Aseptic peritonitis due to peptidoglycan contamination of pharmacopoeia standard dialysis solution

Martis, Leo; Patel, Maitraya; Giertych, Joe; Mongoven, Jim; Taminne, Michel; Perrier, Michele A; Mendoza, Omar; ., N. Rajendra Goud; Costigan, Aidan; Denjoy, Nicole; Verger, Christian; Owen, William F.

doi:10.1016/s0140-6736(05)17908-2

Cited by 35 publications

(21 citation statements)

References 25 publications

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“…At the turn of the century, a number of culture-negative peritonitis episodes were reported that were associated with the usage of icodextrin solution for PD [32–34]. Subsequent investigations revealed that these cases of sterile peritonitis were caused by a peptidoglycan (released from Alicyclobacillus acidocaldarius , a Gram-positive organism) contaminating the cornstarch used for icodextrin production [35]. The problem has since been resolved following implementation of a routine serial monitoring program of icodextrin solutions for peptidoglycan during the manufacturing process.…”

Section: Microbiology Of Peritonitismentioning

confidence: 99%

Dialysis-associated peritonitis in children

2009

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Peritonitis remains a frequent complication of peritoneal dialysis in children and is the most common reason for technique failure. The microbiology is characterized by a predominance of Gram-positive organisms, with fungi responsible for less than 5% of episodes. Data collected by the International Pediatric Peritonitis Registry have revealed a worldwide variation in the bacterial etiology of peritonitis, as well as in the rate of culture-negative peritonitis. Risk factors for infection include young age, the absence of prophylactic antibiotics at catheter placement, spiking of dialysis bags, and the presence of a catheter exit-site or tunnel infection. Clinical symptoms at presentation are somewhat organism specific and can be objectively assessed with a Disease Severity Score. Whereas recommendations for empiric antibiotic therapy in children have been published by the International Society of Peritoneal Dialysis, epidemiologic data and antibiotic susceptibility data suggest that it may be desirable to take the patient- and center-specific history of microorganisms and their sensitivity patterns into account when prescribing initial therapy. The vast majority of patients are treated successfully and continue peritoneal dialysis, with the poorest outcome noted in patients with peritonitis secondary to Gram-negative organisms or fungi and in those with a relapsing infection.

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Section: Microbiology Of Peritonitismentioning

confidence: 99%

Dialysis-associated peritonitis in children

2009

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“…Previously, epidemic outbreaks of culture-negative peritonitis have been reported due to endotoxin or peptidoglycan [1,2,3]. In our study, we investigated sporadic episodes of culture-negative peritonitis, i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Peptidoglycan-contaminated Extraneal batches have been recalled by Baxter in May 2002 following several reports of aseptic peritonitis [1]. The silkworm larvae test had been applied to detect the presence of peptidoglycans, which are components of bacterial walls.…”

Section: Introductionmentioning

confidence: 99%

Sporadic Culture-Negative Peritonitis in Peritoneal Dialysis Patients – Absence of Endotoxin in Dialysate

et al. 2007

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Background: Indiscriminate use of broad-spectrum antibiotics in peritonitis may have either unwanted side effects or contribute to the development of antibiotic resistance. It is tempting to use broad-spectrum antibiotics in cases of culture-negative peritonitis. This study examines whether Gram-negative agents have to be considered in the management of culture-negative peritonitis. Gram-negative agents are manifested by endotoxin easily detected by the Limulus amebocyte lysate (LAL) test. Methods: 138 episodes of Gram-negative and culture-negative peritonitis have been retrospectively analyzed; episodes of Gram-negative peritonitis were controls. Correlation between LAL and culture results was compared between the two groups. The LAL test was performed using a commercial kit by incubating a mixture of dialysate effluent and LAL reagent at 37°C. Development of a stable solid clot was considered positive. Results: In controls, 80 out of 117 Gram-negative peritonitis were LAL positive (68%). None of the 21 culture-negative episodes was LAL positive. In 7 recurrences of Gram-negative peritonitis, the LAL test turned from negative to positive but in none of the recurrences of culture-negative peritonitis. The difference in correlation was highly significant. Conclusions: Gram-negative organisms do not seem to be involved in sporadic culture-negative peritonitis. In episodes of peritonitis in which bacteriologic cultures stay negative for 48 h, initial coverage of Gram-negative organisms may be dropped.

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“…In some patients, use of icodextrin may lead to allergic reaction, mostly manifesting itself as a skin rash [53]. It may also induce sterile peritonitis, which in many cases could be attributed to contamination with peptidoglycan, the bacterial product [54]. Despite the subsequent adherence to peptidoglycan levels <7.4 µg/l in icodextrin, PDF-associated cases of sterile peritonitis still occur [55].…”

Section: Novel Pd Solutions In Clinical Studiesmentioning

confidence: 99%

Novel Peritoneal Dialysis Solutions – What Are the Clinical Implications?

Jörres¹

2012

Blood Purif

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Novel low-glucose degradation products (GDP) peritoneal dialysis (PD) fluids have an improved biocompatibility profile as compared to standard fluids. Clinical studies suggest that their use may be associated with favorable clinical outcomes; however, large prospective randomized studies addressing clinical endpoints such as patient and technique survival are presently lacking. Nevertheless, as their only disadvantage is their cost, they are already being used as the standard treatment by many adult PD centers. This policy is also in line with the latest recommendations from the European Pediatric Dialysis Working Group which advises that conventional, single-chamber PD solutions should be replaced by PD solutions with reduced GDP content. The use of icodextrin, the glucose polymer PD solution, is recommended for patients with high or high-average peritoneal transport and/or ultrafiltration problems who otherwise would resort to hypertonic (3.86% glucose) exchanges.

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Aseptic peritonitis due to peptidoglycan contamination of pharmacopoeia standard dialysis solution

Cited by 35 publications

References 25 publications

Dialysis-associated peritonitis in children

Dialysis-associated peritonitis in children

Sporadic Culture-Negative Peritonitis in Peritoneal Dialysis Patients – Absence of Endotoxin in Dialysate

Novel Peritoneal Dialysis Solutions – What Are the Clinical Implications?

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