Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0341503 (bacterial peritonitis)
 1,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We present the results of a protocol of empiric monotherapy of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis with ciprofloxacin (CPX), with a special emphasis on the evolution of our results after seven years of continued use of this drug. One hundred and fifteen episodes of bacterial peritonitis were treated with CPX between 1988 and 1992 (group A), and 115 episodes were treated between 1993 and 1995 (group B). The etiologic spectrum of peritonitis was similar in both groups, except for a higher incidence of polymicrobial infections in group B. The clinical success rate decreased from 86.5% in group A to 75% in group B (p < 0.05). This was partly due to the high failure rate of CPX against polymicrobial peritonitis, but the success rate also tended to decrease for gram-positive and, especially, gram-negative bacteria. However, in vitro sensitivity to CPX decreased only for coagulase-negative staphylococci, remaining stable for Staphylococcus aureus and gram-negative bacteria. CPX is still a valid alternative for the treatment of CAPD-related peritonitis in our unit. However, bacterial sensitivity must be closely monitored, especially in the case of coagulase-negative staphylococci. A different therapeutic approach may be indicated if polymicrobial peritonitis is suspected.
Adv Perit Dial 1996
PMID:Treatment of CAPD-related peritonitis with ciprofloxacin: results after seven years. 886 98

Nitric oxide plays an important role in mediating the inflammatory process. The aim of this study was to evaluate if nitric oxide production was increased during peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD), and the association with the prognosis. The study population comprised 21 patients with 22 episodes of peritonitis. Fifteen patients without peritonitis were controls. Nitrate was measured by HPLC and nitrite by the Griess method, to reflect nitric oxide production. Peritoneal dialysate effluent and plasma were collected from six patients during peritonitis and 1 week after treatment to study changes in dialysate:plasma ratio. In 15 patients, nitrite was measured during peritonitis and every 3 days for 2 weeks or until normalized for evolutional changes. The dialysate:plasma ratios of nitrate and nitrite during peritonitis were reduced 26% and 41.5%, respectively, after 1 week of treatment, indicating the peritoneal production of nitric oxide during peritonitis. In the evolutional study, a 5.1-fold increase of peak nitrite levels in bacterial peritonitis (n = 13) and a 2.5-fold increase in fungal peritonitis (n = 3) were observed compared to controls. Nitrite gradually declined to control levels (9.3 +/- 7.2 days) after effective antibiotic treatment, but took longer than to normalize leukocyte count in the peritoneal dialysate effluent (3.9 +/- 1.9 days). In four patients with refractory peritonitis (Candida infection in three, Acinetobacter infection in one), the nitrite levels remained elevated 2-fold despite treatment, and the catheters were removed. It is concluded that nitrite levels in peritoneal dialysate effluent may serve as a marker to assess treatment efficacy in CAPD patients with peritonitis.
Nephrol Dial Transplant 1996 Dec
PMID:Peritoneal nitric oxide is a marker of peritonitis in patients on continuous ambulatory peritoneal dialysis. 901 24

Deficient production of nitric oxide may be responsible for the defective defense barrier and persistence of bacterial infection. To gain insight into amino acid-metabolism and L-arginine-nitric oxide system, we studied 34 end-stage renal disease (ESRD) patients on peritoneal dialysis (PD) (20 males, 14 females, with a mean age of 53.5 years and a mean duration on PD of 29.7 months). The concentrations of amino acids, including L-arginine, were measured in peritoneal dialysate and in the serum. The data demonstrated that patients with ESRD on PD have normal serum amino-acid profiles, whereas those with acute peritonitis develop L-arginine deficiency (from 99 +/- 9 to 52 +/- 9 mumol/L). In addition, levels of asparagine, glycine, proline (nonessential) as well as valine, threonine, and lysine (essential) were reduced in patients with peritonitis. The majority of patients with acute bacterial peritonitis have increased nitric oxide production as judged by the level of nitrites in the dialysate (36 +/- 2 vs 57 +/- 6 mumol/L). The recovery from peritonitis was associated with a decline in nitric-oxide generation. There was a smaller subgroup of these patients that showed paradoxically low nitrite levels during acute peritonitis. The nitrite: L-arginine ratio in the peritoneal dialysate was increased in patients with peritonitis, further suggesting the development of substrate deficiency. These findings implicate L-arginine as a conditionally essential amino acid in PD patients with acute peritonitis. Further studies are needed to address the issue of L-arginine supplementation in such patients.
Adv Perit Dial 1997
PMID:Decreased L-arginine during peritonitis in ESRD patients on peritoneal dialysis. 936 Jun 82

