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Dong X, Xie C, Yi C, Ye P, Ye H, Guo Q, Huang F, Kong YZ, Yang X. Clinical characteristics and antibiotic treatment of peritoneal dialysis-associated peritonitis caused by Pseudomonas species: a review of 15 years' experience from southern China. Microbiol Spectr 2024; 12:e0009624. [PMID: 38695572 DOI: 10.1128/spectrum.00096-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/25/2024] [Indexed: 06/06/2024] Open
Abstract
Pseudomonas can lead to peritoneal dialysis-associated peritonitis, which is characterized by a poor prognosis, such as a substantial failure rate and a high death rate. This study aimed to provide an overview of Pseudomonas peritonitis's clinical features, the regimens of antibiotic, antibiotic resistance, and outcomes in peritoneal dialysis (PD) patients. This study observed patients with Pseudomonas peritonitis in two large PD centers in South China from January 2008 to December 2022. The demographics, symptomatology, antibiotics regimens, resistance to common antibiotics, and clinical outcomes of all included patients were reviewed. A total of 3,459 PD patients were included, among them 57 cases of peritonitis caused by Pseudomonas, including 48 cases (84.2%) of Pseudomonas aeruginosa. The incidence rate of Pseudomonas peritonitis was 0.0041 episode per patient-year. Of them, 28.1% (16 cases) of the patients were accompanied by exit site infection (ESI), and all had abdominal pain and turbid ascites at the time of onset. The most commonly used antibiotic combination was ceftazidime combined with amikacin. Approximately 89% of Pseudomonas species were sensitive to ceftazidime, and 88% were sensitive to amikacin. The overall primary response rate was 28.1% (16 patients), and the complete cure rate was 40.4% (23 patients). There was no significant difference in the complete cure rate of peritonitis using three and other antibiotic treatment regimens (44.8% vs 46.4%; P = 0.9). The successful treatment group had higher baseline albumin level (35.9 ± 6.2; P = 0.008) and residual urine volume (650.7 ± 375.5; P = 0.04). Although the incidence of peritonitis caused by Pseudomonas was low, the symptoms were serious, and prognosis was very poor. Pseudomonas was still highly susceptible to first-line antibiotics currently in use against Gram-negative bacteria. Patients with successful treatment had higher albumin levels and higher urine output. IMPORTANCE Although the incidence of peritoneal dialysis-associated peritonitis caused by Pseudomonas is very low, it seriously affects the technique survival of peritoneal dialysis patients. However, there are few studies and reports on Pseudomonas peritonitis in the Chinese mainland area. Therefore, the purpose of this study is to describe the clinical characteristics, the regimens of antibiotic, drug resistance, and outcome of peritoneal dialysis patients in southern China in the past 15 years and summarize the clinical experience in the treatment of Pseudomonas peritonitis.
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Affiliation(s)
- Xiao Dong
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangdong, Guangdong, China
- Department of Nephrology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Chao Xie
- Department of Nephrology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangdong, Guangdong, China
| | - Peiyi Ye
- Department of Nephrology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangdong, Guangdong, China
| | - Qunying Guo
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangdong, Guangdong, China
| | - Fengxian Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangdong, Guangdong, China
| | - Yao-Zhong Kong
- Department of Nephrology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangdong, Guangdong, China
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You L, Zhang B, Zhang F, Wang J. Pathogenic spectrum and risk factors of peritoneal dialysis-associated peritonitis: a single-center retrospective study. BMC Infect Dis 2024; 24:440. [PMID: 38658811 PMCID: PMC11044422 DOI: 10.1186/s12879-024-09334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
The present study aimed to explore the pathogenic spectrum and risk factors of peritoneal dialysis-associated peritonitis (Peritoneal dialysis associated peritonitis, PDAP) in Yongzhou, Hunan, China. The clinical and epidemiological data on regular peritoneal dialysis (Peritoneal dialysis, PD) between January 2016 and December 2020 in Yongzhou were collected for retrospective analysis. The related factors of peritonitis were evaluated by single-factor analysis, while risk factors of refractory PDAP were evaluated by multivariate logistic regression analysis.172/331 172 (51.9%) patients developed peritonitis. The risk factors of PDAP in PD patients included high C-reactive protein (C-reactive protein, CRP), low albumin(Albumin, ALB), low hemoglobin (Hemoglobin, Hb), low educational level (junior high school or lower), preference of spicy food, irregular diet, low annual household income, unfavorable fluid exchange conditions, unstable employment (including working as a farmer), and unfavorable humidity conditions (P < 0.05). 63/172 (36.6%) PDAP patients were intractable cases with a pathogenic bacteria positive rate of 74.60% in the peritoneal dialysate cultures, and 109/172 patients were non-intractable cases with a pathogenic bacteria positive rate of 53.21%. Gram-positive bacteria (G+) were detected in most of the dialysate cultures, with Staphylococcus epidermidis (S. epidermidis) as the most common type, while Escherichia coli (E. coli) was the most common Gram-negative bacteria (G-). Gram-positive bacteria were sensitive to vancomycin and linezolid, while G- bacteria were sensitive to imipenem and amikacin. Lifestyle, educational level, and environmental factors are the major contributors to PDAP in PD patients. Fungal and multi-bacterial infections are the major causes of death; PD is stopped for such patients.
