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Therapeutic Apheresis and Dialysis :... Apr 2022Exit site infection (ESI) is a leading complication of peritoneal dialysis (PD), at an incidence of 0.6 episodes per year in the United States, and a major risk factor... (Review)
Review
Exit site infection (ESI) is a leading complication of peritoneal dialysis (PD), at an incidence of 0.6 episodes per year in the United States, and a major risk factor for catheter removal and peritonitis. An estimated 20% of all peritonitis cases are preceded by an ESI, with up to 50% of Staphylococcus aureus peritonitis associated with ESI. Gram-negative ESIs are less associated with succeeding peritonitis than their gram-positive counterparts, though when present, are associated with a lower peritonitis cure rate. The rate of catheter removal for refractory ESI is relatively highest in ESI due to mycobacteria (up to 40%), S. aureus (35%), Pseudomonas aeruginosa (28%), followed by Corynebacterium, Serratia, and fungi. In review of relevant literature, we found no prophylactic benefit of dressings over nondressings, specific antiseptics over normal saline, or topical honey over topical antibiotic prophylaxis, and thus recommend individualized exit site hygiene. We found topical gentamicin effective for prevention of most ESIs, including gram-negative ESIs, and thus recommend consideration of prophylactic topical gentamicin in areas of high gram-negative peritonitis incidence. With long-term use, observational studies detect up to 25% of gram-positive and 14% of gram-negative ESIs may be mupirocin and gentamicin resistant, respectively. We review empiric and targeted ESI management, including indications for ultrasound, anti-VMRSA, anti-Pseudomonal, and anti-mycobacterial antibiotic use, and catheter removal. We recommend further investigation into the earlier use of second-line treatment agents and the utility of treating post-infectious exit site colonization as avenues to decrease refractory and repeat ESI.
Topics: Administration, Topical; Anti-Bacterial Agents; Catheter-Related Infections; Catheters, Indwelling; Humans; Peritoneal Dialysis; Peritonitis; Staphylococcal Infections; Staphylococcus aureus
PubMed: 34435734
DOI: 10.1111/1744-9987.13726 -
The Veterinary Record Apr 2021Parietal fibrinous peritonitis (PFP) is a complication of laparotomy in cattle, consisting of fluid and fibrin accumulation within a fibrous capsule between the parietal... (Review)
Review
BACKGROUND
Parietal fibrinous peritonitis (PFP) is a complication of laparotomy in cattle, consisting of fluid and fibrin accumulation within a fibrous capsule between the parietal peritoneum and the abdominal muscles. Since scientific information on PFP is scarce, we aim to collect available information to help practitioners in its diagnosis and treatment, and to formulate research perspectives.
METHODS
PubMed and GoogleScholar databases were scanned using "cattle" or "bovine", and one of the following keywords: "seroma", "parietal fibrinous peritonitis", "retroperitoneal abscess", or "wound infection".
RESULTS
Although scientific information is often anecdotal, two recent larger studies shed more light on PFP symptoms, diagnosis and treatment. Symptoms vary according to the cavity's localisation and size, and include anorexia, weight loss and an inflammatory status. Rectal palpation is strongly indicative, but the definitive diagnosis is made by ultrasound. Trueperella pyogenes and Escherichia coli are frequently isolated germs, although it remains unclear whether they are primary or secondary agents. Good survival rates were reported after surgical drainage.
CONCLUSION
Although the diagnosis and treatment seem clear, the exact pathogenesis of PFP should be the focus of ongoing research. This can be achieved by epidemiological data analysis focusing on risk factors like surgery technique, housing and ration.
Topics: Animals; Cattle; Cattle Diseases; Laparotomy; Peritonitis
PubMed: 33729566
DOI: 10.1002/vetr.30 -
Wiadomosci Lekarskie (Warsaw, Poland :... 2022The aim: To determine the diagnostic significance of the level of malondialdehyde (MDA) in various biological media for RP for assessing and predicting the course of the...
OBJECTIVE
The aim: To determine the diagnostic significance of the level of malondialdehyde (MDA) in various biological media for RP for assessing and predicting the course of the disease.
PATIENTS AND METHODS
Materials and methods: Our study included The work was based on the results of surgical treatment of 60 patients with RP: according to MPI I - in 17 (28.3%), MPI II - in 23 (38.4%) and MPI III - in 20 (33.3%) patients. Surgical intervention for RP was aimed at sanitation and drainage of the abdominal cavity. The control group included 15 practi¬cally healthy people, whose blood and urine biochemical parameters served as the norm. According to the clinical course of the disease, the patients were divided depend on admission, The secondary product of lipid peroxidation - MDA was studied in blood serum, peritoneal exudate and urine in patients with RP, depending on the severity of the pathological process according to the Mannheim peritoneal index (MPI) - I severity (I), II severity (II), III severity (III). The work was based on the results of surgical treatment of 60 patients with RP: according to MPI I - in 17 (28.3%), MPI II - in 23 (38.4%) and MPI III - in 20 (33.3%) patients.