Nitric oxide (NO) is produced by various cell types, and it is an important mediator in many biological processes, including macrophage-mediated cellular host defense. The relevance and amount of NO production in peritonitis during peritoneal dialysis (PD) treatment is still not clear. We studied whether human peritoneal macrophages (PMphi) isolated from healthy PD patients or PD patients with peritonitis showed different spontaneous or lipopolysaccharide (LPS)/interferon gamma (IFN-gamma)-induced NO production (LPS, 1 ng/mL-10 microg/mL; IFN-gamma, 10-1000 U/mL; incubation between 6-48 hours; measured by Griess reagent). Results were compared with human blood monocytes (HBM) isolated from buffy coats. Inducible nitric oxide synthetase (iNOS) mRNA expression was looked for in PMphi by reverse transcriptase polymerase chain reaction (RT-PCR). Furthermore, plasma (P) and peritoneal dialysate effluent (D) nitrite concentrations were measured in vivo. The dialysate-to-plasma ratio (D/P) of nitrite concentration was inverse in the case of peritonitis compared to infection-free patients (peritonitis D/P = 1.3, non peritonitis D/P = 0.4; p < 0.01). PMphi from peritonitis patients produced higher amounts of NO than did those from infection-free patients (0.040+/-0.044 nmol per microgram cell protein versus 0.018+/-0.015 nmol per microgram cell protein, p < 0.05). NO release could not be further enhanced by stimulation with LPS plus IFN-gamma (1 ng/mL, 250 U/mL, respectively). However, NO production in PMphi from infection-free patients increased during in vitro stimulation (0.044+/-0.031 nmol per microgram cell protein versus 0.018+/-0.015 nmol per microgram cell protein, p < 0.01). An increase of iNOS mRNA expression could be demonstrated by RT-PCR. Blood monocytes from healthy donors also increased NO release during cytokine stimulation (0.032+/-0.015 nmol per microgram cell protein versus 0.019+/-0.009 nmol per microgram cell protein, p < 0.05). Our results indicate that significant amounts of NO are released intraperitoneally in the case of bacterial peritonitis. PMphi represent a site of NO production, though the absolute amounts released in vitro are only moderate. NO production can be induced in PMphi and HBM by LPS/IFN-gamma stimulation in vitro.
Perit Dial Int 1999
PMID:Nitric oxide production in peritoneal macrophages from peritoneal dialysis patients with bacterial peritonitis. 1040 50

