• Clinical heterogeneity
• Cloudy effluent
• Peritoneal dialysis (PD)
• Peritonitis, vancomycin

• Humans
• Peritonitis/microbiology
• Peritonitis/drug therapy
• Peritonitis/etiology
• Male
• Female
• Middle Aged
• Peritoneal Dialysis/adverse effects
• Retrospective Studies
• Vancomycin/therapeutic use
• Anti-Bacterial Agents/therapeutic use
• Aged
• Gram-Positive Bacterial Infections/drug therapy
• Gram-Positive Bacterial Infections/microbiology
• Microbial Sensitivity Tests
• Adult

• BYSYDL2023004 Clinical Cohort Construction Program of Peking University Third Hospital
• 82470774 National Natural Science Foundation of China

• guidelines
• infection
• pediatric
• peritonitis
• prevention
• treatment

• Adolescent
• Child
• Child, Preschool
• Humans
• Infant
• Anti-Bacterial Agents/therapeutic use
• Catheter-Related Infections/prevention & control
• Catheter-Related Infections/etiology
• Kidney Failure, Chronic/therapy
• Peritoneal Dialysis/adverse effects
• Peritonitis/prevention & control
• Peritonitis/etiology
• Peritonitis/microbiology
• Practice Guidelines as Topic

• COVID-19
• antibiotic resistance
• lymphocyte count
• pathogen spectrum
• peritoneal dialysis
• peritonitis

• Shenzhen San-Ming Project of Medicine
• Shenzhen Postdoctoral Research Grant
• the General Program for Clinical Research at Peking University Shenzhen Hospital

• Coagulase-negative Staphylococci
• Peritoneal dialysis
• Peritoneal dialysis-related peritonitis
• Psm-mec
• SCCmec

• Humans
• Staphylococcus/genetics
• Coagulase/genetics
• Oxacillin
• Peritoneal Dialysis/adverse effects
• Peritonitis
• Staphylococcal Infections/epidemiology
• Microbial Sensitivity Tests
• Anti-Bacterial Agents/pharmacology

• 820RC785 Hainan Provincial Natural Science Foundation of China
• 822RC864 Hainan Provincial Natural Science Foundation of China
• 22A200302 and 21A200441 Healthy department of Hainan province

• Dialysis
• infectious
• patients
• prevention

• Humans
• Renal Dialysis/adverse effects
• Peritoneal Dialysis/adverse effects
• Kidney Failure, Chronic/complications
• Kidney Failure, Chronic/therapy
• Peritonitis
• Anti-Bacterial Agents/therapeutic use
• Bacteremia/etiology
• Bacteremia/prevention & control
• Bacteremia/epidemiology

Coagulase-negative Staphylococci (CoNS) are frequently isolated in peritoneal dialysis (PD)-related peritonitis with a high rate of relapse and repeat peritonitis after initial response to antimicrobials. The optimal treatment regimen for CoNS peritonitis remains debatable. Hence, this study aimed to describe the clinical and microbiologic characteristics of CoNS peritonitis in a PD center and determine predictive factors influencing the outcomes.

All cases of CoNS peritonitis in Selayang Hospital between 2011 and 2019 were reviewed retrospectively.

A total of 906 episodes of peritonitis were recorded; 140 episodes (15%) in 98 patients were caused by CoNS. The oxacillin and gentamicin resistance rates were 47% and 46%, respectively. The overall primary response rate was 90%, and the complete cure rate was 79%. Patients with concomitant exit-site infection (odds ratio (OR) 0.06, 95% confidence interval (CI) 0.01 to 0.40, P < 0.01) and history of recent systemic antibiotic use (OR 0.04, 95% CI 0.01 to 0.82, P=0.04) were less likely to achieve primary response. CoNS episodes that were treated with beta-lactam-based or vancomycin-based therapy had a similar primary response rate and complete cure rate. The rates of relapse and repeat were 12% and 16%, respectively. Relapsed episodes (OR 0.35, 95% CI 0.13 to 0.97, P=0.04) had a significantly lower complete cure rate than the first episodes.

