OBJECTIVE: Peritoneal dialysis(PD)-associated peritonitis is a common and major complication of PD and the most common cause of technical failure of PD. The presence of bacterial biofilm may be an important factor leading to refractory or recurrence of peritonitis. To investigate the formation and characteristics of bacterial biofilms on PD catheters after peritonitis-associated catheter removal. METHODS: The patients with maintenance PD who were regularly followed up in the Peking University People' s Hospital from June 2007 to January 2022 were retrospectively analyzed. The patients who withdrew from PD because of peritonitis and removed the PD catheter in our hospital and underwent the scanning electron microscope examination of the catheter were selected. The general information of the patients, the electron microscope results of the PD catheter and the bacterial culture results of the PD fluid were summarized. RESULTS: (1) A total of 18 patients were included, 11 were female (accounting for 61.1%). The average age of the patients was (59.1±11.5) years, and the average duration of dialysis was (80.1±47.4) months. Primary kidney diseases were predominantly chronic glomerulonephritis (55.6%), followed by diabetic nephropathy (27.8%), and others (16.6%). The reasons for catheters removal in 18 patients were refractory peritonitis in 11 cases, recurrent peritonitis in 5 cases, and fungal peritonitis in 2 cases. (2) 16 of the 18 patients (88.9%) had catheter bacterial biofilm, and the bacterial biofilm forms were all cocci. Some were arranged in grape-like shapes, and their diameters ranged from about 500 nm to 1 000 nm. The bacterial culture results of peritoneal dialysis fluid showed that the three most common pathogens were Escherichia coli, methicillin-sensitive Staphylococcus aureus (MSSA), and Staphylococcus epidermidis. (3) Among the 18 patients enrolled, 13 patients (72.2%) had peritonitis in the past. The causative bacteria of peritonitis in 9 patients were cocci, including coagulase-negative Staphylococci (Staphylococcus suis, Staphylococcus surface, Staphylococcus xylosus, Staphylococcus warneri), Staphylococcus aureus, Streptococcus (Streptococcus salivarius and Aerococus viridans). CONCLUSION Bacterial biofilm formation on the inner surface of PD catheter is common in peritonitis-associated catheter removal patients. Not all PD catheters removed due to peritonitis have bacterial biofilms. Bacterial biofilms and peritonitis pathogens may not be consistent.
Humans ; Biofilms/growth & development* ; Peritonitis/etiology* ; Peritoneal Dialysis/instrumentation* ; Middle Aged ; Female ; Male ; Retrospective Studies ; Catheters, Indwelling/microbiology* ; Device Removal ; Catheter-Related Infections/microbiology* ; Aged ; Adult

Acute Disease ; Aged ; Anti-Bacterial Agents/therapeutic use* ; Bacteremia/microbiology* ; Female ; Hepatitis B, Chronic/complications* ; Hepatitis C, Chronic/complications* ; Humans ; Hypersplenism/complications* ; Liver Cirrhosis/complications* ; Meningococcal Infections/microbiology* ; Neisseria meningitidis/isolation & purification* ; Peritonitis/microbiology*

