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American Journal of Physiology. Renal... Jun 2021Peritonitis, due to a fungal or bacterial infection, leads to injury of the peritoneal lining and thereby forms a hazard for the long-term success of peritoneal dialysis...
Peritonitis, due to a fungal or bacterial infection, leads to injury of the peritoneal lining and thereby forms a hazard for the long-term success of peritoneal dialysis (PD) and remains a lethal complication in patients with PD. This study investigated whether C1 inhibitor (C1-INH) could protect against the progression of peritoneal injuries with five daily administrations of zymosan after mechanical scraping of the rat peritoneum to mimic fungal peritonitis. Severe peritoneal injuries were seen in this model, accompanied by fibrinogen/fibrin exudation and peritoneal deposition of complement activation products such as activated C3 and C5b-9. However, intraperitoneal injection of C1-INH decreased peritoneal depositions of activated C3 and C5b-9, ameliorated peritoneal thickening, reduced the influx of inflammatory cells, and prevented the production of peritoneal fibrous layers with both one and two doses of C1-INH each day. Our results suggest that C1-INH might be useful to protect against peritoneal injuries after causes of peritonitis such as fungal infection. This clinically available agent may thus help extend the duration of PD. Peritoneal injuries associated with peritonitis comprise an important issue to prevent long-term peritoneal dialysis (PD) therapy. Here, we showed that C1 inhibitor (C1-INH), as an anticomplement agent, protected against peritoneal injuries in a peritonitis animal model related to fungal infection. Therefore, C1-INH might be useful to protect against peritoneal injuries after peritonitis due to fungal infection. This clinically available agent may thus help extend the duration of PD.
Topics: Animals; Complement C1 Inhibitor Protein; Epithelial Cells; Epithelium; Fibrin; Fibrinogen; Male; Peritoneum; Peritonitis; Rats; Rats, Sprague-Dawley; Zymosan
PubMed: 33818127
DOI: 10.1152/ajprenal.00600.2020 -
The Kaohsiung Journal of Medical... Oct 2020
Topics: Abdominal Pain; Calcinosis; Fatal Outcome; Humans; Kidney; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritoneum; Salmonella; Salmonella Infections; Sepsis; Tomography, X-Ray Computed
PubMed: 32869493
DOI: 10.1002/kjm2.12258 -
Pediatric Endocrinology, Diabetes, and... 2022Impact of the secondary peritoneal infections on the peritoneal morphology in diabetic population remains unclear.
INTRODUCTION
Impact of the secondary peritoneal infections on the peritoneal morphology in diabetic population remains unclear.
AIM OF THE STUDY
To study the histopathological changes of the peritoneum due to secondary bacterial peritonitis in diabetic rats in compari-son to the normoglycemic animals.
MATERIAL AND METHODS
13 adult male Wistar rats were divided into 2 groups: control (n = 3) and experimental (n = 10). The latter was subdivided into non-diabetic (n = 5) and diabetic (n = 5). T1DM and peritonitis were induced through the single intraperitoneal injec-tion of Streptozotocin (60 mg/kg) and intraperitoneal injection of 2 ml of the faecal matter, respectively.
RESULTS
Macroscopic findings of diabetic rat peritoneum included significant accumulation of the exudate in the peritoneal cavity and presence of intraintestinal adhesions and abscesses. Morphology of the peritonium presented with diffuse, profound degenerative and inflammatory lesions involving the subjacent tissues. In contrast, the underlying muscular layer of the non-diabetic rats remained intact.
CONCLUSIONS
Natural course of the peritoneal infection in diabetic rats (48 hours) is characterised by diffuse severe peritonitis with inter-intestinal abscess formation and more profound subadjacent tissue involvement in comparison with non-diabetic rats.
Topics: Animals; Diabetes Mellitus, Experimental; Humans; Male; Peritoneum; Peritonitis; Rats; Rats, Wistar
PubMed: 35112558
DOI: 10.5114/pedm.2022.112497 -
BMC Infectious Diseases Aug 2019Vancomycin resistant enterococci (VRE) infections are of increasing concern in many hospitalized patients. Patients with cirrhosis are at added risk of infection with...
BACKGROUND
Vancomycin resistant enterococci (VRE) infections are of increasing concern in many hospitalized patients. Patients with cirrhosis are at added risk of infection with VRE, with associated increased risk for complications from infections. The goals of this study were to: [1] identify risk factors for VRE amongst cirrhotic patients before liver transplantation, and [2] evaluate risk of morbidity and mortality at 30-days and one-year after VRE infection.
