta-hemolytic streptococcus is a rare cause of peritonitis, the severity of the infection may be overwhelming and may rapidly lead to serious consequences and death.
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Affiliation(s)
- S I Borra
- Department of Medicine, Kingsbrook Jewish Medical Center, Brooklyn, NY
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