BACKGROUND/AIMS: Data on the epidemiology of alcoholic cirrhosis, especially in Asian countries, are limited. We compared the temporal evolution of patterns of alcoholic and nonalcoholic cirrhosis over the last decade. METHODS: We retrospectively examined the inpatient datasets of five referral centers during 2002 and 2011. The study included patients who were admitted due to specific complications of liver cirrhosis. We compared the causes of hospital admissions and in-hospital deaths between patients with alcoholic and nonalcoholic cirrhosis. RESULTS: Among the included 2,799 hospitalizations (2,165 patients), 1,496 (1,143 patients) were from 2002, and 1,303 (1,022 patients) were from 2011. Over time, there was a reduction in the rate of hepatic encephalopathy (HE) as a cause of hospitalization and an increase in the rate of hepatocellular carcinoma. Deaths that were attributable to HE or spontaneous bacterial peritonitis (SBP) significantly decreased, whereas those due to hepatorenal syndrome (HRS) significantly increased over time in patients with alcoholic cirrhosis. However, in patients with nonalcoholic cirrhosis, hepatic failure and HRS remained the principal causes of in-hospital death during both time periods. CONCLUSIONS: The major causes of in-hospital deaths have evolved from acute cirrhotic complications, including HE or SBP to HRS in alcoholic cirrhosis, whereas those have remained unchanged in nonalcoholic cirrhosis during the last decade.
Aged ; Asia/epidemiology ; Bacterial Infections/etiology/mortality ; Carcinoma, Hepatocellular/etiology/mortality ; Cause of Death ; Female ; Hepatic Encephalopathy/etiology/mortality ; Hepatorenal Syndrome/etiology/mortality ; Hospital Mortality/*trends ; Hospitalization/*trends ; Humans ; Liver Cirrhosis/*complications/mortality ; Liver Cirrhosis, Alcoholic/*complications/mortality ; Liver Neoplasms/etiology/mortality ; Male ; Middle Aged ; Peritonitis/microbiology/mortality ; Retrospective Studies ; Risk Factors ; Time Factors

To analyze the clinical characteristics of continuous ambulatory peritoneal dialysis (CAPD) associated peritonitis in the tertiary hospitals and to discuss the preventive and therapeutic strategy.
 Methods: The clinical characteristics, pathogens, resistance and outcomes of 126 CAPD associated peritonitis in 104 patients from Jan, 2013 to June, 2016, were retrospectively analyzed.
 Results: Among the patients, the incidence rates of abdominal pain, fever, diarrhea and emesis were 104 (82.54%), 56 (44.44%), 49 (38.89%), and 31 (23.60%), respectively. Among them, 88 patients suffered peritonitis once, other 16 patients suffered multiple peritonitis or recurrent peritonitis for 38 times. Among the 38 times, the numbers for recurrent, repeated or catheter-associated peritonitis were 2, 2, or 3, respectively. Peritoneal fluids from 103 cases were cultured, and 64 cases were positive in bacteria, with a rate of 62.14%. A total of 70 strains of bacteria were separated, including 42 strains of gram-positive bacteria, 21 strains of gram-negative bacteria, and 7 strains of fungus. The most common gram-positive pathogens were Staphylococcus epidermidis, Enterococcus faecalis and Staphylococcus haemolyticus, while Escherichia coli, Klebsiella pneumoniae and Klebsiella pneumoniae were the most common gram-negative bacteria. Candida albicans was the major fungal pathogens. Gram-positive cocci showed resistance to gentamycin, levofloxacin, moxifloxacin, vancomycin and linezolid, with a rate at 20.00%, 36.11%, 5%, 0%, and 0%, respectively. The gram-negative bacilli were resistent to cefoperazone/sulbactam, gentamycin, cephazolin, and ceftazidime, with a rate at 6.25%, 10.53%, 64.29%, and 15.38%, respectively. There were no imipenem, amikacin, piperacillin/tazobactam-resistant strains were found.
 Conclusion: The most common pathogen causing CAPD associated peritonitis is gram-positive bacteria. It is crucial to take the anti-infection therapy for CAPD associated peritonitis early. The positive rates for bacterial culture need to be enhanced through improvement of methods. At the same time, doctors could improve the outcome of CAPD associated peritonitis by adjusting the medication according to the drug sensitivity results.
Abdominal Pain ; epidemiology ; Anti-Bacterial Agents ; Bacteria ; Bacterial Infections ; epidemiology ; microbiology ; Candidiasis ; epidemiology ; Catheters ; adverse effects ; microbiology ; Diarrhea ; epidemiology ; Drug Resistance, Bacterial ; Enterococcus faecalis ; Escherichia coli ; Fever ; epidemiology ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Imipenem ; Klebsiella pneumoniae ; Microbial Sensitivity Tests ; Mycoses ; epidemiology ; Penicillanic Acid ; analogs & derivatives ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; adverse effects ; Peritonitis ; complications ; epidemiology ; microbiology ; Piperacillin ; Piperacillin, Tazobactam Drug Combination ; Recurrence ; Retrospective Studies ; Staphylococcus epidermidis ; Staphylococcus haemolyticus ; Vomiting ; epidemiology

