bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biofilm on Tenckhoff Catheters: A Negligible Source of Contamination
Authors: Anne-Marie Christian Verger , Thibault Chesneau Michel , Bataille Nelly 
Published: February 2020

The authors studied the presence and characterization of biofilm in the lumen of Tenckhoff chronic peritoneal dialysis catheters of 17 CAPD patients to elucidate the role of biofilm as a source of peritonitis. At the time of investigation, all 17 patients were peritonitis-free. All used a single-use, Y -system without disinfectant. Previously eight had used the conventional system. Seven had experienced II episodes of peritonitis with their present catheter (4 episodes while on conventional systems). Ten patients had no history of peritonitis. Four samples from each catheter were obtained with aseptic technique: swabs from inside the titanium adaptor, a 5 cm proximal segment removed and sectioned longitudinally to obtain luminal scrapings, a nylon brush sample from the entire length of the catheter, and from fluid run through the catheter after introducing the brush. All samples were treated by different microbiological techniques and incubated under various conditions. In vitro control experiments were performed to recover biofilm with the brush technique. Whereas all controls were positive, 100% of the samples demonstrated no bacterial growth after two -weeks’ incubation. Five patients’ catheters (four with previous peritonitis) examined under light microscopy contained amorphous material without viable bacteria as evidenced by both growth experiments and mi croscopy. Ten catheters were examined on scanning electron microscopy: the inner surface of all were covered with a protein-Iike membra nous deposit. Occasional bacteria and various number of macrophages were observed on three catheters. On two other catheters, biofilm looked like bacterial microcolonies but this was not confirmed by gram-staining and cultures. Results suggest that biofilm is not ubiquitous in catheters of CAPD patients and that the catheter does not appear to be a bacterial reservoir that would provoke peritonitis. Biofilm might be secondary to frequent peritonitis and/or frequent asymptomatic intra-luminal catheter contaminations. The low peritonitis rate of the studied patients and the use of Y -line systems could explain the absence of a typical biofilm. Results also suggest there may be two types of biofilm -one made up of adherent bacteria and glycocalyx, and one made up of non-contaminated protein -like deposits. The presence of each type would depend of the efficacy of connectors in avoiding touch contaminations.
Continuous Ambulatory Peritoneal Dialysis Complicated by Fournier's Syndrome
Authors: Walshe J. Joseph , Reddy Padma V. 
Published: February 2020

Two patients developed Fournier's syndrome while on continuous ambulatory peritoneal dialysis. In both cases, massive scrotal edema appears to have been the precipitating cause of the polymicrobial genital infection. Early recognition and prompt treatment of this syndrome is essential if one is to avoid the high morbidity and mortality associated with this disease. Fournier's syndrome, first described in 1883, is a fulminant necrotising subcutaneous infection of the male external genitalia (I). Although initially thought to be idiopathic, recent evidence suggests that an underlying condition can usually be identified as the precipitating cause of this rare but serious infection (2, 3). Herein, we describe two patients who developed massive scrotal edema while on continuous ambulatory peritoneal dialysis (CAPO). Subsequently, both patients suffered polymicrobial infections of the scrotum with necrosis. We discuss the possible role of CAPO and scrotal edema in leading to the development of Fournier's syndrome.
Chylous Peritonitis: An Infrequent Complication of Peritoneal Dialysis
Authors: Roodhooft Anne Marie , Van Acker Karel J. , De Broe Marc E. 
Published: February 2020

A 13-year-old girl, who had been on chronic peritoneal dialysis for 31/2 years, developed chylous peritonitis after a minor abdominal trauma. Conservative treatment with a lowfat, high-caloric diet supplemented with medium-chain triglycerides, was without success. When peritoneal dialysis was replaced by hemodialysis, the chylous peritonitis gradually resolved as judged from the echographic findings. When chylous peritonitis occurs in the course of chronic peritoneal dialysis and persists after a trial with a dietary regimen, peritoneal dialysis should be temporarily replaced by hemodialysis. A conservative dietary treatment combined with parenteral hyperalimentation may be given at the same time. It is not yet clear whether surgical intervention can thus be avoided in all cases.
The Stability and Compatibility of Clindamycin Phosphate and Gentamicin Sulfate Alone and in Combination in Peritoneal Dialysis Solution
Authors: Kehoe William A. , Weber Joel N. , Fries David S. 
Published: February 2020

