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Clostridium difficile Peritonitis: An Emerging Infection in Peritoneal Dialysis Patients

Recently, the incidence of Clostridium difficile- (C. difficile-) associated infection has increased significantly in hospital and ambulatory care settings in parallel to the increasing use of inappropriate antibiotics. According to the CDC, approximately 83,000 patients who developed C. difficile e...

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Autores principales: Chaughtai, Saira, Gandhi, Bhavika, Chaughtai, Zeeshan, Tarina, Dana, Hossain, Mohammad A., Asif, Arif
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169237/
https://www.ncbi.nlm.nih.gov/pubmed/30327675
http://dx.doi.org/10.1155/2018/3537283
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author Chaughtai, Saira
Gandhi, Bhavika
Chaughtai, Zeeshan
Tarina, Dana
Hossain, Mohammad A.
Asif, Arif
author_facet Chaughtai, Saira
Gandhi, Bhavika
Chaughtai, Zeeshan
Tarina, Dana
Hossain, Mohammad A.
Asif, Arif
author_sort Chaughtai, Saira
collection PubMed
description Recently, the incidence of Clostridium difficile- (C. difficile-) associated infection has increased significantly in hospital and ambulatory care settings in parallel to the increasing use of inappropriate antibiotics. According to the CDC, approximately 83,000 patients who developed C. difficile experienced at least one recurrence and 29,000 died within 30 days of the initial diagnosis. Patients on dialysis (particularly peritoneal dialysis) are predisposed to this infection due to an inherent immunocompromised state and transmural translocation of the bacteria due to the close association of gastrointestinal tract and peritoneal cavity. C. difficile infection in peritoneal dialysis patients is problematic from two aspects: (1) because dialysis patients are immunocompromised, the infection can be devastating and (2) infection directly interferes with their renal replacement therapy. In this article, we present a case of peritoneal dialysis (PD)-related peritonitis caused by C. difficile-associated diarrhea and colitis. In this patient, the peritonitis was caused by transmural translocation of the enteric bacteria. While the peritoneal fluid culture did not grow the organism (possibly because of prior empiric broad-spectrum antibiotics use), the positive PCR on stool analysis suggested C. difficile-related peritonitis, along with the rapid clinical improvement induced by C. difficile-directed therapy (metronidazole) and discontinuation of broad-spectrum antibiotics. The patient was successfully treated with metronidazole without PD catheter removal. C. difficile infection is common and frequently internists are the first contact with such patients. This article highlights C. difficile infection in a PD patient and raises awareness of this infection in dialysis patients.
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spelling pubmed-61692372018-10-16 Clostridium difficile Peritonitis: An Emerging Infection in Peritoneal Dialysis Patients Chaughtai, Saira Gandhi, Bhavika Chaughtai, Zeeshan Tarina, Dana Hossain, Mohammad A. Asif, Arif Case Rep Med Case Report Recently, the incidence of Clostridium difficile- (C. difficile-) associated infection has increased significantly in hospital and ambulatory care settings in parallel to the increasing use of inappropriate antibiotics. According to the CDC, approximately 83,000 patients who developed C. difficile experienced at least one recurrence and 29,000 died within 30 days of the initial diagnosis. Patients on dialysis (particularly peritoneal dialysis) are predisposed to this infection due to an inherent immunocompromised state and transmural translocation of the bacteria due to the close association of gastrointestinal tract and peritoneal cavity. C. difficile infection in peritoneal dialysis patients is problematic from two aspects: (1) because dialysis patients are immunocompromised, the infection can be devastating and (2) infection directly interferes with their renal replacement therapy. In this article, we present a case of peritoneal dialysis (PD)-related peritonitis caused by C. difficile-associated diarrhea and colitis. In this patient, the peritonitis was caused by transmural translocation of the enteric bacteria. While the peritoneal fluid culture did not grow the organism (possibly because of prior empiric broad-spectrum antibiotics use), the positive PCR on stool analysis suggested C. difficile-related peritonitis, along with the rapid clinical improvement induced by C. difficile-directed therapy (metronidazole) and discontinuation of broad-spectrum antibiotics. The patient was successfully treated with metronidazole without PD catheter removal. C. difficile infection is common and frequently internists are the first contact with such patients. This article highlights C. difficile infection in a PD patient and raises awareness of this infection in dialysis patients. Hindawi 2018-09-19 /pmc/articles/PMC6169237/ /pubmed/30327675 http://dx.doi.org/10.1155/2018/3537283 Text en Copyright © 2018 Saira Chaughtai et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Chaughtai, Saira
Gandhi, Bhavika
Chaughtai, Zeeshan
Tarina, Dana
Hossain, Mohammad A.
Asif, Arif
Clostridium difficile Peritonitis: An Emerging Infection in Peritoneal Dialysis Patients
title Clostridium difficile Peritonitis: An Emerging Infection in Peritoneal Dialysis Patients
title_full Clostridium difficile Peritonitis: An Emerging Infection in Peritoneal Dialysis Patients
title_fullStr Clostridium difficile Peritonitis: An Emerging Infection in Peritoneal Dialysis Patients
title_full_unstemmed Clostridium difficile Peritonitis: An Emerging Infection in Peritoneal Dialysis Patients
title_short Clostridium difficile Peritonitis: An Emerging Infection in Peritoneal Dialysis Patients
title_sort clostridium difficile peritonitis: an emerging infection in peritoneal dialysis patients
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169237/
https://www.ncbi.nlm.nih.gov/pubmed/30327675
http://dx.doi.org/10.1155/2018/3537283
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