Spontaneous bacterial peritonitis (SBP) is a common complication of cirrhosis. Based on our current understanding of SBP, the most common etiologies for SBP in cirrhosis are Enterobacter and Streptococcal species. Th e Aeromonas species are ubiquitous in fresh or sea water. Aeromonas caviae is never identified as etiology in cases of SBP. A patient, who had a history of liver cirrhosis related to chronic hepatitis B virus infection for 1 year, presented with diarrhea. He had diarrhea 1 week later returned from coastal city. He was hospitalized and treated with norfloxacin after 7 days of severe symptoms, including fever, abdominal distention, and diarrhea. Analysis of the ascitic specimen revealed a white-cell count of 4.42 × 109 cells/L with 88% neutrophils. Analysis of stool specimen showed a white-cell count of 60 cells per high-power field. Th e patient started the injection of cefriaxone at a dose of 4 g/d. However, the situation was not improved. Th ree days later, stool and ascitic fluid culture showed positive for Aeromonas caviae. Antibiotic susceptibility testing revealed that imipenem, meropenem, amikacin, and cefoperazone-sulbactam were highly sensitive to the Aeromonas caviae. However, the bacilli resisted to ceftriaxone, ceftazidime, ampicillin-sulbactam, levofloxacin, and sulfamethoxazole. Ceftriaxone was then switched to imipenem. The patient was fully recovered 14 days later. Aeromonas caviae is a rare pathogen of SBP in cirrhosis. It resists to third-generation of cephalosporin and fluroquinolone, which are of frequently used dependent on clinical experience. It needs a special attention.
Aeromonas caviae ; Anti-Infective Agents ; Ascitic Fluid ; Gram-Negative Bacterial Infections ; pathology ; Humans ; Leukocyte Count ; Liver Cirrhosis ; Male ; Microbial Sensitivity Tests ; Peritonitis ; microbiology ; pathology

OBJECTIVETo explore the clinical value of serum procalcitonin (PCT) for predicting spontaneous bacterial peritonitis (SBP) in end-stage liver diseases.

METHODSThe clinical data of 362 ascitic inpatients with end-stage liver diseases who had underwent serum PCT assay in our department from March 2011 to June 2013 were analyzed retrospectively. These patients were then divided into SBP group (n=178) and non-SBP group (n=184). The dynamic changes of the PCT values upon admission and after antibiotic treatment were compared. The receiver operating characteristic curve was drawn to identify the optimal cut-off value of serum PCT in diagnosing SBP.

RESULTSThe positive rate of bacteria culture in ascites was only 4.6% (4/87) in SBP group. The median value of serum PCT was 0.73 and 0.15 ng/ml in SBP group and non-SBP group (Z=-11.9, U=0.000), respectively, before antibiotic treatment. In the SBP group, the median value of serum PCT was 1.73 ng/ml in 13 patients with positive culture findings, which was higher than the overall median value in SBP group. Among patients who were responsive to the antibiotic therapy, the median values of serum PCT were 0.40(n=46), 0.32(n=19), and 0.33 ng/ml(n=25), respectively, 3, 5, and 7 days after the effective antibiotics treatment, which were significantly lower than the pre-treatment levels [0.86(Z=-5.91, U=0.000), 0.72(Z=-3.10, U=0.002), and 0.79 ng/ml(Z=-4.37, U=0.000), respectively]. ROC analysis showed that a serum PCT value of more than 0.462 ng/ml had a sensitivity of 83.7% and a specificity of 94.9%(AUC:0.95, 95%CI:0.93-0.97, P=0.00) in diagnosing SBP in patients with end-stage liver diseases.

