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

Hausmann, Michael; Yulzari, Robert; Vorobiov, Marina; Douvdevani, Amos; Zlotnik, Moshe

doi:10.1159/000112042

Cited by 6 publications

(3 citation statements)

References 28 publications

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“…In our study, treatment of culture-negative peritonitis was often successful, with resolution 88% of the time. Previous studies suggest that culture-negative peritonitis episodes are due to gram-positive bacterial infections that fail to reach the threshold of detection (15,27). Therefore, early treatment with empirical antibiotics against grampositive bacteria is a likely explanation for the high success rate.…”

Section: Discussionmentioning

confidence: 99%

Variability in Culture-Negative Peritonitis Rates in Pediatric Peritoneal Dialysis Programs in the United States

Davis

Bryant

Rodean

et al. 2021

CJASN

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Background and objectivesInternational guidelines suggest a target culture-negative peritonitis rate of <15% among patients receiving long-term peritoneal dialysis. Through a pediatric multicenter dialysis collaborative, we identified variable rates of culture-negative peritonitis among participating centers. We sought to evaluate whether specific practices are associated with the variability in culture-negative rates between low– and high–culture-negative rate centers.Design, setting, participants, & measurementsThirty-two pediatric dialysis centers within the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) collaborative contributed prospective peritonitis data between October 1, 2011 and March 30, 2017. Clinical practice and patient characteristics were compared between centers with a ≤20% rate of culture-negative peritonitis (low-rate centers) and centers with a rate >20% (high-rate centers). In addition, centers completed a survey focused on center-specific peritoneal dialysis effluent culture techniques.ResultsDuring the 5.5 years of observation, 1113 patients had 1301 catheters placed, totaling 19,025 patient months. There were 620 episodes of peritonitis in 378 patients with 411 catheters; cultures were negative in 165 (27%) peritonitis episodes from 125 (33%) patients and 128 (31%) catheters. Low-rate centers more frequently placed catheters with a downward-facing exit site and two cuffs (P<0.001), whereas high-rate centers had more patients perform dialysis themselves without the assistance of an adult care provider (P<0.001). The survey demonstrated that peritoneal dialysis effluent culture techniques were highly variable across centers. No consistent practice or technique helped to differentiate low- and high-rate centers.ConclusionsCulture-negative peritonitis is a frequent complication of maintenance peritoneal dialysis in children. Despite published recommendations for dialysis effluent collection and culture methods, great variability in culture techniques and procedures exists among individual dialysis programs and respective laboratory processes.

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Section: Discussionmentioning

confidence: 99%

Variability in Culture-Negative Peritonitis Rates in Pediatric Peritoneal Dialysis Programs in the United States

Davis

Bryant

Rodean

et al. 2021

CJASN

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“…Bu oranı artır-mak için çeşitli yöntemler denenmiştir. İsrail'de yapılan bir çalışmada Limulus amebosit lizat (LAL) testiyle hassasiyetin artırılabileceği bildirilmiştir (13). LAL pozitifliği Gram-pozitif etkenleri ekarte ederken, negatifliği Gram-negatif etkenlere bağlı peritoniti ekarte ettirmez.…”

Section: İrdelemeunclassified

“…Uluslararası Periton Diyalizi Derneği (ISPD) her ne kadar aminoglikozid antibiyotiklerin kullanımı-na karşı çıksa da kültür-negatif peritonitlerdeki kullanımını açık bırakmıştır. Aynı çalışmada bu tür hastalarda intraperitoneal aminoglikozid kesilip yerine non-nefrotoksik kinolonlar başlanmış ve iyi klinik yanıt alınmıştır (13). Tedaviye yanıt açı-sından kültür-negatif peritonitler üç çalışmada araştırılmış, ikisinde (11,14) selim bir seyir izlediği belirtilirken diğerinde (12) tam iyileşme oranı oldukça düşük (%67.5) olarak bildirilmiştir.…”

Section: İrdelemeunclassified

The Effect of Culture Technique on Culture Positivity in Peritoneal Dialysis Patients with Peritonitis