Relapsed CoNS peritonitis was common and was associated with worse outcomes than the first episode of CoNS peritonitis. Oxacillin resistance was common, but the treatment outcome remained favourable when a beta-lactam-based regimen was used as empirical therapy.

• Guideline
• ISPD
• peritonitis
• prevention
• treatment

• Anti-Bacterial Agents/therapeutic use
• Antibiotic Prophylaxis
• Humans
• Peritoneal Dialysis/adverse effects
• Peritoneal Dialysis/methods
• Peritonitis/drug therapy
• Peritonitis/etiology
• Peritonitis/prevention & control
• Renal Dialysis/adverse effects

Peritoneal dialysis-related peritonitis remains a significant complication and an important cause of technique failure. Based on current International Society for Peritoneal Dialysis guidelines, diagnosis of peritonitis is made when two of the three following criteria are met: 1) clinical features consistent with peritonitis; 2) dialysis effluent white blood cell count of >100 cells/μL; 3) positive effluent culture. However, early and accurate diagnosis can still be faulty, and emphasis has been placed on improving the timeliness and accuracy of diagnosis to facilitate early effective treatment. There have been advances in the novel diagnostic tests such as point-of-care molecular tests, genetics sequencing, mass spectrometry, and machine learning algorithm with immune fingerprinting. This article will discuss the latest evidence and updates of these tests in the management of peritoneal dialysis-related peritonitis.

The blood-clotting protein fibrin(ogen) plays a critical role in host defense against invading pathogens, particularly against peritoneal infection by the Gram-positive microbe Staphylococcus aureus. Here, we tested the hypothesis that direct binding between fibrin(ogen) and S. aureus is a component of the primary host antimicrobial response mechanism and prevention of secondary microbe dissemination from the peritoneal cavity. To establish a model system, we showed that fibrinogen isolated from Fibγ^Δ5 mice, which express a mutant form lacking the final 5 amino acids of the fibrinogen γ chain (termed fibrinogenγ^Δ5), did not support S. aureus adherence when immobilized and clumping when in suspension. In contrast, purified wildtype fibrinogen supported robust adhesion and clumping that was largely dependent on S. aureus expression of the receptor clumping factor A (ClfA). Following peritoneal infection with S. aureus USA300, Fibγ^Δ5 mice displayed worse survival compared to WT mice coupled to reduced bacterial killing within the peritoneal cavity and increased dissemination of the microbes into circulation and distant organs. The failure of acute bacterial killing, but not enhanced dissemination, was partially recapitulated by mice infected with S. aureus USA300 lacking ClfA. Fibrin polymer formation and coagulation transglutaminase Factor XIII each contributed to killing of the microbes within the peritoneal cavity, but only elimination of polymer formation enhanced systemic dissemination. Host macrophage depletion or selective elimination of the fibrin(ogen) β2-integrin binding motif both compromised local bacterial killing and enhanced S. aureus systemic dissemination, suggesting fibrin polymer formation in and of itself was not sufficient to retain S. aureus within the peritoneal cavity. Collectively, these findings suggest that following peritoneal infection, the binding of S. aureus to stabilized fibrin matrices promotes a local, macrophage-mediated antimicrobial response essential for prevention of microbe dissemination and downstream host mortality.

The Gram-positive bacterium Staphylococcus aureus (S. aureus) produces a number of soluble and surface-associated proteins that bind the host coagulation protein fibrinogen. The contribution of fibrinogen-S. aureus binding through the fibrinogen receptor clumping factor A (ClfA) in peritoneal infection has not been defined. Elimination of the binding motif on fibrinogen for ClfA or deletion of ClfA from S. aureus significantly reduced S. aureus-fibrinogen binding and bacterial clumping in solution. In a mouse model of peritonitis, loss of these activities resulted in diminished bacterial killing, increased bacterial dissemination, and worsened host survival. Although fibrin polymer formation and fibrin(ogen)-macrophage binding are mechanistically linked to the local antimicrobial response, fibrin formation in and of itself is not sufficient to suppress microbe dissemination. These discoveries have identified important components of the fibrin(ogen)-dependent host antimicrobial response against S. aureus, providing further understanding of this physiological response to infection which could uncover potential therapeutic strategies for peritonitis patients.