RESULTS
Results: Analyses of results showed that the average value of MDA in various biomedicals of recovered (n = 18) and subsequently died (n = 5) patients with MPI II are given in Table. 2. As can be seen from the presented data, the average value of MDA in blood serum and peritoneal exudate in patients with a lethal outcome is significantly higher than in those who have recovered. This fact indicates a more pronounced endogenous intoxication in patients who died from RP.
CONCLUSION
Conclusions: The content of MDA in the blood serum before surgery in patients with a lethal outcome was 190% (p <0.001). The level of MDA in urine in patients according to MPI II who subsequently died before surgery was 110% (p <0.001), and in those who recovered by 300% (p <0.001) it was higher than the norm. exudate taken during the operation averaged 4.14 ± 0.33 nmol / ml, then in the recovered - 2.89 ± 0.08 nmol / ml. A high level of MDA in the blood serum, peritoneal exudate with a decrease in the elimination of MDA in the urine in the postoperative period are prognostically unfavorable signs in patients, indicating the continuation of endogenous intoxication and a possible death.
Topics: Humans; Peritonitis; Peritoneum; Severity of Illness Index; Prognosis
PubMed: 36723326
DOI: 10.36740/WLek202212127 -
BMC Nephrology Dec 2022Peritonitis is one of the major complications of peritoneal dialysis. The most common cause of peritonitis is infection at the catheter exit site. This study aimed to... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Peritonitis is one of the major complications of peritoneal dialysis. The most common cause of peritonitis is infection at the catheter exit site. This study aimed to determine the effect of propolis on the incidence of catheter exit site infection and peritonitis in peritoneal dialysis patients.
METHOD
This study was a double-blind clinical trial (2019-2020) with peritoneal dialysis patients. Ninety peritoneal dialysis patients were allocated to three groups (placebo, control, intervention) using block randomization method. Catheter exit site was washed with 0.9% normal saline and dressing was done every other day after the morning peritoneal dialysis exchange by use of normal saline in placebo, mupirocin in control, and propolis in intervention group, for 6 months.
DISCUSSION
10% of the patients in the placebo and 6.7% in the control group developed catheter Exit Site Infection, but none patient in the intervention group developed this infection (P = 0.469). Whereas 6.7% in both the placebo and control groups developed peritonitis, but none patient in the intervention group contracted peritonitis (P = 0.997). No significant differences in the incidence of catheter exit site infection and peritonitis among the three groups were observed. Considering that mupirocin is of chemical origin and may lead to drug resistance whereas propolis is of plant origin and does not produce drug resistance, the use of propolis is recommended.
TRIAL REGISTRATION
Iranian Registry of Clinical Trials [ IRCT20110427006318N10 ] (17/01/2019).
Topics: Humans; Anti-Bacterial Agents; Catheters, Indwelling; Iran; Mupirocin; Peritoneal Dialysis; Peritonitis; Propolis; Saline Solution; Double-Blind Method
PubMed: 36564743
DOI: 10.1186/s12882-022-03036-7 -
Frontiers in Immunology 2021Endogenous mechanisms underlying bacterial infection resolution are essential for the development of novel therapies for the treatment of inflammation caused by...
Endogenous mechanisms underlying bacterial infection resolution are essential for the development of novel therapies for the treatment of inflammation caused by infection without unwanted side effects. Herein, we found that erythropoietin (EPO) promoted the resolution and enhanced antibiotic actions in ()- and ()-initiated infections. Levels of peritoneal EPO and macrophage erythropoietin receptor (EPOR) were elevated in self-limited initiated peritonitis. Myeloid-specific EPOR-deficient mice exhibited an impaired inflammatory resolution and exogenous EPO enhanced this resolution in self-limited infections. Mechanistically, EPO increased macrophage clearance of bacteria peroxisome proliferator-activated receptor γ (PPARγ)-induced CD36. Moreover, EPO ameliorated inflammation and increased the actions of ciprofloxacin and vancomycin in resolution-delayed - and -initiated infections. Collectively, macrophage EPO signaling is temporally induced during infections. EPO is anti-phlogistic, increases engulfment, promotes infection resolution, and lowers antibiotic requirements.
