BACKGROUND/AIMS: The aim of this study was to evaluate the peritonitis-causing bacteria detected in peritoneal fluid using a blood culture bottle in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). METHODS: One-hundred and eleven dialysates from 43 patients suspected of peritonitis related to CAPD were retrospectively evaluated between May 2000 and February 2008. In all cases, 5 to 10 mL of dialysate was inoculated into a pair of BacT/Alert blood culture bottles, and 50 mL of centrifuged dialysate was simultaneously inoculated into a solid culture media for conventional culture. The results were compared to those of the conventional culture method. Isolated microorganisms were compared between the two methods. RESULTS: The blood culture method was positive in 78.6% (88 / 112) of dialysate specimens and the conventional culture method in 50% (56 / 112, p < 0.001). CONCLUSIONS: The blood culture method using the BacT/Alert system is useful for culturing dialysates and improves the positive culture rate in patients with suspected peritonitis compared to the conventional culture method.
Culture Media ; Dialysis Solutions ; Gram-Negative Bacterial Infections/*diagnosis/microbiology ; Gram-Positive Bacterial Infections/*diagnosis/microbiology ; Humans ; Kidney Failure, Chronic/*therapy ; Microbiological Techniques/*methods ; Peritoneal Dialysis, Continuous Ambulatory/*adverse effects ; Peritonitis/*diagnosis/microbiology ; Sensitivity and Specificity

Peritonitis is a common problem in patients undergoing peritoneal dialysis. However, peritonitis due to Cunninghamella (C.) bertholletiae, a fungus of the class Zygomycetes, is rare. We present a case of fungal peritonitis in a patient on continuous ambulatory peritoneal dialysis due to kidney rejection. Direct examination of the patient's peritoneal fluid showed fungal hyphae, and the culture was identified as C. bertholletiae. A cumulative dose of 1,600 mg fluconazole was given to the patient intraperitoneally over a one-week period. When his condition had stabilised, oral antifungal treatment was administered for two weeks. After removal of the Tenckhoff catheter, the patient was discharged with arteriovenous fistulation for haemodialysis. Zygomycosis due to C. bertholletiae is often fatal and non-responsive to systemic antifungal therapy. This case is the first from India with a successful outcome, and highlights the importance of early detection and intervention for successful outcome of peritonitis caused by C. bertholletiae.
Antifungal Agents ; administration & dosage ; Cunninghamella ; isolation & purification ; Drug Administration Routes ; Fluconazole ; administration & dosage ; Follow-Up Studies ; Graft Rejection ; complications ; Humans ; Kidney Failure, Chronic ; complications ; therapy ; Kidney Transplantation ; Male ; Middle Aged ; Mucormycosis ; drug therapy ; etiology ; microbiology ; Peritoneal Dialysis, Continuous Ambulatory ; adverse effects ; Peritonitis ; drug therapy ; etiology ; microbiology

The prevalence of antibiotic resistance is higher in patients undergoing renal replacement therapy (RRT) than in patients who did not undergo RRT. We investigated the presence of KP (Klebsiella pneumoniae) in patients who underwent RRT. All data were collected retrospectively by accessing patient medical records from 2004 to 2011 for the culture results of all patients who were positive for KP. We grouped the patients by the presence of extended-spectrum beta-lactamase (ESBL) into a KP ESBL(-) group (KP[-]) and a KP ESBL(+) group (KP[+]). In total, 292 patients (23.1%) were in the KP(+) group, and 974 patients (76.9%) were in the KP(-) group. A greater percentage of KP(+) was found in patients who underwent RRT (7.5%) than in patients who did not undergo RRT (3.2%) (OR, 2.479; 95% CI,1.412-4.352). A Cox's hazard proportional model analysis was performed, and for patients with pneumonia, the risk of KP(+) was 0.663 times higher in patients who had lower albumin levels, 2.796 times higher in patients who had an inserted Levin tube, and 4.551 times higher in patients who underwent RRT. In conclusion, RRT can be a risk factor for KP(+) in patients with pneumonia.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/*microbiology/therapy ; Klebsiella Infections/*epidemiology/microbiology/mortality ; Klebsiella pneumoniae/*enzymology/isolation & purification ; Male ; Middle Aged ; Odds Ratio ; Pneumonia/diagnosis/*epidemiology/microbiology ; Prevalence ; Proportional Hazards Models ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors ; Serum Albumin/analysis ; beta-Lactamases/*metabolism