The aim of this study was to determine whether nitric oxide (NO) production is altered during peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD), and if so, whether there is an association between this alteration and the severity and prognosis of CAPD-induced peritonitis. The study population comprised 30 patients with 30 episodes of peritonitis. Thirteen patients without peritonitis were used as CAPD-control, and eighteen patients with normal renal function were used as normal-control. Total NO metabolites (NOx; nitrite + nitrate) were measured by the Griess method to reflect nitric oxide production. Peritoneal dialysate effluent and plasma were collected from 30 patients during episodes of peritonitis every day for the first 3 days, and then every 3 days for 2 weeks or until the patients were discharged. Plasma NOx levels in the control, CAPD-control, and CAPD-peritonitis groups were 87.0 +/- 11.5, 163.0 +/- 30.7 and 146.3 +/- 18.1 microM, respectively. Dialysate NOx levels in the CAPD-control and CAPD-peritonitis groups were 91.8 +/- 13.1 and 103.8 +/- 14.1 microM, respectively, and dialysate NOx levels did not differ between the two groups. The peak dialysate/plasma (D/P) ratios during the acute phase exceeded 1.0 in 46.7% of the patients of the CAPD-peritonitis group. The D/P ratios of NOx levels before and after treatment were 1.03 +/- 0.07 and 0.56 +/- 0.05, respectively. On the contrary, NOx levels in dialysate after treatment were not decreased, but those in plasma were increased after effective treatment. The peak D/P ratio increased 2.1-fold in the bacterial peritonitis group and 2.3-fold in the fungal peritonitis group, compared with the CAPD-control group. The lowest D/P ratios after treatment were similar to those in the CAPD-control group in patients with effective treatment, but remained 1.5-fold higher in patients for whom treatment was ineffective. In the evolutional study, the D/P ratios of NOx levels gradually declined to CAPD-control group levels (6.6 +/- 2.5 days) after effective antibiotic treatment, but it took longer for leukocyte counts in the peritoneal dialysate effluents (3.8 +/- 1.2 days) to normalize. In 5 patients with refractory peritonitis (Candida infection in three, Staphylococcus aureus infection in two), the D/P ratios of NOx levels remained elevated by 1.5-fold despite treatment, and the catheters were removed. These results suggest that dialysate NOx may be influenced not only by local NO production, but also by plasma NO or NOx diffusion. Therefore, we can suppose that the D/P ratio of NOx levels provides more clinical significance than dialysate NOx levels only. In conclusion, the D/P ratios of NOx levels may serve as a marker to assess the severity of peritoneal inflammation, treatment efficacy, and progression of refractory peritonitis in CAPD patients with peritonitis.
Adv Perit Dial 1998
PMID:Nitric oxide is a marker of peritonitis in patients on continuous ambulatory peritoneal dialysis. 1064 19

Fungal peritonitis (FP) is a rare complication of peritoneal dialysis (PD). Although treatment with fluconazole (FCZ) has improved catheter survival and preservation of the peritoneal membrane, FP still carries a high morbidity and mortality in pediatrics. High-risk factors for FP include previous usage of systemic antibiotics and recurrent bacterial peritonitis. A prospective experience in the treatment of FP was conducted at the University of Miami/Jackson Children's Hospital from 1992 to 1997. All patients received either oral or intravenous loading dose of FCZ (5-7 mg/kg) followed by intraperitoneal (i.p.) FCZ (75 mg/L). Amphotericin B (amp B) was added when clinical sepsis was present. A total of 6 patients had FP (all Candida sp.; mean age: 6 years). Two of these patients were neonates with Tenckhoff-catheter placement at less than 1 week of age. Five patients achieved sterilization of the peritoneal fluid. One patient required catheter removal (C. tropicalis). The 2 neonates were infection free for 29 and 41 days, respectively, but both died of superimposed bacterial sepsis. The remaining 4 patients survived and completed 6 weeks of FCZ treatment. Two have had preservation of the peritoneal membrane for more than 1 year. The other 2 were switched to hemodialysis. We conclude that FCZ is an effective treatment for fungal peritonitis in pediatric patients. Adjunct therapy with amp B is usually necessary if sepsis is present. Although eradication of the fungus is possible in a majority of cases, neonates and immunocompromised hosts remain at high risk for morbidity and mortality.
Adv Perit Dial 1998
PMID:Fungal peritonitis in pediatric patients. 1064 35

The aim of the study was to investigate the characteristics of PD-related peritonitis caused by gram-negative bacteria (GNP). We retrospectively studied the medical records of 164 patients (114 males, 50 females; mean age 46 +/- 15 years) who continued PD beyond 5 months between 1984 and 1998. The average observation time was 40 +/- 28 months (total of 6609 patient-months). A total of 166 episodes of peritonitis occurred during that time (mean incidence: 1 episode/40 patient-months). Of these, 35 were GNPs, and GNP incidence stayed almost constant over time. Most GNP patients (63%) recovered without complication with an average of 14 days' antibiotic treatment. In only 4 cases was PD abandoned. Clinical features of GNP were similar to those of spontaneous bacterial peritonitis (SBP). The unchanged incidence of GNP over time with advanced connection devices suggests that there are important mechanisms promoting micro-organisms of endogenous origin into the peritoneal cavity in PD patients.
Adv Perit Dial 1999
PMID:Peritoneal dialysis--associated peritonitis caused by gram-negative bacteria: characteristics similar to spontaneous bacterial peritonitis? 1068 1