CONCLUSIONSAscitic fluid positive rate is low in SBP patients. Serum PCT is a sensitive and specific marker for predicting peritoneal bacteria infection in end-stage liver disease patients with ascites. Higher serum PCT can be expected in these patients with heavier infections, it can also be used to evaluate the effectiveness of anti-bacteria therapies.

Adult ; Aged ; Ascitic Fluid ; microbiology ; Bacterial Infections ; complications ; diagnosis ; Calcitonin ; blood ; Calcitonin Gene-Related Peptide ; Female ; Humans ; Liver Diseases ; complications ; Male ; Middle Aged ; Peritonitis ; complications ; diagnosis ; Protein Precursors ; blood ; Retrospective Studies ; Sensitivity and Specificity

No abstract available.
Amphotericin B/therapeutic use ; Antifungal Agents/pharmacology/therapeutic use ; Cryptococcosis/*diagnosis/drug therapy/microbiology ; Cryptococcus/classification/drug effects/*isolation & purification ; DNA, Ribosomal/chemistry/metabolism ; Fluconazole/therapeutic use ; Humans ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis/*diagnosis/etiology ; Phylogeny ; Saccharomyces cerevisiae/drug effects/isolation & purification ; Sequence Homology, Nucleic Acid

Spontaneous bacterial peritonitis (SBP) is the most common infection in liver cirrhosis patients, and is not a result of surgery or intra abdominal infection. Argon plasma coagulation (APC) is an endoscopic procedure used with a high-frequency electrical current for control of bleeding from gastrointestinal vascular ectasias including angiodysplasia and gastric antral vascular ectasia. This procedure is known to be safe because it uses a noncontact method. Therefore, tissue injury is minimal and up to two to three millimeters. However, we experienced a case of SBP occurring immediately after performance of APC for control of severe bleeding from angiodysplasia in the colon in a patient with liver cirrhosis and hepatocellular carcinoma.
Aged ; Angiodysplasia/complications/*diagnosis ; Anti-Bacterial Agents/therapeutic use ; *Argon Plasma Coagulation ; Bacterial Infections/*diagnosis/drug therapy/microbiology ; Carcinoma, Hepatocellular/complications/diagnosis ; Colonic Diseases/complications/*diagnosis ; Colonoscopy ; Female ; Gastrointestinal Hemorrhage/therapy ; Gram-Negative Bacteria/isolation & purification ; Humans ; Liver Cirrhosis/complications/diagnosis ; Liver Neoplasms/complications/diagnosis ; Peritonitis/*diagnosis/drug therapy/microbiology

OBJECTIVETo investigate the correlation between human neutrophil peptide (HNP) and spontaneous bacterial peritonitis (SBP) in order to assess the diagnostic value of quantitative measurement of these alpha-defensins.

METHODSSeventy-seven patients with cirrhosis and ascites were divided into two groups according to diagnosis of SBP (n = 45 with SBP and n = 32 without SBP). Twenty-eight healthy individuals were analyzed as controls. HNP was detected by double-antibody sandwich assay. Peripheral white blood cell (WBC) counts, neutrophil ratio, and levels of procalcitonin (PCT) and C-reactive protein (CRP) were determined by standard methods. Receiver operating characteristic (ROC) curves were used to compare the diagnostic values of HNP, PCT and CRP in SBP.