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Affiliation(s)
- Linshuang You
- Department of Nephropathy, The Central Hospital of Yongzhou, Yongzhou, China
| | - Baoguo Zhang
- Department of Nephropathy, The Central Hospital of Yongzhou, Yongzhou, China
| | - Fan Zhang
- Department of Nephropathy, The Central Hospital of Yongzhou, Yongzhou, China
| | - Jianwen Wang
- Department of Nephropathy, Third Xiangya Hospital of Central South University, Changsha, Hunan Province, 410013, China.
- Department of Critical Kidney Disease Research Center, Third Xiangya Hospital of Central South University, Changsha, China.
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Tobijaszewska M, Martus G, Sunnerhagen T, Segelmark M, Ljungquist O. A population-based study on the incidence and aetiology of infectious complications in peritoneal dialysis in South Sweden. Infect Dis (Lond) 2024; 56:230-243. [PMID: 38100541 DOI: 10.1080/23744235.2023.2292133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/03/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Peritonitis is a major cause of morbidity in peritoneal dialysis (PD) and an independent risk factor for elevated all-cause mortality. The aims of this study were to report the incidence, trend, aetiology, and antimicrobial susceptibility of PD-associated peritonitis and catheter-related infections in South Sweden between 2011-2020. METHODS This population-based observational cohort study included all patients with PD between the years 2011-2020 in the county of Skåne. Data was accessed through the Swedish Renal Registry and the Department of Clinical Microbiology in Lund. Definitions issued by the International Society for Peritoneal Dialysis were implemented to assess PD-associated infections. RESULTS Medical records of 675 paediatric and adult PD patients were eligible for inclusion. Of those, 208 (31%) were female and the median age was 67 years (range 0-91). The overall rate of PD-peritonitis was 0.38 episodes per year at risk. Out of 484 episodes of peritonitis, 61% (n = 295) were caused by Gram-positive bacteria. There were 289 occurrences of exit site infections, of which most (n = 152, 53%) were Gram-positive. Tunnel infections occurred in 16 episodes and were caused by S. aureus or P. aeruginosa. Among all isolates, 37 were of MRSE, four of ESBL-producing E. coli, and one of MRSA. CONCLUSION The crude rate of PD-peritonitis was stable during the study period. Gram-positive bacteria dominated the microbial aetiology, and antibiotic resistance was limited. It is important to monitor the aetiology, incidence, and resistance rates in PD-associated infections, to base empirical antibiotic regimens and facilitate prevention.