Topics: Animals; Anti-Bacterial Agents; Disease Models, Animal; Disease Susceptibility; Drug Resistance, Bacterial; Erythropoietin; Escherichia coli; Escherichia coli Infections; Host-Pathogen Interactions; Macrophages; Mice; PPAR gamma; Peritonitis; Phagocytosis; Signal Transduction; Staphylococcal Infections; Staphylococcus aureus
PubMed: 33927725
DOI: 10.3389/fimmu.2021.658715 -
Clinical and Experimental Immunology Dec 2023Peritonitis and the resulting peritoneal injuries are common problems that prevent long-term peritoneal dialysis (PD) therapy in patients with end-stage kidney diseases....
Peritonitis and the resulting peritoneal injuries are common problems that prevent long-term peritoneal dialysis (PD) therapy in patients with end-stage kidney diseases. Previously, we have analyzed the relationship between the complement system and progression of peritoneal injuries associated with PD, particularly focusing on the early activation pathways and effects of the anaphylatoxins. We here utilized a novel mAb 2H2 that blocks assembly of the membrane attack complex (MAC) to investigate roles of the complement terminal pathway in PD-associated peritoneal injury. We intraperitoneally injected mAb 2H2 anti-C5b-7 (2.5 or 5 mg/rat) once or twice over the five-day course of the experiment to investigate the effects of inhibiting formation of MAC in a fungal rat peritonitis model caused by repeated intraperitoneal administration of zymosan after methylglyoxal pretreatment (Zy/MGO model). Rats were sacrificed on day 5 and macroscopic changes in both parietal and visceral peritoneum evaluated. Peritoneal thickness, the abundance of fibrinogen and complement C3 and MAC deposition in tissue and accumulation of inflammatory cells were pathologically assessed. The results showed that mAb 2H2, but not isotype control mAb, reduced peritoneal thickness and accumulation of inflammatory cells in a dose and frequency-dependent manner in the Zy/MGO model. These effects were accompanied by decreased C3, MAC, and fibrinogen deposition in peritoneum. In conclusion, in the rat Zy/MGO model, complement terminal pathway activation and MAC formation substantially contributed to development of peritoneal injuries, suggesting that MAC-targeted therapies might be effective in preventing development of peritoneal injuries in humans.
Topics: Humans; Rats; Animals; Peritoneum; Magnesium Oxide; Rats, Sprague-Dawley; Peritonitis; Complement Activation; Complement Membrane Attack Complex; Fibrinogen
PubMed: 37549240
DOI: 10.1093/cei/uxad088 -
Frontiers in Immunology 2024Peritoneal dialysis is a widely used method for treating kidney failure. However, over time, the peritoneal structure and function can deteriorate, leading to the... (Review)
Review
Peritoneal dialysis is a widely used method for treating kidney failure. However, over time, the peritoneal structure and function can deteriorate, leading to the failure of this therapy. This deterioration is primarily caused by infectious and sterile inflammation. Sterile inflammation, which is inflammation without infection, is particularly concerning as it can be subtle and often goes unnoticed. The onset of sterile inflammation involves various pathological processes. Peritoneal cells detect signals that promote inflammation and release substances that attract immune cells from the bloodstream. These immune cells contribute to the initiation and escalation of the inflammatory response. The existing literature extensively covers the involvement of different cell types in the sterile inflammation, including mesothelial cells, fibroblasts, endothelial cells, and adipocytes, as well as immune cells such as macrophages, lymphocytes, and mast cells. These cells work together to promote the occurrence and progression of sterile inflammation, although the exact mechanisms are not fully understood. This review aims to provide a comprehensive overview of the signals from both stromal cells and components of immune system, as well as the reciprocal interactions between cellular components, during the initiation of sterile inflammation. By understanding the cellular and molecular mechanisms underlying sterile inflammation, we may potentially develop therapeutic interventions to counteract peritoneal membrane damage and restore normal function.
Topics: Humans; Peritoneal Dialysis; Peritoneum; Animals; Stromal Cells; Cell Communication; Inflammation; Peritonitis
PubMed: 38779674
DOI: 10.3389/fimmu.2024.1387292 -
Journal of Equine Veterinary Science Jan 2021Intraperitoneal ceftriaxone administration in healthy horses results in high and prolonged peritoneal concentrations. Recent findings suggest that intraperitoneal...
