Outbreak of sterile peritonitis among continuous cycling peritoneal dialysis patients

Mangram, Alicia; Archibald, Lennox K.; Hupert, Mark; Tokars, Jerome I.; Silver, Leah Christine; Brennan, Patrick; Arduino, Matthew J.; Peterson, Sonya; Parks, Seaul; Raymond, Alicia; Mccullough, Margaret; Jones, Martha S.; Wasserstein, Allen; Kobrin, Sidney; Jarvis, William R.

doi:10.1046/j.1523-1755.1998.00110.x

Cited by 34 publications

(28 citation statements)

References 7 publications

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“…The RPT and the LAL still are the standard methods to test tubes, membranes, and the dialysis solutions. Still a certain percentage of patients develops fever following dialysis, sometimes traceable to pyrogens (Karanicolas et al, 1977;Mangram et al, 1998). For example in 2001-2003, a global recall was issued for a certain icodextrin-containing dialysate.…”

Section: Missed Opportunity: Pyrogen-control Of Dialysis Fluidsmentioning

confidence: 99%

The human whole blood pyrogen test – lessons learned in twenty years

Hartung

2015

ALTEX

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Section: Missed Opportunity: Pyrogen-control Of Dialysis Fluidsmentioning

confidence: 99%

The human whole blood pyrogen test – lessons learned in twenty years

Hartung

2015

ALTEX

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“…even when applying the most careful standards for dialysis solutions, from time to time adverse drug reaction (ADR) complaints arise (Karanicolas et al, 1977;Mangram et al, 1998;Benevent et al, 1984;tuncer et al, 2000;Gokal et al, 1981), for example in [2001][2002][2003], when a global recall was issued for a certain icodextrin-containing dialysate. Patients using these batches complained about abdominal pain, nausea, vomiting, diarrhea, fever, and emitted a cloudy dialysate.…”

Section: Case Study Dialysis Solutionmentioning

confidence: 99%

Evidence for the detection of non-endotoxin pyrogens by the whole blood monocyte activation test

Hasiwa

Daneshian

Bruegger

et al. 2013

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“…Detection of bacterial components in dialysate may thus contribute to the eventual identification of bacteria involved in the pathogenesis of aseptic peritonitis. Previously, two epidemics in PD patients of aseptic peritonitis caused by endotoxin (lipopolysaccharide) have been reported [2, 3]. Small amounts of bacterial endotoxin can be detected in biological fluids by a 1-hour test known as the Limulus amebocyte lysate (LAL) assay.…”

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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Outbreak of sterile peritonitis among continuous cycling peritoneal dialysis patients

Abstract: Our results suggest that this outbreak was caused by intrinsic PDS contamination with endotoxin. Pre-sterilization colony counts may be an important quality control indicator for CCPD fluids in conjunction with endotoxin levels.

Cited by 34 publications

References 7 publications

The human whole blood pyrogen test – lessons learned in twenty years

The human whole blood pyrogen test – lessons learned in twenty years

Evidence for the detection of non-endotoxin pyrogens by the whole blood monocyte activation test

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

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