The stability and compatibility of clindamycin phosphate and gentamicin sulfate alone and in combination in peritoneal dialysis solution was studied. Peritoneal dialysis solutions (Dianeal PD-2, Travenol) were prepared in triplicate containing either clindamycin 200 mcg/mL, gentamicin 10 mcg/mL, or a combination of the two. Drug concentrations were determined at intervals over a 96-h period. At each time, solutions were observed for visual incompatibility. No significant changes in drug concentrations or visual characteristics were noted at the times and temperatures tested. We conclude that clindamycin phosphate and gentamicin sulfate are stable and compatible alone and in combination in the peritoneal dialysis solution tested.
Pharmacokinetics of Aztreonam Administered loP o in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients
Authors: Nikolaidis Paul , Dombros Nicholas , Alexiou Panagiotis , Balaskas Elias , Tourkantonis Achilles 
Published: February 2020

The pharmacokinetics of Aztreonam (AZT) administered i.p. in six stable patients undergoing continuous ambulatory peritoneal dialysis (CAPD) for end-stage renal disease (ESRD) were studied. One gram of AZT was added into a 2 L bag of dialysate (Medital-Bieffe®) just prior to infusion into the peritoneal cavity. The dwell time was 8 h. The serum maximum concentration of AZT was 42.5 ± 12.4 mg/L (x ± SD), achieved in 4.6 ± 1.0 h. The elimination half-life was 2.4 ± 0.8 h, almost equal to that found in normal subjects (1.7–2 h). The pharmacokinetic parameters of elimination, as elimination rate constant and clearance of AZT from peritoneal cavity were found 0.305 ± 0.101 h-1 and 10.05 ± 3.7 mL/min, respectively, while the bioavailability via the peritoneal mem brane was 90.8 ± 3.05% of administered dose. It is concluded that AZT is eliminated from dialysate at a high rate after i.p. administration and its dialysate and serum levels exceed the MIC for the majority of sensitive organisms including Pseudomonas species. Aztreonam appears to be a potentially useful antibiotic for CAPD peritonitis.
Staphylococcus Aureus Nasal Carriage, Exit-Site Infection and Catheter Loss in Patients Treated with Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Davies S.J. , 099 C.S. , Cameron J.S. , Poston S. , Noble W.C. 
Published: February 2020

Over a three-year period, 217 episodes of bacterial peritonitis occurred in 183 patient years. Thirty-seven episodes were due to Staphylococcus aureus and 19 (51 %) of these required removal of the catheter to eradicate infection. This compared with catheter loss in 4/63 (6.3%) coagulase negative staphylococci infections ( p < 0.001); 7/67 (9.5%) culture negative peritonitis ( p < 0.001); and 10/30 (33.3%) episodes due to gram-negative organisms ( p < 0.05). Over half (51.3%) the episodes due to S. aureus were associated with exit-site infections, and this rose to 100% (10/10) with recurrent peritonitis ( p < 0.01). A prospective analysis of nasal carriage and exit-site infections due to S. aureus was carried out in 87 patients. Exit-site infections were present in 21 (24%), almost entirely due to different strains as judged by sensitivity patterns and phage typing. Nasal carriage, defined as two positive swabs within the study period, was present in 20 (23%) patients. Fourteen (70%) of these had exit site infections due to the same strain as that isolated from the nose, whereas no patient grew different strains from either site. Nasal carriage increased the risk of infection sixfold ( p < 0.001).
Splenic Abscess and Peritonitis in a Continuous Ambulatory Peritoneal Dialysis (CAPD) Patient
Authors: Blake Peter , Abraham Georgi , Bargman Joanne , Vas Stephen , Mathews Raymond , Haberstroh Bernard , Oreopoulos Dimitrios G. 
Published: February 2020

A 26-year-old female was on continuous ambulatory peritoneal dialysis (CAPD) because of diabetic endstage renal failure. She developed an acute peritonitis that relapsed repeatedly despite appropriate antibiotic treatment. Investigations showed the presence of a splenic abscess, and splenectomy and peritoneal cannula removal were required. The patient died of myocardial infarction two weeks postoperatively. This is the first recorded case of peritonitis secondary to splenic abscess in a CAPD patient. Autopsy findings suggest that the abscess developed from infection of a splenic infarct.
Peritoneal Solute Clearances after four Years of Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Park Min Sun , Lee Jean , Lee Moon Sung , Baick Seung Ho , Hwang Seung Duk , Lee Hi Bahl 
Published: February 2020

