ABSTRACT
Peritonitis is the major complication of peritoneal dialysis (PD) patients. Staphylococcus is the leading causative organism of PD-related peritonitis. However, there were more reports of unusual organisms causing peritonitis. Clinical features, management, and outcome of peritonitis from unusual organisms are important information. We reported herein a 72-year-old female patient who presented with fever, abdominal pain, and cloudy dialysate for 3 days. Upon admission, ceftazidime and vancomycin were given intraperitoneally. A preliminary report of blood and PD fluid culture showed the presence of Gram-positive bacilli. Her clinical status improved 48 hours after the commencement of the antibiotics. Subsequently, culture reports of blood and PD fluid showed Lysinibacillus sphaericus which was susceptible to vancomycin at a minimal inhibitory concentration of less than 0.25 µg/mL. The patient was given intraperitoneal vancomycin for a total of 14 days. Then, the PD effluent was clear, and its cell count was below 100 cells/mm3 in 3 days. The patient did not have a recurrence of peritonitis after antibiotic discontinuation. The possibility of this organism infection is environmental contamination related to the patient's gardening activities.
ABSTRACT
BACKGROUND: The objective of this systematic review and meta-analysis was to assess the risks of incident and recurrent Clostridium difficile-associated diarrhea in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) requiring dialysis. METHODS: A literature search was performed from inception to February 2015. Studies that reported relative risks, odds ratios, or hazard ratios comparing the risks of C. difficile-associated diarrhea in patients with CKD or ESRD versus those without CKD or ESRD were included. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance method. RESULTS: Twenty studies (nine case-control, seven cohort, and four cross-sectional studies with 162,218,041 patients) were included in the meta-analysis. Pooled RRs of C. difficile-associated diarrhea in patients with CKD and ESRD were 1.95 (95% CI 1.81-2.10) and 2.63 (95% CI 2.04-3.38), respectively. When meta-analysis was limited only to cohort and case-control studies with confounder-adjusted analysis, the pooled RRs of C. difficile-associated diarrhea in patients with CKD and ESRD were 1.89 (95% CI 1.75-2.05) and 2.50 (95% CI 1.49-4.17), respectively. The pooled RR of recurrent C. difficile-associated diarrhea in patients with CKD was 2.61 (95% CI 1.53-4.44). Data on the risk of recurrent C. difficile-associated diarrhea were limited. CONCLUSION: This meta-analysis demonstrates significantly increased risks of incident and recurrent C. difficile-associated diarrhea in patients with CKD. Furthermore, the magnitude of increased risk of C. difficile-associated diarrhea in ESRD patients is even higher.
Subject(s)
Clostridioides difficile/pathogenicity , Enterocolitis, Pseudomembranous/epidemiology , Kidney Failure, Chronic/epidemiology , Renal Insufficiency, Chronic/epidemiology , Anti-Bacterial Agents/therapeutic use , Case-Control Studies , Clostridioides difficile/drug effects , Comorbidity , Drug Therapy, Combination , Enterocolitis, Pseudomembranous/diagnosis , Enterocolitis, Pseudomembranous/drug therapy , Female , Follow-Up Studies , Humans , Incidence , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/therapy , Male , Randomized Controlled Trials as Topic , Recurrence , Renal Dialysis/methods , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/therapy , Risk AssessmentABSTRACT
BACKGROUND: The objective of this systematic review and meta-analysis was to evaluate the mortality risk in patients with chronic kidney diseases (CKD) and end stage renal disease (ESRD) requiring dialysis with Clostridium difficile infection (CDI). METHODS: A literature search was performed from inception through February 2015. Studies that reported relative risks, odds ratios, or hazard ratios comparing the mortality risk of CKD or ESRD patients with CDI versus those without CDI were included. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance method. RESULTS: Four cohort studies with 8,214,676 patients were included in the meta-analysis. Pooled RR of mortality in CKD patients with CDI was 1.73 (95% CI 1.39-2.15). When meta-analysis was limited only to included studies with ESRD patients, the pooled RR of mortality in patients with ESRD was 2.15 (95% CI, 2.07-2.23). CONCLUSION: This meta-analysis demonstrates significantly increased risks of mortality in CKD and ESRD patients with CDI. The magnitudes of mortality risk are high.