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Affiliation(s)
- Marta Tobijaszewska
- Department of Infectious Diseases, Helsingborg hospital, Helsingborg, Sweden
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Giedre Martus
- Department of Endocrinology, Nephrology and Rheumatology, Skåne University Hospital, Lund, Sweden
- Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Torgny Sunnerhagen
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
- Clinical Microbiology, Infection Prevention and Control, Office for Medical Services, Region Skåne, Lund, Sweden
| | - Mårten Segelmark
- Department of Endocrinology, Nephrology and Rheumatology, Skåne University Hospital, Lund, Sweden
- Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Oskar Ljungquist
- Department of Infectious Diseases, Helsingborg hospital, Helsingborg, Sweden
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
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He Y, Yang G, Wang P, Wang X, Xiong Z, He Y, Xiong Z. Evolution of Peritoneal Dialysis-Associated Peritonitis: Pathogen, Antibiotic Resistance, and the Impact of Lymphocyte Count on Treatment Outcomes. Infect Drug Resist 2024; 17:685-696. [PMID: 38405055 PMCID: PMC10887942 DOI: 10.2147/idr.s442641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/07/2024] [Indexed: 02/27/2024] Open
Abstract
Purpose Antibiotic administration leads to alterations in pathogenic organisms and antibiotic resistance, posing a significant risk to peritoneal dialysis patients' health. This study aimed to investigate changes in the cause-specific peritonitis, pathogen profiles, antibiotic resistance, and the prognostic factors among patients with peritoneal dialysis-associated peritonitis (PDAP) at our center. Patients and Methods We included 463 PDAP patients who attended Peking University Shenzhen Hospital between 2002 and 2023. We analyzed the effects of empirical treatment regimens with cefazolin and ceftazidime or gentamicin. Results From 2002 to 2023, we observed that gram-positive staphylococci emerged as the primary causative agents, while the proportion of gram-negative bacillary, enteric peritonitis, and catheter-associated peritonitis decreased significantly. However, the overall cure rate for PDAP and gram-negative bacillary peritonitis declined significantly from 2014 to 2023. Notably, we observed no increase in antibiotic resistance associated with antibiotic drugs use. In addition, reduced lymphocyte counts due to the prevalence of 2019 coronavirus disease (COVID-19) emerged as an independent risk factor for treatment failure in cases of gram-negative bacillary peritonitis. Conclusion We did not observe elevated antibiotic resistance in our center when employing empirical dosing strategies involving cefazolin, ceftazidime, or gentamicin. Additionally, we found that a decrease in lymphocyte count due to the COVID-19 epidemic was a significant risk factor for treatment failure in cases of gram-negative bacillary peritonitis at our center. This study provides a foundation for developing clinical treatment strategies for PDAP.
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Affiliation(s)
- YuJian He
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
- Renal Division, PKU-Shenzhen Clinical Institute of Shantou University Medical College, Shenzhen, People’s Republic of China
| | - Guang Yang
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
| | - Pengpeng Wang
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
- Renal Division, PKU-Shenzhen Clinical Institute of Shenzhen University Medical College, Shenzhen, People’s Republic of China
| | - Xu Wang
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
- Renal Division, PKU-Shenzhen Clinical Institute of Shenzhen University Medical College, Shenzhen, People’s Republic of China
| | - Zuying Xiong
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
| | - Yan He
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
| | - Zibo Xiong
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
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Yu J, Zhu L, Ni J, Tong M, Wang H. Technique failure in peritoneal dialysis-related peritonitis: risk factors and patient survival. Ren Fail 2023; 45:2205536. [PMID: 37125594 PMCID: PMC10134955 DOI: 10.1080/0886022x.2023.2205536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the association between patient clinical characteristics and technique failure in peritoneal dialysis-related peritonitis (PDRP). The effect of peritonitis-associated technique failure on patient survival was also assessed. METHODS Patients diagnosed with PDRP from January 1, 2010 to June 30, 2022 were retrospectively reviewed and analyzed. Relevant demographic, biochemical, and clinical data were collected. Univariate and multivariate logistic regression analyses were used to determine the predictors of peritonitis-associated technique failure in PD. Patients were divided into technique failure (F group) and nontechnique failure (NF group) groups. Patients were followed until death or until the date of Oct 1, 2022. Kaplan-Meier survival curves and landmark analysis were used to assess the survival of the PDRP cohort. Cox regression models were used to assess the association between potential risk factors and mortality. RESULTS A total of 376 patients with 648 cases of PDRP were included in this study. Multivariate logistic regression analysis demonstrated that peritoneal dialysis (PD) duration (OR = 1.12 [1.03, 1.21], p = 0.005), dialysate WBC count on Day 3 after antibiotic therapy (OR = 1.41 [1.22, 1.64], p = 0.001), blood neutrophil-to-lymphocyte ratio (NLR) (OR = 1.83 [1.25, 2.70], p = 0.002), and serum lactate dehydrogenase (LDH) (OR = 4.13 [1.69, 10.11], p = 0.002) were independent predictors for technique failure in PDRP. Furthermore, serum high-density lipoprotein (HDL) (OR = 0.28 [0.13, 0.64], p = 0.002) was a protective factor against technique failure. According to the Kaplan-Meier analysis, patients experiencing peritonitis-associated technique failure had lower postperitonitis survival (log-rank = 4.326, p = 0.038). According to the landmark analysis, patients with a history of peritonitis-associated technical failures had a higher 8-year mortality after peritoneal dialysis. A Cox model adjusted for plausible predetermined confounders showed that technique failure was independently associated with all-cause mortality. CONCLUSIONS Dialysate WBC count on Day 3, PD duration, NLR, and LDH were independent risk factors for technique failure, whereas HDL was a protective factor. Peritonitis-associated technique failure had a higher risk of mortality and adverse effects on postperitonitis survival.