METHODS
Chart review of 533 cirrhotic patients hospitalized at a tertiary medical center was performed. Patients infected with VRE (n = 65) were separately compared to patients infected with gram-negative organisms (n = 80) and uninfected patients (n = 306).
RESULTS
In multivariable logistic regression analyses, female gender (OR 3.73(95% CI1.64,8.49)), severity of liver disease measured by higher Child Pugh scores (OR 0.37(95%CI 0.16,0.84)), presence of ascites (OR 9.43(95% CI 3.22,27.65) and any type of dialysis (OR 3.31,95% CI (1.21,9.04), oral antibiotic prophylaxis for spontaneous bacterial peritonitis and rifaximin use were statistically significantly associated with VRE infection (OR 2.37 (95%CI 1.27, 4.42)). VRE-infected patients had significantly longer mean ICU and total hospital stays (both p < 0.0001), with increased one-year mortality compared to cirrhotic patients without VRE infection, adjusted for age, sex, Hispanic ethnicity, and disease severity.
CONCLUSIONS
It is unclear whether VRE infection serves as an independent risk factor for increased mortality or an indicator for patients with more severe illnesses and thus a higher risk for death.
Topics: Adult; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Child; Female; Gram-Positive Bacterial Infections; Humans; Intensive Care Units; Length of Stay; Liver Cirrhosis; Liver Transplantation; Male; Middle Aged; Peritonitis; Retrospective Studies; Risk Factors; Vancomycin Resistance
PubMed: 31409282
DOI: 10.1186/s12879-019-4352-1 -
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 -
Renal Failure Dec 2023This study aimed to investigate the association between patient clinical characteristics and technique failure in peritoneal dialysis-related peritonitis (PDRP). The...
OBJECTIVE
This study aimed to investigate the association between patient clinical characteristics and technique failure in peritoneal dialysis-related peritonitis (PDRP). The effect of peritonitis-associated technique failure on patient survival was also assessed.
METHODS
Patients diagnosed with PDRP from January 1, 2010 to June 30, 2022 were retrospectively reviewed and analyzed. Relevant demographic, biochemical, and clinical data were collected. Univariate and multivariate logistic regression analyses were used to determine the predictors of peritonitis-associated technique failure in PD. Patients were divided into technique failure (F group) and nontechnique failure (NF group) groups. Patients were followed until death or until the date of Oct 1, 2022. Kaplan-Meier survival curves and landmark analysis were used to assess the survival of the PDRP cohort. Cox regression models were used to assess the association between potential risk factors and mortality.
RESULTS
A total of 376 patients with 648 cases of PDRP were included in this study. Multivariate logistic regression analysis demonstrated that peritoneal dialysis (PD) duration (OR = 1.12 [1.03, 1.21], = 0.005), dialysate WBC count on Day 3 after antibiotic therapy (OR = 1.41 [1.22, 1.64], 0.001), blood neutrophil-to-lymphocyte ratio (NLR) (OR = 1.83 [1.25, 2.70], = 0.002), and serum lactate dehydrogenase (LDH) (OR = 4.13 [1.69, 10.11], = 0.002) were independent predictors for technique failure in PDRP. Furthermore, serum high-density lipoprotein (HDL) (OR = 0.28 [0.13, 0.64], = 0.002) was a protective factor against technique failure. According to the Kaplan-Meier analysis, patients experiencing peritonitis-associated technique failure had lower postperitonitis survival (log-rank = 4.326, = 0.038). According to the landmark analysis, patients with a history of peritonitis-associated technical failures had a higher 8-year mortality after peritoneal dialysis. A Cox model adjusted for plausible predetermined confounders showed that technique failure was independently associated with all-cause mortality.
CONCLUSIONS
Dialysate WBC count on Day 3, PD duration, NLR, and LDH were independent risk factors for technique failure, whereas HDL was a protective factor. Peritonitis-associated technique failure had a higher risk of mortality and adverse effects on postperitonitis survival.