We report four episodes of non Candida albicans peritonitis (NCAP) in 3 patients on continuous ambulatory peritoneal dialysis (CAPD). Risk factors for NCAP included diabetes mellitus and prior antibiotic use in half of the cases. The antibiotic treatment was prescribed for exit-site infection (ESI) or peritonitis in the patient. Treatment for NCAP included antifungal therapy with oral fluconazole or intravenous amphotericin B. The NCAP resulted in catheter loss in 100% of the patients over time. Initial catheter salvage in one patient was followed 6 months later by catheter loss following treatment of a bacterial peritonitis that was complicated by the development of Candida (Torulopsis) glabrata peritonitis unresponsive to treatment with intravenous amphotericin B. Although the literature suggests that Candida peritonitis responds to oral fluconazole with and without catheter removal, this series suggests that the treatment of NCAP includes removal of the peritoneal dialysis catheter with appropriate antifungal agents.
Adv Perit Dial 2001
PMID:Non Candida albicans fungal peritonitis in continuous ambulatory peritoneal dialysis patients. 1151 Feb 70

The present study evaluates the long-term effects of single peritonitis episodes on peritoneal equilibration test (PET) results in continuous ambulatory peritoneal dialysis (CAPD) patients. Twenty-five patients (10 men, 15 women) with a mean age of 37.4 +/- 18.7 years were enrolled in this study because all had uneventful peritoneal dialysis periods for more than one year after a first peritonitis episode. Data from a total of 69 PETs were available [25 from before the first peritonitis episode (initial PET), 23 within 1 year after the episode (1-year PET), and 21 within 1-2 years after the episode (2-year PET)]. The changes in the PET results were evaluated using the dialysate-to-plasma ratio of creatinine (D/PCr) and the dialysate-to-instilled glucose ratio (D4/D0) after a 4-hour dwell. The mean values of D/PCr and D4/D0 showed no statistically significant changes between the initial PETs, 1-year PETs, and 2-year PETs. However, analysis of the results for patients with culture-positive peritonitis (n = 17) revealed significant changes in the mean values of D/PCr and D4/D0 between the initial PET and the 2-year PET (0.63 +/- 0.06 vs 0.70 +/- 0.09, p = 0.01; and 0.41 +/- 0.05 vs 0.37 +/- 0.06, p = 0.04, respectively). The long-term effect of a definite bacterial peritonitis episode seems to be an increase in small-molecule transport. In patients with culture-negative peritonitis, the episode had less impact on peritoneal transport.
Adv Perit Dial 2001
PMID:The long-term effects of single peritonitis episodes on peritoneal equilibration test results in continuous ambulatory peritoneal dialysis patients. 1151 Feb 73

Peritonitis is one of the most frequent complications of peritoneal dialysis (PD) and 1% - 15% of episodes are caused by fungal infections. The mortality rate of fungal peritonitis (FP) varies from 5% to 53%; failure to resume PD occurs in up to 40% of patients. The majority of these FP episodes are caused by Candida species. Candida albicans has historically been reported to be a more common cause than non-albicans Candida species, but in recent reports a shift has been observed and non-albicans Candida may now be more common. Unusual, often "nonpathogenic," fungi are being increasingly reported as etiologic agents in FP. Clinical features of FP are not different from those of bacterial peritonitis. Phenotypic identification of fungi in clinical microbiology laboratories is often difficult and delayed. New molecular diagnostic techniques (e.g., polymerase chain reaction) are being developed and evaluated, and may improve diagnosis and so facilitate early treatment of infected patients. Abdominal pain, abdominal pain with fever, and catheter left in situ are risk factors for mortality and technique failure in FP. In programs with high baseline rates of FP, nystatin prophylaxis may be beneficial. Each program must examine its own history of FP to decide whether prophylaxis would be beneficial. Catheter removal is indicated immediately after fungi are identified by Gram stain or culture in all patients with FP. Prolonged treatment with antifungal agents to determine response and attempt clearance is not encouraged. Antifungals should be continued for 10 days to 2 weeks after catheter removal. Attempts at reinsertion should be made only after waiting for 4 - 6 weeks.
Perit Dial Int
PMID:Fungal peritonitis in peritoneal dialysis patients. 1598 67


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