Gürsu¹,

Aydın²,

Öztürk³

et al. 2011

Klimik Dergisi

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ÖzetAmaç: Ünitemizde kaydedilen peritonit atakları irdelenerek kül-tür pozitifliğiyle diyalizat örneğinin alım ve ekim yöntemi arasındaki ilişkinin araştırılması amaçlanmıştır. Yöntemler: 103 hasta geriye dönük olarak incelendi. Klinik bulgular, periton sıvısındaki hücre sayımı, kültüründe üreyen mikroorganizmalar, uygulanan tedavi rejimine yanıtlar kaydedildi. Conclusions: Culture negativity, reported to be up to 20%, decreases the effectiveness of treatment, increases the incidence of autotoxicity, and loss of residual renal function due to antibiotics, results in secondari fungal peritonitis attacks and emergence of vancomycin-resistant enterococci. Inappropriate culture technique and recent antibiotic use were leading causes of culture negativity. Prevention of inappropriate antibiotic use and improving culture techniques, as in our study, may increase culture positivity. Klimik Dergisi 2011; 24(2): 94-7.

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Renal TRPathies

Dietrich¹,

Chubanov²,

Gudermann³

2010

Journal of the American Society of Nephrology

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One key function of the kidneys is the ultrafiltration of plasma by glomeruli to dispose of metabolic end products, excess electrolytes, and water. A vast array of ion channels and transporters are critical for filtration, secretion, and resorption of electrolytes to maintain homeostasis. In recent years, investigations have focused on several members of the large transient receptor potential (TRP) family of ion channels, because mutations in genes encoding members of three different TRP ion channel subfamilies have been linked to human kidney diseases. 1 Mutations in PKD1 (encoding TRPP1) and PKD2 (coding for TRPP2) occur at high frequency in individuals with autosomal dominant polycystic kidney disease. 2,3 The latter mutations and the pathophysiology of polycystic kidney disease are not discussed further in this overview because the topic has been covered by numerous insightful review articles. 4 -7 Missense and nonsense mutations in the gene coding for TRPC6 segregate with autosomal dominant FSGS, a kidney disease that leads to progressive renal failure. 8,9 Loss-of-function mutations in TRPM6 are also associated with hypomagnesemia with secondary hypocalcemia (HSH), a rare autosomal recessive disorder. 10 -12 The involvement of TRP channel mutations in hereditary kidney disease has shed new light on the molecular pathogenesis of renal failure and significantly enhanced our appreciation of the physiologic roles of TRP channels on tubular function. In this review, we focus exclusively on TRPC6 and TRPM6. TRPC6 AND PODOCYTE FUNCTIONTRPC6 is a nonselective cation channel and one of the seven members of the classical transient receptor potential (TRPC) family, which can be divided into subfamilies on the basis of amino acid similarity. Whereas TRPC1 and TRPC2 are almost unique, TRPC4 and TRPC5 share approximately 64% amino acid identity. TRPC3, TRPC6, and TRPC7 form a structural and functional subfamily displaying 65 to 78% identity at the amino acid level and share a common activator, diacylglycerol (DAG). 13 DAG is produced by phospholipase C isozymes activated after agonist binding to appropriate receptors, such as the interaction of angiotensin II (AngII) with AT 1 receptors.Like all TRPC family members, TRPC6 harbors an invariant sequence, the TRP box (containing the amino acid sequence EWKFAR), in its C-terminal tail as well as three ankyrin repeats in the N-terminus (Figure 1, A and B). The predicted transmembrane topology is similar to that of other TRP channels with intracellular N-and C-termini, six membrane-spanning helices (S1 through S6), and a presumed pore-forming loop (P) between S5 and S6 (Figure 1, A and B). As deduced from Northern blot analyses, TRPC6 channels are most prominently expressed in lung tissues, 14 where they ABSTRACTMany ion channels and transporters are involved in the filtration, secretion, and resorption of electrolytes by the kidney. In recent years, the superfamily of transient receptor potential (TRP) ion channels have received deserved attention because mutated TRP ch...

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

Cited by 6 publications

References 28 publications

Variability in Culture-Negative Peritonitis Rates in Pediatric Peritoneal Dialysis Programs in the United States

Variability in Culture-Negative Peritonitis Rates in Pediatric Peritoneal Dialysis Programs in the United States

The Effect of Culture Technique on Culture Positivity in Peritoneal Dialysis Patients with Peritonitis

Renal TRPathies

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