RESULTSThere were no significant differences between the three groups (SBP, non-SBP, and healthy controls) for WBC count ((6.01+/-2.25)*109 /L, (4.85+/-1.94)*109 /L, and (5.49+/-1.76)*109 /L; F = 2.91, P more than 0.05) and neutrophil ratio (70.70%+/-10.42%, (68.20%+/-8.97%, and 69.50%+/-8.69%; F = 3.07, P more than 0.05). However, compared to the non-SBP group and the healthy controls, the SBP group showed significantly higher levels of HNP ((9.99+/-3.33) ng/ml and (8.92+/-2.30) ng/ml vs. (17.66+/-6.40) ng/ml; q = 3.20 vs. 3.52, P less than 0.05), serum CRP ((15.08+/-9.95) ng/ml and (5.96+/-2.91) ng/ml vs. (31.32+/-18.65) mg/L; q = 11.03 vs. 3.69, P less than 0.05), and positive rate of PCT (25.0% and 10.0% vs. 62.2%; X2 = 10.41 vs. 15.40, P less than 0.0125). The areas under the curve (AUC) showed the following descending trend: HNP more than PCT more than CRP (0.719, 0.707, and 0.629 respectively). Using cut-off points of 10 ng/ml for HNP, 0.5 ng/ml for PCT, and 8 mg/L for CRP, the respective sensitivities for diagnosis of SBP were 71.1%, 62.2%, and 73.3%, the respective specificities were 71.9%, 75.0%, and 56.3%, and the respective Youden's indexes were 0.430, 0.372, and 0.296.

CONCLUSIONHNP is closely related to SBP and can diagnose SBP as reliably as PCT. CRP may help to diagnose SBP, but the results from routine blood testing did not show sufficient statistical significance for diagnosing SBP.

Adult ; Aged ; Bacterial Infections ; blood ; diagnosis ; C-Reactive Protein ; metabolism ; Calcitonin ; blood ; Calcitonin Gene-Related Peptide ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; Peritonitis ; blood ; diagnosis ; microbiology ; Protein Precursors ; blood ; alpha-Defensins ; blood

OBJECTIVETo investigate the effect of Pseudomonas quinolone signal (PQS) on the virulence of Pseudomonas aeruginosa.

METHODSPseudomonas aeruginosa strain PAO1 was treated with PQS alone, PQS plus farnesol, or farnesol alone. The transcriptional levels of the regulator gene ExsA and virulence protein gene ExoS of type III secretion system were examined using quantitative real-time PCR, and spectrophotometry was employed to detect pyocyanin production in the bacteria. The adhesion and invasiveness of the treated PAO1 in cultured alveolar epithelial cells A549 were assessed on plate count agar, and their effects on the survival of a mouse model of peritonitis was compared.

RESULTSThe increase or decrease of PQS did not affect the growth of PAO1. Compared with the untreated bacteria, PQS-treated PAO1 showed obviously increased transcription levels of ExsA and ExoS (P<0.01) and pyocyanin production, which was significantly lowered by farnesol (P<0.01). In A549 cell cultures, farnesol-treated PAO1 exhibited significantly lowered adhesion and invasiveness, while PQS-treated PAO1 caused a significantly decreased survival time of mice with peritonitis (P<0.01). Farnesol treatment did not obviously affected ExsA transcription (P>0.05) but caused a significant reduction in the transcriptional level of Exos (P<0.05) in PAO1. PQS showed no significant effect on the adhesion and invasiveness of PAO1 (P<0.05).

CONCLUSIONPQS can maintain the adhesion and invasiveness of Pseudomonas aeruginosa, and in the hosts of the bacteria, PQS concentration is positively correlated with pyocyanin production and hence negatively with the survival time of the hosts.

ADP Ribose Transferases ; genetics ; metabolism ; Animals ; Bacterial Adhesion ; Bacterial Proteins ; genetics ; metabolism ; Bacterial Toxins ; genetics ; metabolism ; Cell Line ; Humans ; Male ; Mice ; Mice, Inbred BALB C ; Peritonitis ; microbiology ; Pseudomonas aeruginosa ; genetics ; metabolism ; pathogenicity ; Quinolones ; pharmacology ; Recombinant Fusion Proteins ; genetics ; metabolism ; Signal Transduction ; Trans-Activators ; genetics ; metabolism ; Transcription, Genetic ; Virulence