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Affiliation(s)
- Jin Yu
- Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine (Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University), Hangzhou, P. R. China
| | - Lingli Zhu
- Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine (Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University), Hangzhou, P. R. China
| | - Jun Ni
- Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine (Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University), Hangzhou, P. R. China
| | - Mengli Tong
- Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine (Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University), Hangzhou, P. R. China
| | - Hua Wang
- Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine (Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University), Hangzhou, P. R. China
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He Y, Zhu J, Xiao F, Luo Q, Wang P, Wang X, He Y, Xiong Z. Association of Different Total Bilirubin Levels with Prognosis of Peritoneal Dialysis-Associated Peritonitis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1837. [PMID: 37893555 PMCID: PMC10607946 DOI: 10.3390/medicina59101837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/24/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Peritoneal dialysis-associated peritonitis (PDAP) poses significant challenges in peritoneal dialysis (PD) patient management and outcomes. Total bilirubin has gained attention due to its antioxidant and immunomodulatory properties. However, its relationship with PDAP prognosis remains underexplored. Materials and Methods: We conducted a retrospective single-center study involving 243 PDAP patients stratified into tertile-based groups according to total bilirubin levels. The association between total bilirubin levels and treatment failure risk was investigated through statistical analyses and restricted cubic spline curve analysis. Results: Our analysis revealed a non-linear correlation between total bilirubin levels and PDAP treatment failure risk. At total bilirubin levels below 8.24 µmol/L, a protective effect was observed, while levels exceeding this threshold heightened the risk of treatment failure. Conclusions: This study unveils a dual role of total bilirubin in PDAP prognosis. Below a certain threshold, it confers protection, while higher levels exacerbate the risk of treatment failure. These findings emphasize the need for further investigation in larger, multicenter prospective studies to validate and elucidate the mechanisms behind bilirubin's impact on PDAP, potentially guiding the development of targeted therapeutic strategies.
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Affiliation(s)
- Yujian He
- Renal Division, Peking University Shenzhen Hospital, Lianhua Road 1120, Shenzhen 518036, China; (Y.H.); (J.Z.); (F.X.); (Q.L.); (P.W.); (X.W.); (Y.H.)
- PKU-Shenzhen Clinical Institute of Shantou University Medical College, Lianhua Road 1120, Shenzhen 518036, China
| | - Jingjing Zhu
- Renal Division, Peking University Shenzhen Hospital, Lianhua Road 1120, Shenzhen 518036, China; (Y.H.); (J.Z.); (F.X.); (Q.L.); (P.W.); (X.W.); (Y.H.)
- PKU-Shenzhen Clinical Institute of Shenzhen University Medical College, Lianhua Road 1120, Shenzhen 518036, China
| | - Fei Xiao
- Renal Division, Peking University Shenzhen Hospital, Lianhua Road 1120, Shenzhen 518036, China; (Y.H.); (J.Z.); (F.X.); (Q.L.); (P.W.); (X.W.); (Y.H.)
- PKU-Shenzhen Clinical Institute of Shantou University Medical College, Lianhua Road 1120, Shenzhen 518036, China
| | - Qingyun Luo
- Renal Division, Peking University Shenzhen Hospital, Lianhua Road 1120, Shenzhen 518036, China; (Y.H.); (J.Z.); (F.X.); (Q.L.); (P.W.); (X.W.); (Y.H.)
- PKU-Shenzhen Clinical Institute of Shenzhen University Medical College, Lianhua Road 1120, Shenzhen 518036, China
| | - Pengpeng Wang
- Renal Division, Peking University Shenzhen Hospital, Lianhua Road 1120, Shenzhen 518036, China; (Y.H.); (J.Z.); (F.X.); (Q.L.); (P.W.); (X.W.); (Y.H.)