Topics: Humans; Retrospective Studies; Peritoneal Dialysis; Dialysis Solutions; Risk Factors; Peritonitis; Kidney Failure, Chronic
PubMed: 37125594
DOI: 10.1080/0886022X.2023.2205536 -
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 -
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 -
Frontiers in Immunology 2021Peritoneal fibrosis is characterized by abnormal production of extracellular matrix proteins leading to progressive thickening of the submesothelial compact zone of the...
Peritoneal fibrosis is characterized by abnormal production of extracellular matrix proteins leading to progressive thickening of the submesothelial compact zone of the peritoneal membrane. This process may be caused by a number of insults including pathological conditions linked to clinical practice, such as peritoneal dialysis, abdominal surgery, hemoperitoneum, and infectious peritonitis. All these events may cause acute/chronic inflammation and injury to the peritoneal membrane, which undergoes progressive fibrosis, angiogenesis, and vasculopathy. Among the cellular processes implicated in these peritoneal alterations is the generation of myofibroblasts from mesothelial cells and other cellular sources that are central in the induction of fibrosis and in the subsequent functional deterioration of the peritoneal membrane. Myofibroblast generation and activity is actually integrated in a complex network of extracellular signals generated by the various cellular types, including leukocytes, stably residing or recirculating along the peritoneal membrane. Here, the main extracellular factors and the cellular players are described with emphasis on the cross-talk between immune system and cells of the peritoneal stroma. The understanding of cellular and molecular mechanisms underlying fibrosis of the peritoneal membrane has both a basic and a translational relevance, since it may be useful for setup of therapies aimed at counteracting the deterioration as well as restoring the homeostasis of the peritoneal membrane.
Topics: Animals; Biomarkers; Cell Communication; Cytokines; Disease Susceptibility; Epithelial Cells; Humans; Immunity, Innate; Inflammation Mediators; Leukocytes; Peritoneal Dialysis; Peritoneal Fibrosis; Peritoneum; Peritonitis; Stromal Cells; T-Lymphocyte Subsets
PubMed: 33854496
DOI: 10.3389/fimmu.2021.607204 -
Renal Failure Dec 2021Peritonitis is one of the most serious complications of peritoneal dialysis (PD). This study aimed to explore the relationship between peritoneal transport status and...
BACKGROUND
Peritonitis is one of the most serious complications of peritoneal dialysis (PD). This study aimed to explore the relationship between peritoneal transport status and the first episode of peritonitis, as well as the prognosis of patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
METHOD
A retrospective cohort study was conducted, analyzing data of CAPD patients from 1st January 2009, to 31st December 2017. Baseline data within 3 months after PD catheter placement was recorded. Cox multivariate regression analysis was performed to determine the risk factors for the first episode of peritonitis, technique failure and overall mortality.
RESULTS
A total of 591 patients were included in our analysis, with a mean follow-up visit of 49 months (range: 27-75months). There were 174 (29.4%) patients who had experienced at least one episode of peritonitis. Multivariate Cox regression analysis revealed that a higher peritoneal transport status (high and high-average) (HR 1.872, 95%CI 1.349-2.599, = 0.006) and hypoalbuminemia (HR 0.932,95% CI 0.896, 0.969, = 0.004) were independent risk factors for the occurrence of the first episode of peritonitis. In addition, factors including gender (male) (HR 1.409, 95%CI 1.103, 1.800, = 0.010), low serum albumin (HR 0.965, 95%CI 0.938, 0.993, = 0.015) and the place of residence (rural) (HR 1.324, 95%CI 1.037, 1.691, = 0.024) were independent predictors of technique failure. Furthermore, low serum albumin levels (HR 0.938, 95%CI 0.895, 0.984, = 0.008) and age (>65years) (HR 1.059, 95%CI 1.042, 1.076, < 0.001) were significantly associated with the risk of overall mortality of PD patients.
CONCLUSIONS
Baseline hypoalbuminemia and a higher peritoneal transport status are risk factors for the first episode of peritonitis. Factors including male gender, hypoalbuminemia, and residing in rural areas are associated with technique failure, while hypoalbuminemia and age (>65years) are predictors of the overall mortality in PD patients. Nevertheless, the peritoneal transport status does not predict technique failure or overall mortality of PD patients.
Topics: Adult; Age Factors; Female; Humans; Hypoalbuminemia; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritoneum; Peritonitis; Prognosis; Retrospective Studies; Risk Factors; Sex Factors; Survival Analysis
PubMed: 34233593
DOI: 10.1080/0886022X.2021.1949350