In order to evaluate peritoneal membrane function and responsiveness of peritoneal microcirculation to vasoactive agents in long-term continuous ambulatory peritoneal dialysis (CAPD) patients, we studied peritoneal clearances of urea (Curea) and creatinine (Ccr), protein concentrations in drained dialysate (D PC), peritoneal glucose absorption (% GA), and drained dialysate volume ( VD) before and after nitroprusside (NP) addition to dialysis solution in 17 long-term CAPD patients (mean duration of CAPD: 52 months) and the results were compared to those of 18 patients who were just trained for CAPD (mean duration: 0.6 month). There were no differences in the control (without NP) Curea, Ccr, D PC, %GA, and VD between the new and long-term CAPD patients. Curea, Ccr, and D PC increased significantly with NP in both new and long-term patients. Curea and Ccr with NP were not different between the new and long-term patients but D PC with NP was significantly lower in the long-term CAPD patients. The results of this study suggest that peritoneal solute clearances and the responsiveness of peritoneal microcirculation to NP remain unchanged after four years of CAPD, despite recurrent episodes of peritonitis.
Analysis of Factors in the Prognosis of Diabetics on Continuous Ambulatory Peritoneal Dialysis (CAPO): Long Term Experience
Authors: Coronel Francisco , Hortal Luis , Naranjo Pablo , Pozo Carlos , Torrente Jaime , Prats Dolores , Barrientos Alberto 
Published: February 2020

After five years of treating diabetics by continuous ambulatory peritoneal dialysis (CAPD), we analyzed the factors involved in prognosis. Forty-one patients were included in the study, with a cumulative experience of 784 months. Good control of blood glucose was obtained with intraperitoneal (i.p.) insulin and the blood pressure was controlled in 87% of patients without medication, which probably favored the stabilization of visual acuity in 60% of 15 patients evaluated after two years. The follow-up of patients was longer in those who began CAPD with a higher residual creatinine clearance. In spite of the large number of patients who were blind or had very poor vision, 83% of all patients were self-sufficient and well-trained for CAPD, and 39% were able to work full time. The incidence of peritonitis declined to 1 episode per 17.5 patient months associated with the introduction of new preventive measures. Patients over 50 years old had the highest mortality rate and myocardial infarction was the main cause of death. Patient survival at 6, 12, 24, 36, and 42 months was 100, 90, 80, 62, and 62%, respectively. Age and cardiac problems are important factors in survival. Self-sufficiency, rehabilitation, and low incidence of peritonitis are also important factors in the life quality of diabetic patients on CAPD.
Cytotoxic Effects of Commercial Continuous Ambulatory Peritoneal Dialysis (CAPD) Fluids and of Bacterial Exoproducts on Human Mesothelial Cells in Vitro
Authors: Van Bronswijk Hans , Verbrugh Henri A. , Bos Harry J. , Heezius Eric C. J. M. , Oe P. Liem , Van Der Meulen Jan , Verhoef Jan 
Published: February 2020

Cultured human mesothelial cells were exposed to peritoneal dialysis fluids, supernatants from cultures of Staphylococcus aureus and S. epidermidis, and antibiotics. Mesothelial cell monolayer cultures were derived from surgically removed omentum. The cytotoxicity of various agents for the cultured mesothelial cells was measured by a 51 Cr-release assay. All brands of fresh peritoneal dialysis fluids induced a more than 50% 51 Cr-release after 18 h. Morphological changes observed included retraction and shrinking of cells, pyknosis of the nuclei and, finally, detachment of cells over an 18-h period. Neutralization of the acid (pH 5.2–5.5) fluids to pH 7.3 did not abolish the cytotoxicity. In contrast, effluent dialysis fluids were not toxic for mesothelial cells; neither was acid (pH 5.5) culture medium nor culture medium with glucose up to 2%. However, higher glucose concentrations induced increasing 51 Cr-release. Furthermore, filter-sterilized supernatants of S. aureus were cytotoxic for mesothelial cell monolayers in 4/7 (57%) strains of S. aureus tested. In contrast, only 4/29 (14%) strains of S. epidermidis produced cytotoxic exoproducts (p = 0.03). Antibiotics were not found to be cytotoxic, with the possible exception of erythromycin. We conclude that currently available peritoneal dialysis fluids are cytotoxic for mesothelial cells in vitro and that during episodes of peritonitis exoproducts of some bacterial strains may further reduce mesothelial cell viability.
Comparison of Peritonitis Rates during Long Term Use of Standard Spike versus Ultraset in Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Burkart John M. , Hylander Britta , Durnell-Figel Theresa , Roberts Denise 
Published: February 2020