- PKU-Shenzhen Clinical Institute of Shenzhen University Medical College, Lianhua Road 1120, Shenzhen 518036, China
| | - Xu Wang
- Renal Division, Peking University Shenzhen Hospital, Lianhua Road 1120, Shenzhen 518036, China; (Y.H.); (J.Z.); (F.X.); (Q.L.); (P.W.); (X.W.); (Y.H.)
- PKU-Shenzhen Clinical Institute of Shenzhen University Medical College, Lianhua Road 1120, Shenzhen 518036, China
| | - Yan He
- Renal Division, Peking University Shenzhen Hospital, Lianhua Road 1120, Shenzhen 518036, China; (Y.H.); (J.Z.); (F.X.); (Q.L.); (P.W.); (X.W.); (Y.H.)
| | - Zibo Xiong
- Renal Division, Peking University Shenzhen Hospital, Lianhua Road 1120, Shenzhen 518036, China; (Y.H.); (J.Z.); (F.X.); (Q.L.); (P.W.); (X.W.); (Y.H.)
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Al Jalali V, Matzneller P, Pham AD, van Os W, Wölfl-Duchek M, Sanz-Codina M, Vychytil A, Reiter B, Stimpfl T, Zeitlinger M. Plasma and intraperitoneal pharmacokinetics of ceftazidime/avibactam in peritoneal dialysis patients. Clin Microbiol Infect 2023; 29:1196.e1-1196.e7. [PMID: 37301439 DOI: 10.1016/j.cmi.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/26/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Peritonitis is a serious complication in patients undergoing automated peritoneal dialysis (APD) that increases morbidity and frequently disqualifies patients from the peritoneal dialysis programme. Ceftazidime/avibactam (CAZ/AVI) is a potential treatment option for APD patients with peritonitis caused by resistant Gram-negative bacteria, but limited data exist on systemic and target-site pharmacokinetics (PK) in patients undergoing APD. This study set out to investigate the PK of CAZ/AVI in plasma and peritoneal dialysate (PDS) of patients undergoing APD. METHODS A prospective, open-label PK study was conducted on eight patients undergoing APD. CAZ/AVI was administered as a single intravenous dose of 2 g/0.5 g over 120 minutes. APD cycles were initiated 15 hours after the study drug administration. Dense PDS and plasma sampling was performed for 24 hours after the start of administration. PK parameters were analysed with population PK modelling. Probability of target attainment (PTA) was simulated for different CAZ/AVI doses. RESULTS PK profiles of both drugs in plasma and PDS were similar, indicating that the two drugs are well suited for a fixed-dose combination. A two-compartment model best described the PK of both drugs. A single dose of 2 g/0.5 g CAZ/AVI led to concentrations that far exceeded the PK/PD targets of both drugs. In the Monte Carlo simulations, even the lowest dose (750/190 mg CAZ/AVI) achieved a PTA of >90% for MICs up to 8 mg/L (The European Committee on Antimicrobial Susceptibility Testing epidemiological cut-off value for Pseudomonas aeruginosa) in plasma and PDS. DISCUSSION On the basis of PTA simulations, a dose of 750/190 mg CAZ/AVI would be sufficient to treat plasma and peritoneal fluid infections in patients undergoing APD.