No abstract available.
Anti-Bacterial Agents/therapeutic use ; Cardiac Tamponade/etiology ; Drainage ; Empyema, Pleural/diagnosis/*etiology/microbiology/therapy ; Heart Diseases/diagnosis/*etiology/microbiology/therapy ; Humans ; Kidney Failure, Chronic/*therapy ; Male ; Methicillin-Resistant Staphylococcus aureus/isolation & purification ; Middle Aged ; Pericardial Effusion/etiology ; Pericardial Window Techniques ; Pericardiocentesis ; Peritoneal Dialysis, Continuous Ambulatory/*adverse effects ; Peritonitis/diagnosis/drug therapy/*etiology/microbiology ; Pleural Effusion/etiology ; Staphylococcal Infections/diagnosis/drug therapy/*etiology/microbiology ; Tomography, X-Ray Computed ; Treatment Outcome

BACKGROUND/AIMS: It has been suggested that chronic kidney disease (CKD) is a risk factor for Clostridium difficile infection (CDI) and is associated with increased mortality among patients infected with C. difficile. However, recent studies of the clinical impact of CKD on CDI in Asians are still insufficient. We sought to determine the relationship between CKD and CDI in a Korean population. METHODS: This was a single-center, retrospective case-control study. In total, 171 patients with CDI were included as cases and 342 age- and gender-matched patients without CDI were used as controls. We compared the prevalence of CKD in the study sample and identified independent risk factors that could predict the development or prognosis of CDI. RESULTS: Independent risk factors for CDI included stage IV to V CKD not requiring dialysis (odds ratio [OR], 2.90) and end-stage renal disease requiring dialysis (OR, 3.34). Patients with more advanced CKD (estimated glomerular filtration rate < 30) and CDI showed higher in-hospital mortality and poorer responses to the initial metronidazole therapy. CONCLUSIONS: More advanced CKD is an independent risk factor for CDI and is associated with higher in-hospital mortality and poor treatment responses in CDI patients. Thus, in CKD patients, careful attention should be paid to the occurrence of CDI and its management to improve the outcome of CDI.
Aged ; Anti-Infective Agents/therapeutic use ; Chi-Square Distribution ; Clostridium difficile/*pathogenicity ; Enterocolitis, Pseudomembranous/diagnosis/drug therapy/*microbiology/mortality ; Female ; Hospital Mortality ; Humans ; Kidney Failure, Chronic/*complications/diagnosis/therapy ; Logistic Models ; Male ; Metronidazole/therapeutic use ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Prevalence ; Renal Dialysis ; Renal Insufficiency, Chronic/*complications/diagnosis/mortality/therapy ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Treatment Outcome

Isolated bone marrow infection by nontuberculous mycobacteria (NTM) is extremely rare. Recently, we encountered a case of bone marrow Mycobacterium avium complex (MAC) infection, which presented as a fever of unknown origin shortly after starting continuous ambulatory peritoneal dialysis (CAPD). The patient was diagnosed with MAC infection on the basis of PCR-restriction fragment length polymorphism analysis and sequencing of DNA obtained from bone marrow specimens. Although this was a case of severe MAC infection, there was no evidence of infection of other organs. End-stage renal disease (ESRD) patients undergoing dialysis can be considered immunodeficient; therefore, when these patients present with fever of unknown origin, opportunistic infections such as NTM infection should be considered in the differential diagnosis.
Aged ; Anti-Bacterial Agents/therapeutic use ; Bacterial Proteins/genetics ; Bone Marrow/microbiology/pathology ; Diagnosis, Differential ; Female ; HIV Infections/diagnosis ; Humans ; Kidney Failure, Chronic/therapy ; *Mycobacterium avium Complex/genetics/isolation &purification ; Mycobacterium avium-intracellulare Infection/*diagnosis/drug therapy/microbiology ; *Peritoneal Dialysis, Continuous Ambulatory ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Sequence Analysis, DNA