• Animals
• Coagulase/immunology
• Coagulase/metabolism
• Fibrin/metabolism
• Fibrinogen/immunology
• Mice
• Peritonitis/immunology
• Peritonitis/metabolism
• Staphylococcal Infections/immunology
• Staphylococcal Infections/metabolism
• Staphylococcus aureus/immunology
• Staphylococcus aureus/metabolism

• R01 HL160046 NHLBI NIH HHS
• R35 HL144976 NHLBI NIH HHS
• R01 AI137273 NIAID NIH HHS
• U01 HL143403 NHLBI NIH HHS
• R01 DK112778 NIDDK NIH HHS
• R01 CA211098 NCI NIH HHS
• R01 AI020624 NIAID NIH HHS
• National Institutes of Health

• Non-tuberculous mycobacterium
• peritoneal dialysis
• peritonitis

The pathogenic role of staphylococci in hospital-acquired postoperative intra-abdominal infections (HAIs) has never been evaluated. In a tertiary care university hospital, we assessed the clinical characteristics and outcomes of patients admitted to the intensive care unit for HAIs according to the presence of staphylococci (S-HAI) or their absence (nS-HAI) in peritoneal cultures. Patients with S-HAIs were compared to nS-HAIs patients. Overall, 380 patients were analyzed, including 87 (23%) S-HAI patients [29 Staphylococcus aureus (Sa-HAIs) and 58 coagulase-negative staphylococci (CoNS-HAIs)]. The clinical characteristics did not differ between the S-HAI and nS-HAI patients. Adequacy of empirical anti-infective therapy was achieved less frequently in the staphylococci group (54 vs 72%, respectively, p < 0.01). The 90-day (primary endpoint) and one-year mortality rates did not differ between these groups. The S-HAI patients had decreased rates of postoperative complication (p < 0.05). The adjusted analysis of the clinical outcomes reported a decreased frequency of surgical complications in the staphylococci group (OR 0.43, 95% CI [0.20–0.93], p = 0.03). While the trends toward decreased morbidity criteria were observed in S-HAI patients, the clinical outcomes were not different between the CoNS-HAI and Sa-HAI patients. In summary, our data are not substantial enough to conclude that staphylococci exhibit no pathogenicity in HAIs.

• Bacterial peritonitis
• PFGE
• Peritoneal dialysis
• Sccmec
• Staphylococcus epidermidis
• mecA

Peritonitis is the leading cause of morbidity and technique failure in peritoneal dialysis (PD) patients. The International Society for Peritoneal Dialysis (ISPD) recommends each centre to monitor the peritonitis rates and the causative organisms in order to guide local empiric antibiotic protocols. The aim of this study was to report on the peritonitis rates and describe the causative microorganisms and the antibiotic susceptibility in continuous ambulatory peritoneal dialysis (CAPD) adult patients at the Universitas Academic Hospital.

A single-centre, retrospective descriptive survey was conducted to determine the peritonitis rates in PD patients (January–December 2016). All CAPD patients aged ≥18 years, who presented with clinical features of PD-associated peritonitis, were included. The peritonitis episodes were studied per patient, and the causative microorganisms and the antibiotic susceptibility of the organisms were described.

One hundred and twenty-eight patients underwent CAPD. The peritonitis rate was 1.45 episodes per year at risk. The prevalence of CAPD patients affected by at least one episode of CAPD-associated peritonitis during 2016 was 56.3%. The majority of episodes (76.7%) (n = 122) were mono-microbial. Gram-positive organisms accounted for 73.0% (n = 116) of the peritonitis episodes, coagulase-negative Staphylococcus being the most common. Gram-negative organisms accounted for 15.7% (n = 25) of the peritonitis episodes, and the common pathogens was Enterobacteriaceae.

