Aseptic Peritonitis in Patients on Maintenance Peritoneal Dialysis

Gandhi, Vasant C.; Kamadana, M. R.; Ts, Ing; Daugirdas, John T.; Viol, G. W.; Robinson, Jay A.; Wp, Geis; Hano, Jessie E.

doi:10.1159/000181728

Cited by 14 publications

(3 citation statements)

References 4 publications

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“…The early diagnostic usefulness of the LAL assay was demonstrated by Ghandi et al (15) in the late 1970s. Despite attractive later studies (9-14), we continued to view the LAL assay with a doubting eye.…”

Section: Discussion Discussion Discussion Discussionmentioning

confidence: 97%

Diagnostic Value of Effluent Endotoxin Level in Gram-Negative Peritonitis in Capd Patients

2001

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Objective To evaluate the diagnostic usefulness of effluent endotoxin by Limulus amoebocyte lysate (LAL) assay in gram-negative peritonitis patients on continuous ambulatory peritoneal dialysis (CAPD) therapy. Design Prospective study with patients serving as their own controls. Standard microbiologic work up and endotoxin analysis of effluents (night dwell) were done during the pre- and posttreatment phases. Setting Specimens from three teaching hospitals were processed and tested at a common center. Patients were left for treatment at their respective centers without intervention. Patients 32 clinical peritonitis and 40 infection-free CAPD patients were studied. Results 75% ( n = 24) of cultures were positive: 41.6% ( n = 10) gram-negative and 58.4% ( n = 14) gram-positive bacteria. Effluents of pre- and posttreated gram-negative cultures had endotoxin levels of 1.53 ± 0.169 and 0.214 ± 0.085 endotoxin units (EU)/mL, respectively ( p < 0.0001); pre- and posttreated gram-positive levels of 0.102 ± 0.06 and 0.122 ± 0.052 EU/mL, respectively ( p > 0.05); pre- and posttreated culture-negative peritonitis levels of 0.110 ± 0.025 and 0.087 ± 0.031 EU/mL, respectively ( p > 0.05); peritonitis-free effluents contained 0.117 ± 0.079 EU/mL. The diagnostic specificity and the sensitivity of LAL assay were 100% and 98.2% respectively. Conclusion Where initial microbiological work-up cannot demonstrate a pathogen, effluent endotoxin determined by quantitative LAL assay is a useful marker for diagnosis and management, within safe time limits, of gram-negative peritonitis in CAPD patients.

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Section: Discussion Discussion Discussion Discussionmentioning

confidence: 97%

Diagnostic Value of Effluent Endotoxin Level in Gram-Negative Peritonitis in Capd Patients

2001

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“…There are reports of 56 patients involved in 7 series of outbreak peritonitis in PD patients (Table 3) (3-9). All peritonitis outbreaks reported were related to a single type of organism, including Acinetobacter calcoaceticus, Candida tropicalis, Candida parapsilosis , or Rhodotorula rubra (3,4,6,8), and the common sources of outbreak were traced to contaminated warm waterbath for dialysate, contaminated dialysate, and colonization from pigeon guano on windowsills (3-5,7-9). Outbreak peritonitis in IPD patients was only reported in one case-control study (3); the other episodes of outbreak were related to CAPD patients (4-9).…”

Section: Resultsmentioning

confidence: 99%

Polymicrobial Outbreak of Intermittent Peritoneal Dialysis Peritonitis during External Wall Renovation at a Dialysis Center

Cheng

Woo

et al. 2001

Perit Dial Int

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Objective To investigate an outbreak of peritonitis in intermittent peritoneal dialysis (IPD) patients. Design An outbreak investigation was performed to identify the etiology of the polymicrobial outbreak, and a retrospective case-control study was conducted to assess the risk factors for development of peritonitis. Setting Renal dialysis center. Patients Ten episodes of peritonitis occurred in 8 of 61 patients over a 6-month period in which 669 IPD procedures were analyzed. Interventions Field visit to renal dialysis center to examine the entire IPD procedure, inspect the hospital environment, and perform air bacterial count. Main Outcome Measures The environmental factors and risk factors contributing to the polymicrobial peritonitis outbreak in IPD patients. The incidence of IPD peritonitis was determined before and after interventions. Results The causative organisms included Acinetobacter baumanii ( 6 ), Stenotrophomonas maltophilia ( 2 ), Pseudomonas aeruginosa ( 1 ), Candida albicans ( 1 ), C. tropicalis ( 1 ), Enterococcus ( 3 ), and Enterobacteriaceae ( 2 ). Four episodes of peritonitis involved infection by more than one organism. Air sampling of the environment detected a median of 110 colony forming units of bacteria per cubic meter of air, 10% of which were found to be Acinetobacter baumanii. The source of this polymicrobial outbreak was attributed to the bamboo scaffolding structure covering the external wall of the hospital during renovation. A retrospective case-control study indicated that the absence of the flush-before-fill step was a risk factor for development of peritonitis. Conclusion In addition to invasive aspergillosis in transplant or oncology patients, Acinetobacter peritonitis in dialysis patients should be considered another microbial cause of outbreak associated with hospital renovation.

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“…During most epi sodes, common pathogenic bacteria, including Staphylo coccus aureus, were recovered from the peritoneal ef fluent. During other episodes, the peritoneal fluid was found to be sterile, suggesting aseptic or chemical perito nitis [1,21], Recently, peritoneal sclerosis was described in 2 CAPD patients, each of whom had suffered multiple bouts of peritonitis. Cultures of peritoneal fluid some times grew bacteria, but frequently failed to grow either bacteria or fungi.…”

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confidence: 99%

Peritoneal Sclerosis in Peritoneal Dialysis Patients

Ing

Daugirdas

Gandhi³

1984

Am J Nephrol

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Peritoneal sclerosis, a disorder similar to that previously identified in nonuremic patients, is being noted in peritoneal dialysis patients with increasing frequency. The etiology in dialysis patients remains unknown. An association with previous or ongoing peritoneal inflammation or irritation suggests that the incidence of peritoneal sclerosis could be reduced by rapidly controlling peritonitis and by eliminating the irritant properties of catheters, dialysate, and other materials used in performing peritoneal dialysis. If peritoneal sclerosis does supervene, weight loss, abdominal pain, and intestinal obstruction may occur and further peritoneal dialysis may become impossible because of abdominal pain or poor fluid and solute transfer.

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Aseptic Peritonitis in Patients on Maintenance Peritoneal Dialysis

Cited by 14 publications

References 4 publications

Diagnostic Value of Effluent Endotoxin Level in Gram-Negative Peritonitis in Capd Patients

Diagnostic Value of Effluent Endotoxin Level in Gram-Negative Peritonitis in Capd Patients

Polymicrobial Outbreak of Intermittent Peritoneal Dialysis Peritonitis during External Wall Renovation at a Dialysis Center

Peritoneal Sclerosis in Peritoneal Dialysis Patients

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