An infective aetiology, including fungal infection, should be considered in the differential diagnosis of immunocompromised patients presenting with skin lesions. Dematiaceous fungi are recognised as pathogens in organ transplant recipients. Herein, we describe a rare case of a chronic necrotising granulomatous skin lesion caused by Pyrenochaeta romeroi in a renal transplant recipient, and review the existing literature on the topic. To the best of our knowledge, this is the first report of such a case in Singapore. Recognition of infections caused by dematiaceous fungi is important because some strains are difficult to identify and require special molecular diagnostic techniques. Treatment involves surgical excision and long-term antifungal therapy. Data on the optimal antifungal regimen in such a diagnosis is limited.
Abscess ; microbiology ; Antifungal Agents ; therapeutic use ; Ascomycota ; Fatal Outcome ; Humans ; Immunocompromised Host ; Kidney Failure, Chronic ; complications ; therapy ; Kidney Transplantation ; adverse effects ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Mitosporic Fungi ; Mycoses ; complications ; drug therapy ; Myocardial Infarction ; complications ; Postoperative Complications ; Singapore ; Transplant Recipients ; Treatment Outcome

Agranulocytosis is a rare adverse effect associated with prolonged vancomycin therapy, and is potentially serious, especially in end stage renal disease (ESRD) patients. We describe a continuous ambulatory peritoneal dialysis (CAPD) patient that developed vancomycin-induced agranulocytosis during treatment for methicillin-resistant Staphylococcus aureus (MRSA) -associated external cuff infection and pneumonia. The agranulocytosis was rapidly resolved by granulocyte colony-stimulating factor (G-CSF) therapy and by the discontinuation of vancomycin.
Aged ; Agranulocytosis/*chemically induced/drug therapy ; Anti-Bacterial Agents/*adverse effects/therapeutic use ; Catheters, Indwelling/microbiology ; Granulocyte Colony-Stimulating Factor/therapeutic use ; Human ; Kidney Failure, Chronic/complications/therapy ; Male ; Peritoneal Dialysis, Continuous Ambulatory ; Staphylococcal Infections/drug therapy ; Vancomycin/*adverse effects/therapeutic use

BACKGROUND/AIMS: Serum procalcitonin (PCT) levels are low in healthy individuals but are elevated in patients with a serious bacterial infection or sepsis. In this study, we examined the ability of serum PCT concentration to diagnose infections in end-stage renal disease (ESRD) patients, and sought to determine an appropriate threshold level. METHODS: Serum PCT levels were measured in ESRD patients on antibiotic therapy for a suspected bacterial infection (ESRD infection [iESRD] group, n = 21), and compared with those of ESRD patients on hemodialysis with no sign of infection (ESRD control [cESRD] group, n = 20). RESULTS: The mean serum PCT concentration of the iESRD group was significantly higher than in the cESRD group (2.95 +/- 3.67 ng/mL vs. 0.50 +/- 0.49 ng/mL, p = 0.006), but serum PCT concentrations did not correlate with severity of infection. The optimized threshold level derived for serum PCT was 0.75 ng/mL, rather than the currently used 0.5 ng/mL; this threshold demonstrated a sensitivity and specificity of 76.2% and 80.0% for infection and 100% and 60.6% for systemic inflammatory response syndrome, respectively, compared with the cutoff of 0.5 ng/mL. CONCLUSIONS: This study suggests that serum PCT at a cutoff value of 0.75 ng/mL is an appropriate indicator of infection in ESRD patients.
Adult ; Aged ; Area Under Curve ; Bacterial Infections/*blood/complications/*diagnosis/microbiology ; Biomarkers/blood ; Calcitonin/*blood ; Case-Control Studies ; Female ; Humans ; Inflammation Mediators/*blood ; Kidney Failure, Chronic/*complications/diagnosis/therapy ; Male ; Middle Aged ; Peritoneal Dialysis ; Predictive Value of Tests ; Protein Precursors/*blood ; ROC Curve ; Renal Dialysis ; Reproducibility of Results ; Up-Regulation