The peritonitis rate was alarmingly high, with 1.45 episodes per year at risk; this is three times more than the recommended 0.5 episodes per year according to the ISPD guidelines. The culture-negative rate of 8.8% is within ISPD-acceptable limits. There is a need to strengthen preventive measures with regard to peritonitis.

• CAPD patients
• Universitas Academic Hospital
• bacterial distribution
• peritoneal dialysis
• peritonitis

• Infection
• Peritoneal dialysis
• Peritonitis
• Serum albumin
• Transitioning

• Bacteria
• biofilm
• multiple peritonitis

• Escherichia coli
• antimicrobial resistance
• peritoneal dialysis
• peritonitis
• virulence factors

• Escherichia coli
• Peritoneal dialysis
• Peritonitis
• Virulence

• peritoneal dialysis
• related peritonitis

Peritonitis is a debilitating infectious complication of peritoneal dialysis (PD). Drug-resistant bacterial peritonitis typically has a lower response rate to antibiotics. In the past 15 years, newer antibiotics with activities against drug-resistant Gram-positive bacteria have been developed. In most circumstances, peritonitis due to methicillin-resistant staphylococci responds to vancomycin. If vancomycin cannot be used due to allergy and/or non-susceptibility, there is increasing evidence that linezolid and daptomycin are the drugs of choice. It is reasonable to start linezolid orally or intravenously, but subsequent dose reduction may be necessary in case of myelosuppression. Daptomycin can be given intravenously or intraperitoneally and has excellent anti-biofilm activity. Other treatment options for drug-resistant Gram-positive bacterial peritonitis include teicoplanin, tigecycline and quinupristin/dalfopristin. Teicoplanin is not available in some countries (e.g. the USA). Tigecycline can only be given intravenously. Quinupristin/dalfopristin is ineffective against Enterococcus faecalis and there is only low-quality evidence to support its efficacy in the treatment of peritonitis. Effective newer antibiotics against drug-resistant Gram-negative bacteria are lacking. Polymyxins can be considered, but evidence on its efficacy is limited. In this review, we will discuss the potential use of newer antibiotics in the treatment of drug-resistant bacterial peritonitis in PD patients.

• CAPD
• end-stage renal disease
• peritoneal dialysis
• peritonitis
• sepsis

• ISPD
• Peritonitis
• guidelines
• prevention
• treatment

• Candida spp.
• antifungal susceptibility
• biofilm
• peritoneal dialysis
• peritonitis

• Peritonitis
• empirical therapy
• gentamicin
• resistance patterns
• vancomycin

Peritonitis continues to be a major complication of peritoneal dialysis (PD), and adequate treatment is crucial for a favorable outcome. There is no consensus regarding the optimal therapeutic regimen, and few prospective controlled studies have been published. The objective of this manuscript is to review the results of PD peritonitis treatment reported in narrative reviews, systematic reviews, and proportional meta-analyses. Two narrative reviews, the only existing systematic review and its update published between 1991 and 2014 were included. In addition, we reported the results of a proportional meta-analysis published by our group. Results from systematic reviews of randomized control trials (RCT) and quasi-RCT were not able to identify any optimal antimicrobial treatment, but glycopeptide regimens were more likely to achieve a complete cure than a first generation cephalosporin. Compared to urokinase, simultaneous catheter removal and replacement resulted in better outcomes. Continuous and intermittent IP antibiotic use had similar outcomes. Intraperitoneal antibiotics were superior to intravenous antibiotics in reducing treatment failure. In the proportional meta-analysis of RCTs and the case series, the resolution rate (86%) of ceftazidime plus glycopeptide as initial treatment was significantly higher than first generation cephalosporin plus aminoglycosides (66%) and glycopeptides plus aminoglycosides (75%). Other comparisons of regimens used for either initial treatment or treatment of gram-positive rods or gram-negative rods did not show statistically significant differences. The superiority of a combination of a glycopeptide and a third generation cephalosporin was also reported by a narrative review study published in 1991, which reported an 88% resolution rate.

• Peritonitis
• Peritoneal dialysis
• Antibiotic
• Treatment