The response of human peritoneal macrophages to stimulation with bacteria isolated from episodes of continuous ambulatory peritoneal dialysis-related peritonitis

Article Abstract:

Peritonitis refers to inflammation of the lining of the abdominal cavity. Peritonitis due to coagulase-negative Staphylococcus epidermidis (Se-) is a frequent cause of morbidity (illness) in patients with end-stage renal failure who are receiving continuous ambulatory peritoneal dialysis (CAPD). Peritoneal infections due to coagulase-positive Staphylococcus aureus (Sa+) are usually more serious. The attachment of these gram-positive staphylococci to dialysis catheters or to the abdominal wall, the development of a biofilm, and exotoxins may be virulence factors that contribute to the development and severity of CAPD peritonitis. In addition to polymorphonuclear leukocytes (PMNL), peritoneal macrophages are the body's first response to infection. (PMNLs, also known as neutrophils, are white blood cells that respond to foreign substances, including disease-causing bacteria. Macrophages are cells that engulf and digest foreign substances, such as bacteria.) In response to various stimuli, such as S. aureus and S. epidermis from CAPD patients, peritoneal macrophages have been shown to oxidatively metabolize arachidonic acid, a nutritionally essential unsaturated fatty acid. This process yields products of the lipoxygenase and cyclooxygenase metabolic pathways: prostaglandins (pg), thromboxanes (tx) and leukotrienes (lk), collectively called eicosanoids. The relation of the bacterial contaminants in peritoneal fluids and the metabolic response of peritoneal macrophages was studied to determine whether the production of eicosanoids was specific to the species or to the strain of bacteria. Results of the nature of peritoneal macrophage responses are provided. They indicate that the responses are species-specific, rather than strain-specific, and that the biological pathways yielding varying levels of eicosanoids are independently regulated. Thus, in response to the gram-positive species of staphylococci, the CAPD peritoneal macrophages produce an eicosanoid (leukotriene) that facilitates PMNL activity. Similarly, the production of other eicosanoids (prostaglandin and thromboxane) was inhibited according to the species tested. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Macrophages, Neutrophils, Staphylococcus, Staphylococcal infections, Eicosanoic acid

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Continuous ambulatory peritoneal dialysis associated with peritonitis in older patients

Article Abstract:

Peritoneal dialysis is a procedure for clearing the body of wastes by infusing a sterile solution into the peritoneal cavity (the space between the two layers of membrane covering the abdominal organs), and then, after a period of time has elapsed, removing the fluid that has accumulated. This fluid has picked up metabolic wastes from the blood stream, which are thereby removed from the body. Continuous ambulatory peritoneal dialysis (CAPD) is a form of dialysis used to treat chronic renal (kidney) failure, in which a catheter (thin tube) is implanted into the peritoneal cavity. A risk associated with CAPD is the development of peritonitis (infection of the peritoneum, the membranous lining of the peritoneal cavity), which is of particular concern among elderly people. To study this issue, the medical records of 37 CAPD patients who were more than 55 years of age were examined. The diagnosis of catheter-related peritonitis was made if all of the following were found: abdominal pain and tenderness; no other apparent cause of peritonitis; an elevated white blood cell count in the peritoneal fluid; and isolation of bacteria from the peritoneal fluid. Results showed that 31 patients had 61 episodes of peritonitis in an average follow-up period of three and one-half years. The average number of episodes per patient per year was 1.4, with the average time from catheter insertion until the first episode being 1.8 years. Sixteen of the cases of peritonitis were associated with systemic sepsis (blood-borne infection), and of these, 13 could not be medically managed and required removal of the catheters. Four of the septic patients died, and the mortality for the entire group was 7 percent. This rate is considerably higher than rates from studies of younger patients. In summary, CAPD-related peritonitis is a serious problem in the elderly, and should be treated by removal of the dialysis catheter and laparotomy, opening the abdominal cavity for treatment of the infection, when indicated. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Surgical complications of continuous ambulatory peritoneal dialysis

Article Abstract:

Continuous ambulatory peritoneal dialysis (CAPD) is a popular and efficient method of treating patients with end-stage kidney disease. Peritoneal dialysis corrects an electrolyte imbalance in the blood and removes toxins and other wastes that are normally excreted by the kidney. CAPD requires the placement of a permanent indwelling catheter for fluid instillation. Patients receiving CAPD generally have a better quality of life than patients receiving hemodialysis. A report is presented of surgical experience over a 10-year period of 260 patients with end-stage kidney disease who were treated with CAPD. The average patient age was 51 years, and the average length of CAPD treatment was 2 years. The most common cause of kidney failure was diabetes (42 percent). There were 311 catheters inserted; 151 (49 percent) had to be removed. Most of the catheters were removed (74 percent) because of peritonitis (inflammation of the peritoneum). Peritonitis occurred an average of once per 10 patient months of catheter placement. Other complications included catheter leakage, malposition, obstruction, and abdominal wall hernias. Length of catheter placement duration improved consistently over the course of the study, as did related infections. The most common cause of infection appeared to be failure to use sterile techniques when the distillate bags were changed. Incidence of peritonitis showed gradual improvement. Cumulative patient survival at one year was 80 percent, at two years 60 percent, and at three years 35 percent. Patients with diabetes had lower survival rates. Although CAPD is associated with a high rate of complications, major improvements have been made over the past 10 years in catheter longevity, infection rates, and hospital stays due to complications. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation

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