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Affiliation(s)
- Valentin Al Jalali
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Peter Matzneller
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria; Service of Rheumatology, South Tyrol Health System ASDAA-SABES, South Tyrol, Italy
| | - Anh Duc Pham
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Wisse van Os
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Michael Wölfl-Duchek
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Maria Sanz-Codina
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Andreas Vychytil
- Department of Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Birgit Reiter
- Clinical Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Stimpfl
- Clinical Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
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Ling CW, Sud K, Lee VW, Peterson GM, Van C, Zaidi STR, Patel RP, Castelino RL. Treatment and outcomes of peritonitis due to Rothia species in patients on peritoneal dialysis: A systematic review and multicentre registry analysis. ARCH ESP UROL 2022:8968608221140227. [DOI: 10.1177/08968608221140227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Peritoneal dialysis (PD)-associated peritonitis remains a severe complication of PD. Although peritonitis due to Rothia spp. is rare, the treatment recommendations and outcomes are uncertain. Our study aims to review (1) published literature on peritonitis caused by Rothia spp. and (2) reported cases of peritonitis due to Rothia spp. in patients on PD in Australia and New Zealand. A literature search of PubMed, Scopus, Embase and Google Scholar for articles published between January 1949 and February 2022 was conducted. To be eligible, articles had to describe antibiotic therapy and treatment outcomes in all PD patients for peritonitis caused by Rothia or Stomatococcus spp. Data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry of PD patients who developed peritonitis due to Rothia spp. between July 2011 and May 2020 were also reviewed. A total of 12 articles and 28 episodes were identified from the literature search and ANZDATA registry analysis, respectively. Over 60% of the peritonitis cases due to Rothia spp. were from the Rothia mucilaginosa species (8/12 and 17/28, respectively), while Rothia dentocariosa was the second most commonly identified species in both the literature search and the ANZDATA registry analysis (4/12 and 5/28, respectively). A majority 8 (66.7%) of the articles in the literature search employed a combination antibiotic regimen, while the remaining 4 (33.3%) used a single antibiotic regimen. In contrast, most of the episodes, 22 (78.6%) described in the ANZDATA registry analysis, employed a single antibiotic regimen, and only 6 (21.4%) episodes were treated with a combination antibiotic regimen. The duration of antibiotic therapy ranged from 2 to 3 weeks in the literature search, and 1 to 3 weeks in the ANZDATA registry. While no deaths within 30 days of developing peritonitis were reported, catheter removal was reported in three (25%) and two (7.1%) episodes in both the literature search and the ANZDATA registry analysis, respectively, of which the majority occurred in patients treated for ≤2 weeks. PD-associated peritonitis due to Rothia spp. is uncommon and associated with relatively good outcomes. Antibiotic treatment for 3 weeks is associated with better outcomes.
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Affiliation(s)
- Chau Wei Ling
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Kamal Sud
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Nepean Kidney Research Centre, Department of Renal Medicine, Nepean Hospital, Sydney, New South Wales, Australia
- Peritoneal Dialysis Unit, Regional Dialysis Centre, Blacktown Hospital, Sydney, New South Wales, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry Peritoneal Dialysis Working Group, Adelaide, South Australia, Australia
- Departments of Renal Medicine, Blacktown and Westmead Hospitals, New South Wales, Australia
| | - Vincent W Lee
- Departments of Renal Medicine, Blacktown and Westmead Hospitals, New South Wales, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Connie Van
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | | | - Rahul P Patel
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Ronald L Castelino
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Department of Pharmacy, Blacktown Hospital, New South Wales, Australia
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Li J, Wei X, Song Y, Li X, Wang C. In Vitro Study of the Effect of Inhibition of Quorum Sensing by Brominated Furanone on Peritoneal Dialysis-Associated Peritonitis Associated with Escherichia Coli Infection. Curr Microbiol 2022; 79:337. [PMID: 36201068 DOI: 10.1007/s00284-022-03040-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022]
Abstract
In recent years, the occurrence of peritoneal dialysis (PD)-associated peritonitis (PDAP) with Escherichia coli infection has gradually increased. The presence of quorum sensing (QS) among bacteria facilitates the expansion of antibiotic resistance. Brominated furanone (BMF), a halogenated furanone compound isolated from macroalgae, is a new type of quorum-sensing inhibitor that can inhibit bacterial quorum sensing and reduce bacterial resistance. In this study, we established an in vitro peritoneal dialysis-associated peritonitis biofilm model. After intervention with BMF, the biofilm was destroyed, as shown by scanning electron microscopy, and the number of viable bacteria was reduced. Crystal violet semiquantitative determination showed that biofilm absorption significantly decreased, and RT-PCR showed that luxS expression was downregulated after drug intervention. Therefore, we propose that BMF can effectively inhibit E. coli QS by disrupting the bacterial biofilm and downregulating QS gene expression to reduce the bacterial resistance, providing a direction for the development of novel antibacterial drugs.
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Affiliation(s)
- Jinqiu Li
- Department of Nephrology, the First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
| | - Xiaofang Wei
- Department of Nephrology, the First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
| | - Yashan Song
- Department of Nephrology, the First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
| | - Xiaohua Li
- Department of Nephrology, the First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
| | - Chengyu Wang
- Department of Nephrology, the First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China.