Intraperitoneal ceftriaxone administration in healthy horses results in high and prolonged peritoneal concentrations. Recent findings suggest that intraperitoneal ceftriaxone might increase survival rates in horses affected by peritonitis. The present study aimed to evaluate plasma and peritoneal concentrations of ceftriaxone after intraperitoneal administration in horses with septic peritonitis. Twenty-six horses presenting clinical, laboratorial, and sonographic findings compatible with the disease were included. All horses received daily intraperitoneal ceftriaxone (25 mg/kg bwt) in addition or not with other antibiotics and support therapies. High-performance liquid chromatography was used to determine plasma and peritoneal ceftriaxone concentrations before and after 12 and 24 hours of ceftriaxone administration. Mean plasma concentrations 12 and 24 hours after administration were, respectively, 1.84 ± 0.43 and 0.37 ± 0.07 μg/mL, and mean peritoneal concentrations were 5.7 ± 2.84 and 0.42 ± 0.13 μg/mL. Ceftriaxone concentration was lower in comparison with previous studies in healthy horses and presented under the minimal inhibitory concentration for enterobacteria (≤1 μg/mL) and for gram-positive isolates (≤0.5 μg/mL) at 24 hours. The variation of the results obtained between healthy horses and with septic peritonitis demonstrated that pharmacokinetics/dynamics are different between these patients and suggests the use of an interval of dose of 12 hours.
Topics: Animals; Ceftriaxone; Horse Diseases; Horses; Injections, Intraperitoneal; Peritoneum; Peritonitis; Plasma
PubMed: 33349404
DOI: 10.1016/j.jevs.2020.103310 -
International Journal of Molecular... Mar 2023Chronic kidney disease (CKD) incidence is growing worldwide, with a significant percentage of CKD patients reaching end-stage renal disease (ESRD) and requiring kidney... (Review)
Review
Chronic kidney disease (CKD) incidence is growing worldwide, with a significant percentage of CKD patients reaching end-stage renal disease (ESRD) and requiring kidney replacement therapies (KRT). Peritoneal dialysis (PD) is a convenient KRT presenting benefices as home therapy. In PD patients, the peritoneum is chronically exposed to PD fluids containing supraphysiologic concentrations of glucose or other osmotic agents, leading to the activation of cellular and molecular processes of damage, including inflammation and fibrosis. Importantly, peritonitis episodes enhance peritoneum inflammation status and accelerate peritoneal injury. Here, we review the role of immune cells in the damage of the peritoneal membrane (PM) by repeated exposure to PD fluids during KRT as well as by bacterial or viral infections. We also discuss the anti-inflammatory properties of current clinical treatments of CKD patients in KRT and their potential effect on preserving PM integrity. Finally, given the current importance of coronavirus disease 2019 (COVID-19) disease, we also analyze here the implications of this disease in CKD and KRT.
Topics: Humans; Peritoneum; Renal Dialysis; COVID-19; Dialysis Solutions; Peritonitis; Renal Insufficiency, Chronic; Inflammation; Kidney Failure, Chronic; Immunity
PubMed: 36982834
DOI: 10.3390/ijms24065763 -
The Journal of Vascular Access Mar 2021Relapsing peritonitis due to the development of a biofilm in the catheter's lumen remains an important complication of peritoneal dialysis therapy that endangers...
BACKGROUND
Relapsing peritonitis due to the development of a biofilm in the catheter's lumen remains an important complication of peritoneal dialysis therapy that endangers technique continuity. Taurolidine catheter lock has proven efficient reducing infection rates in permanent hemodialysis catheters based on its biocidal activity and biofilm detachment effect. Efficacy evidence on its use in peritoneal dialysis catheters is lacking.
METHODS
We retrospectively analyzed all relapsing peritonitis episodes from June 2018 until October 2019 in our center. Patients were identified and data were collected from our electronic renal registry and patient's records.
RESULTS
Six patients were identified during the study period. Most patients (66.6%) were on automated peritoneal dialysis and the median duration of peritoneal dialysis before the episode of taurolidine was started was 43.66 ± 29.64 months. Mean taurolidine doses were 10 (range: 9-11) and 83.3% (five patients, with peritonitis caused by , and ) had a favorable response and microbial eradication without relapses after taurolidine treatment. Only one patient relapsed by the same organism () due to non-adherence to the antibiotic treatment prescribed. None of the patients experienced any relevant adverse events, with only two out of six presenting mild transient abdominal discomfort.
CONCLUSION
We believe that peritoneal catheter taurolidine lock could be considered in cases of relapsing or refractory peritonitis, as it could prevent catheter removal and permanent switch to hemodialysis in selected cases, although literature is scarce and further studies are needed.
Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Catheter-Related Infections; Catheterization; Catheters, Indwelling; Female; Humans; Male; Middle Aged; Peritoneal Dialysis; Peritonitis; Recurrence; Retrospective Studies; Risk Assessment; Risk Factors; Taurine; Thiadiazines; Time Factors; Treatment Outcome
PubMed: 32605474
DOI: 10.1177/1129729820937099