Continuous ambulatory peritoneal dialysis (CAPD) is an increasingly popular means of end-stage renal disease replacement therapy. Unfortunately, peritonitis continues to be a major source of both morbidity and mortality. The Ultraset incorporates a “flush-before-fill” concept which should theoretically decrease peritonitis rates when compared to the standard spike procedure, while allowing patients the convenience of disconnect. To investigate the impact of long-term use of the Ultraset on peritonitis rates, we conducted the following study. We prospectively compared 21 new CAPD patients using the standard spike to 20 new CAPD patients using the Ultraset. Peritonitis episodes, episodes of exit -site infection, and the association of peritonitis with exit-site infection were monitored. Peritonitis rates were 7.57 months/episode for the group using the standard spike vs. 27.79 months/episode in the group using the Ultraset. Exit-site infection rates were 22.21 months/infection with the standard spike vs. 37.05 months/infection with the Ultraset. Using Kaplan-Meier plots, there was a statistically significant difference in the estimated time to the first episode of peritonitis, but there was no statistically significant difference regarding the risk of exit-site infections.
Peritonitis-Related Deaths in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients
Authors: Digenis George E. , Abraham Georgi , Savin Eugene , Blake Peter , Dombros Nicholas , Sombolos Kostas , Vas Stephen , Mathews Raymond , Oreopoulos D. G. 
Published: February 2020

A total of 636 episodes of peritonitis occurred in 440 patients who entered our continuous ambulatory peritoneal dialysis (CAPD) program from September 1977 to February 1988. Sixteen patients (8 male and 8 female, aged 37–77 years) died during an episode of peritonitis (fatality rate 2.5%). They had been on CAPD for 3 to 105 (average 39) months. Six of them were diabetics. The peritonitis rate among these 16 patients were 1 episode per 12 patient months, while the corresponding figure for the whole (440) CAPD population was 14 patient months. Risk factors present in the 16 patients were: cardiovascular disease (12), cerebrovascular accident (2) peripheral artery disease (1) and pulmonary fibrosis (1). Fever and leukocytosis were present on admission in 11 patients, while total serum proteins and albumin were significantly lower (p < 0.001) than the corresponding values before peritonitis (56 ± 8 vs. 65 ± 5). Staph. aureus was isolated in 8 patients (50%), multiple organisms in 6, Pseudomonas and Candida albicans in 1 each. An abdominal abscess was found in 4 (25%) patients. The peritoneal catheter was removed between the 5th and 10th day in 6 and after the 10th day in 7 patients. Peritonitis with sepsis was the cause of death in 13 patients. Contributing factors were cardiovascular accident in 9, uremic coma in 2, extensive GI bleeding in 2, GI performation in 2, intestinal infarction in 1, and pneumonia in 2 patients. We conclude that the risk of peritonitis-related death in CAPD patients is increased with Staph. aureus or multibacterial peritonitis. Contributing factors are concomitant cardiovascular disease and delayed (>5 days) catheter removal.
Absence of Leakage by Insertion of Peritoneal Dialysis Catheter through the Rectus Muscle
Authors: Stegmayr Bernd , Hedberg Bengt , Sandzen Birger , Wikdahl Ann Marie 
Published: February 2020

To reduce leakage of peritoneal dialysis fluid, insertion of a 2-cuff Tenckhoff catheter (TeC) was performed under local anaesthesia by a lateral approach on 30 occasions in 26 patients. Incision was 3 cm laterally of the linea alba. The inner cuff of the TeC was fixed by a purse-string suture of the peritoneal membrane on the abdominal side of the cuff and another purse-string suture, of the inner fascial blade, around the distal end of the cuff. A third purse-string suture was placed around the TeC at the exit through the outer fascial blade. A subcutaneus tunnel completed the insertion. In all patients, dialysis was started immediately after TeC insertion. The median treatment time was 6.5 months (range 3 days-15 months). No leakage developed in any patient and no hernia was created from this approach. Peritonitis was treated on 8 occasions over a period of 163 months. We conclude that the technique is simple, enables immediate start of dialysis with low risk for leakage.
Peritoneal Defence Mechanisms and Staphylococcus Aureus in Patients Treated with Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Davies Simon J. , Yewdall Virginia M. A. , Ogg Chisholm S. , Cameron J. Stewart 
Published: February 2020

Peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients due to S. aureus is associated with an adverse clinical outcome, suggesting impaired clearance of this organism by the host. The ability of peritoneal macrophages (PMO) derived from CAPD patients to take up S. aureus and mount a respiratory burst was investigated. Whilst significant activity was observed in the absence of opsonin, both parameters of phagocytosis were augmented by addition of 20% pooled human serum (PHS), complement-depleted PHS, and fibronectin. When used as sole opsonin, fibronectin resulted in a dose-related increase in chemiluminescent response by both blood neutrophils and PMO. The opsonic activity of dialysis effluent, as judged by neutrophil chemiluminescence, correlated with IgG and fibronectin content, but not with complement as assessed by C3 levels. The addition of urokinase to dialysate improved its opsonic properties whilst having no effect on the activity of PHS-20%; this would suggest that the formation of fibrin in dialysate, promoted by S. aureus, interferes with phagocytosis. This and the low IgG, complement and fibronectin levels in dialysate may explain in part the relatively poor clearance of this organism from the peritoneum.
Stability of Cotrimoxazole in Peritoneal Dialysis Fluid
Authors: Holmes Sandra E. , Aldous Stephen 
Published: February 2020

This study examines the stability of both components of the antibacterial combination, cotrimoxazole (trimethoprim and sulphamethoxazole) in peritoneal dialysis fluid stored in polyvinyl chloride bags and glass ampoules at room temperature for up to nine days. Greater than 10% loss of trimethoprim occurred within three days for admixtures stored in plastic bags, whereas the original concentration remained virtually unchanged after nine days for similar solutions stored in glass ampoules. This indicated that the loss of trimethoprim observed in solutions stored in plastic bags was associated primarily with the nature of the container, presumably due to some form of uptake by or loss through the plastic. Greater than 10% loss of sulphamethoxazole occurred within two days for all admixtures examined, stored in either glass or plastic containers. This degree of loss was achieved within 12 h for one admixture stored in plastic. There was also the time-dependent appearance of an additional peak in HPLC analyses of these solutions, indicating that loss of sulphamethoxazole was due to chemical decomposition of the drug in the peritoneal dialysis fluid. The shelf-life of such admixtures would be limited by the stability of the sulphamethoxazole component, with the available data suggesting a shelf-life of 12 h for solutions stored at room temperature.
Ampicillin and Sulbactam Pharmacokinetics and Pharmacodynamics in Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Blackwell Brad G. , Leggett James E. , Johnson Curtis A. , Zimmerman Stephen W. , Craig William A. 
Published: February 2020

The fixed combination antibiotic ampicillin/sulbactam may provide a new, safe, and effective method of treating dialysis-related bacterial peritonitis. The pharmacokinetics of this antibiotic combination were determined in patients receiving continuous ambulatory peritoneal dialysis (CAPD). The pharmacodynamic activity of this drug was also determined by use of mean bactericidal titers against selected bacterial strains. Six noninfected CAPD patients in a randomized twoway crossover study were given a fixed dose of ampicillin (2 gm) and sulbactam (1 gm) either intravenously or intra peritoneally. The mean peak ampicillin and sulbactam serum concentrations following intravenous dosing were 170.3 and 87.5 μg/mL, respectively. The mean peak serum concentrations of ampicillin and sulbactam following intraperitoneal dosing were 48.0 an d 27.8 μg/mL, respectively. Absolute bioavailabilities of the intraperitoneal ampicillin and sulbactam doses were 60% and 68%. Both drugs exhibited similar distribution and elimination characteristics. Renal failure markedly reduced drug elimination. Intraperitoneal administration of ampicillin/sulbactam provided satisfactory inhibitory and bactericidal antibiotic titers for most organisms in dialysate at 6 h but not 24 h. Ampicillin/sulbactam (2 gm/1 gm) should be administered every 12 h to patients with peritoneal dialysis-related peritonitis.