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Billah M, Uribarri J, Charen E, Sharma S. Unusual cases of peritonitis: A case series of five patients. Semin Dial 2022; 36:255-262. [PMID: 35929618 DOI: 10.1111/sdi.13121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/11/2022] [Accepted: 07/24/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Peritonitis is a complication in patients on peritoneal dialysis that frequently results from touch contamination. Most cases of peritoneal dialysis-related peritonitis are caused by skin organisms. Herein, we are presenting a series of peritonitis cases with unusual organisms in a single home dialysis center at an academic hospital in New York City. METHODS The records of five patients with an unusual cause of peritonitis were reviewed by a clinician. We have chronologically tabulated the cell count of the dialysate, microbiologic cultures, and antibiotics received by each patient. Additionally, both a table and figure detail the microbiologic organisms that our dialysis unit encountered over the 3-year period concurrent with the infections reported. RESULTS The first patient presented with refractory polymicrobial peritonitis due to a liver abscess. Another patient presented with diverticulitis and developed enteric peritonitis with various organisms. The following patient had peritonitis in the setting of bowel pathologies and from Rhizobium after exposure to plants. The next patient developed Pasteurella peritonitis from his cat. The final patient developed multiple episodes of peritonitis from organisms including flora native to soil and water. CONCLUSION These uncommon cases of peritonitis with unusual circumstances bring awareness to various elements that can lead to peritonitis.
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Affiliation(s)
- Marzuq Billah
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jaime Uribarri
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elliot Charen
- Division of Nephrology, Department of Medicine, Mount Sinai Beth Israel, New York, New York, USA
| | - Shuchita Sharma
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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11
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Meng L, Yang L, Zhu X, Zhang X, Li X, Cheng S, Guo S, Zhuang X, Zou H, Cui W. Development and Validation of a Prediction Model for the Cure of Peritoneal Dialysis-Associated Peritonitis: A Multicenter Observational Study. Front Med (Lausanne) 2022; 9:875154. [PMID: 35559352 PMCID: PMC9086557 DOI: 10.3389/fmed.2022.875154] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/24/2022] [Indexed: 12/03/2022] Open
Abstract
Aim Peritoneal dialysis (PD)-associated peritonitis (PDAP) is a severe complication of PD. It is an important issue about whether it can be cured. At present, there is no available prediction model for peritonitis cure. Therefore, this study aimed to develop and validate a prediction model for peritonitis cure in patients with PDAP. Methods Patients with PD who developed PDAP from four dialysis centers in Northeast China were followed up. According to the region of PD, data were divided into training and validation datasets. Initially, a nomogram for peritonitis cure was established based on the training dataset. Later, the nomogram performance was assessed by discrimination (C-statistic), calibration, and decision curves. Results Totally, 1,011 episodes of peritonitis were included in the final analysis containing 765 in the training dataset and 246 in the validation dataset. During the follow-up period, peritonitis cure was reported in 615 cases from the training dataset and 198 from the validation dataset. Predictors incorporated in the final nomogram included PD duration, serum albumin, antibiotics prior to admission, white cell count in peritoneal dialysate on day 5 (/μl) ≥ 100/μl, and type of causative organisms. The C-statistic values were 0.756 (95% CI: 0.713–0.799) in the training dataset and 0.756 (95% CI: 0.681–0.831) in the validation dataset. The nomogram exhibited favorable performance in terms of calibration in both the training and validation datasets. Conclusion This study develops a practical and convenient nomogram for the prediction of peritonitis cure in patients with PDAP, which assists in clinical decision-making.
