Opsonic deficiency of peritoneal dialysis effluent in continuous ambulatory peritoneal dialysis

Abstract

Staphylococcus epidermidis peritonitis frequently complicates the clinical course of patients treated with continuous ambulatory peritoneal dialysis (CAPD). Since bacterial opsonization is critical to the effective defense of the peritoneal cavity by phagocytic cells, we prospectively evaluated the opsonic activity of peritoneal dialysis effluent obtained from 17 CAPD patients during 102 patient months. Samples of peritoneal dialysis effluent contained concentrations of opsonins against S. epidermidis that were less than 2% of that observed in serum. Moreover, heat-labile opsonic activity against Escherichia coli was absent from all dialysis effluents. During the study, there were ten episodes of peritonitis in nine CAPD patients (1 per 10.2 patient months). S. epidermidis was isolated in seven episodes, a gram-negative bacillus in one, and two episodes were culture negative. the incidence of S. epidermidis peritonitis was 1 per 62 patient months in the patients with "high" peritoneal dialysis effluent opsonic activity against S. epidermidis but was nearly tenfold greater in patients with "low" opsonic activity (1 per 6.7 patient months). We conclude that peritoneal dialysis effluent opsonic activity predicts which CAPD patients are at an increased risk to develop S. epidermidis peritonitis.

Consensus Guidelines for the Prevention and Treatment of Catheter-Related Infections and Peritonitis in Pediatric Patients Receiving Peritoneal Dialysis: 2012 Update

“…Keane et al found evidence of increased opsonizing activity and a significant decline in the peritonitis rate associated with the daily intraperitoneal infusion of 250 mg IgG in individuals with low pre-study dialysate IgG levels (250,256). Lamperi and Carozzi detected a significant reduction in the peritonitis rate from 1 episode in 6.2 patient-months to 1 episode in 21.6 patient-months associated with a rise in peritoneal effluent IgG levels achieved by infusing 12 g IgG intraperitoneally every 3 weeks (257).…”

“…An inverse relationship has been reported between the frequency of peritonitis and opsonic activity or the immunoglobulin G (IgG) concentration of dialysate, or both (250)(251)(252). Decreased macrophage bactericidal activity is found in patients with a high incidence of peritonitis.…”

Effect of virulent anaerobes on the outcome of peritoneal dialysis associated peritonitis

“…Bacteroides fragilis can also interact with peritoneal macrophages inducing procoagulant activity and fibrin deposition that impairs clearance of the infecting organisms. 16 Neutrophils killing ability can be inhibited by short chain fatty acids produced by Bacteroides fragilis and other anaerobic gram-negative bacilli (AGNB). 17 The impact of anaerobes on their outcome revealed that 25.0% loss of life and 5.6% hospitalization were more significant with Bacteroides fragilis while 5.6% loss of life was more frequent in Fusobacterium nucleatum as shown in table 1.…”

“…It is a retrospective study involving patients undergoing CAPD at our centre who developed PD associated peritonitis over a period of 16 Aerobic, mycobacterium, polymicrobial and fungal peritonitis were excluded from the analysis due to their different outcomes.…”

Peritonitis following endoscopic polypectomy in a peritoneal dialysis patient: The need for antibiotic prophylaxis

“…First, the continuous exchange of dialysate in the peritoneal cavity results in dilution of both cellular and humeral components of the host defense system, such as opsonins [8]. Secondly, the unphysiological composition of peritoneal dialysate, including low pH and high glucose content, may impair the function of phagocytic cells, thereby increasing the risk of infection [9,10].…”