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Affiliation(s)
- Lingfei Meng
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Liming Yang
- Department of Nephrology, The First Hospital of Jilin University-The Eastern Division, Changchun, China
| | - Xueyan Zhu
- Department of Nephrology, Jilin Central Hospital, Jilin, China
| | - Xiaoxuan Zhang
- Department of Nephrology, Jilin FAW General Hospital, Changchun, China
| | - Xinyang Li
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Siyu Cheng
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Shizheng Guo
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Xiaohua Zhuang
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Hongbin Zou
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Wenpeng Cui
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
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孟 令, 朱 学, 杨 立, 李 忻, 程 思, 郭 师, 庄 小, 邹 洪, 崔 文. [Development and validation of a prediction model for treatment failure in peritoneal dialysis-associated peritonitis patients: a multicenter study]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2022; 42:546-553. [PMID: 35527490 PMCID: PMC9085593 DOI: 10.12122/j.issn.1673-4254.2022.04.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To develop and validate a risk prediction model of treatment failure in patients with peritoneal dialysis-associated peritonitis (PDAP). METHODS We retrospectively analyzed the data of patients undergoing peritoneal dialysis (PD) in 3 dialysis centers in Jilin Province who developed PDAP between January 1, 2013 and December 31, 2019. The data collected from the Second Hospital of Jilin University and Second Division of First Hospital of Jilin University) were used as the training dataset and those from Jilin Central Hospital as the validation dataset. We developed a nomogram for predicting treatment failure using a logistic regression model with backward elimination. The performance of the nomogram was assessed by analyzing the C-statistic and the calibration plots. We also plotted decision curves to evaluate the clinical efficacy of the nomogram. RESULTS A total of 977 episodes of PDAP were included in the analysis (625 episodes in the training dataset and 352 episodes in the validation dataset). During follow-up, 78 treatment failures occurred in the training dataset and 35 in the validation dataset. A multivariable logistic regression prediction model was established, and the predictors in the final nomogram model included serum albumin, peritoneal dialysate white cell count on day 5, PD duration, and type of causative organisms. The nomogram showed a good performance in predicting treatment failure, with a C-statistic of 0.827 (95% CI: 0.784-0.871) in the training dataset and of 0.825 (95% CI: 0.743-0.908) in the validation dataset. The nomogram also performed well in calibration in both the training and validation datasets. CONCLUSION The established nomogram has a good accuracy in estimating the risk of treatment failure in PDAP patients.
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Affiliation(s)
- 令飞 孟
- 吉林大学第二医院肾病内科,吉林 长春 130041Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
| | - 学研 朱
- 吉林市中心医院肾病内科,吉林 长春 132011Department of Nephrology, Second Division of First Hospital of Jilin University, Changchun 130031, China
| | - 立明 杨
- 吉林大学 第一医院二部肾病内科,吉林 长春 130031Department of Nephrology, Jilin Central Hospital, Changchun 132011, China
| | - 忻阳 李
- 吉林大学第二医院肾病内科,吉林 长春 130041Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
| | - 思宇 程
- 吉林大学第二医院肾病内科,吉林 长春 130041Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
| | - 师正 郭
- 吉林大学第二医院肾病内科,吉林 长春 130041Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
| | - 小花 庄
- 吉林大学第二医院肾病内科,吉林 长春 130041Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
| | - 洪斌 邹
- 吉林大学第二医院肾病内科,吉林 长春 130041Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
| | - 文鹏 崔
- 吉林大学第二医院肾病内科,吉林 长春 130041Department of Nephrology, Second Hospital of Jilin University, Changchun 130041, China
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The Impact of Preoperative Risk Factors on Peritoneal Dialysis-Related Peritonitis: A Single-Center Prospective Study in Japan. Medicina (B Aires) 2022; 58:medicina58020313. [PMID: 35208636 PMCID: PMC8878486 DOI: 10.3390/medicina58020313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 12/01/2022] Open
Abstract
Background and Objectives: Peritoneal dialysis (PD)-related peritonitis is a critical problem. However, preoperative risk factors for PD-related peritonitis have not been established. Thus, we aimed to determine the preoperative risk factors for PD-related peritonitis. Materials and Methods: This is a single-center prospective observational study. All peritonitis episodes during the study period were recorded, and preoperative and intraoperative clinical parameters were compared between patients with and without peritonitis to examine risk factors for PD-related peritonitis. Furthermore, subcutaneous and abdominal fat volumes were evaluated using computed tomography. Results: Among a total of 118 patients, 24 patients developed peritonitis. The proportion of male patients (83% vs. 61%, p = 0.04), body mass index (25 vs. 22 kg/m2, p = 0.04), and subcutaneous fat area (120 vs. 102 cm2, p = 0.01) were significantly higher and the proportion of patients living with family members (75% vs. 94%, p = 0.02) was significantly lower in the peritonitis group than in the non-peritonitis group. There were no significant differences in age, operation method, surgeon experience, previous abdominal surgery, medical history of diabetic nephropathy, serum albumin level, and renal function between the two groups. Conclusions: Male patients with high subcutaneous fat who are living alone might be at higher risk of PD-related peritonitis. These characteristics might be useful in risk assessment and patient education before PD induction.
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