RU2449273C1 - Method of predicting development of recurring and repeated dialysis peritonitis of staphylococcal etiology - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method of predicting development of recurring and repeated dialysis peritonitis of staphylococcal etiology, includes determination of causative agent species and its anti-lysozyme activity, pure culture of causative agent, isolated from discharged peritoneal dialysate is identified, its anti-lysozyme activity is determined and if as causative agent determined is staphylococcus with the level of anti-lysozyme activity 1.6 mcg/mlOD, development of recurring or repeated dialysis peritonitis is predicted.

EFFECT: objectivity, reproducibility, possibility to estimate possibility of development of recurring and repeated dialysis peritonitis in due time.

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Description

The invention relates to medicine, to methods for early prediction of the development of recurrent or repeated dialysis peritonitis.

Peritonitis with peritoneal dialysis (PD) is a complication characterized by an inflammatory reaction of the peritoneum to microbial contamination of the abdominal cavity or other irritating factors. Peritonitis is one of the main and serious complications in the treatment of PD. It is the most common cause of a decrease in PD adequacy, removal of a peritoneal catheter, and transfer of patients to hemodialysis.

The total frequency of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) is 1-1.3 episodes per year (Gahrmani N. et al., 1995; Monteon F. et al., 1998). It is traditionally accepted to isolate simple dialysis peritonitis, in which positive clinical and bacteriological dynamics are observed 2-3 days after the start of antibiotic therapy; refractory dialysis peritonitis, characterized by the preservation of signs of inflammation for 5 days of adequate antibacterial therapy; recurrent dialysis peritonitis (there is an episode of peritonitis that occurred within 4 weeks from discontinuation of therapy for a previous episode of dialysis peritonitis, but caused by another microorganism); recurrent dialysis peritonitis (occurring within 4 weeks of discontinuing therapy for a previous episode of dialysis peritonitis caused by the same microorganism) and repeated dialysis peritonitis, which develops more than 4 weeks after cessation of therapy for the previous episode of dialysis peritonitis, caused by the same microorganism (Gurevich K.Ya. et al., 2003; Choi P., et al., 2004).

In the treatment of patients with end-stage chronic renal failure on peritoneal dialysis, the development of recurrent, recurrent, and repeated peritonitis is of particular difficulty. If the cause of recurrent, rarely recorded peritonitis is, as a rule, non-compliance with the sanitary-epidemiological regimen (which is extremely rare in practice), then the leading factors in the development of recurrent and repeated dialysis peritonitis include nasopharyngeal bacterial carriage, intestinal dysbiosis, and other variants of persistence microorganisms, including the intracellular persistence of bacteria, is quite difficult for both diagnosis and effective eradication (Ko priva-Altfahrt G. et al., 2005). In this regard, it is important to timely predict the possibility of developing recurrent and re-dialysis peritonitis. This will allow a timely and targeted implementation of a set of measures to prevent adverse complications and, therefore, improve the quality of patient care and reduce the material costs of their treatment.

To date, methods are known for predicting the likelihood of developing dialysis peritonitis based on taking into account indicators characterizing the patient's condition: nutritional status of patients, hypoalbuminemia, and diabetes mellitus (Tomilina N.A. et al., 2003; Chernysheva N.N. et al., 2007; Shutov E.V., Chernysheva N.N., 2007). However, these methods do not take into account the important etiological component of the pathology under consideration - the microbial factor and, in particular, the biological properties of microorganisms that allow long-term existence in adverse conditions. Also, these methods do not allow to predict the likelihood of repeated episodes of dialysis peritonitis, namely recurrent and repeated, which are a common reason for refusing further use of PD and transferring patients to hemodialysis.

The novelty of the proposed method is that the authors predict the nature of the development of subsequent episodes of dialysis peritonitis by type and antilysocyme activity of the pathogen that caused the first episode of dialysis peritonitis.

A significant difference of the proposed method is that during the development of the first episode of peritonitis, a pure culture of the pathogen isolated from the fused peritoneal dialysate is identified and its antilysocyme activity is determined, and when staphylococcus is detected as the causative agent with an antilysocyme activity level> 1.6 μg / ml, the development of recurrent or repeated dialysis peritonitis.

The studies were conducted in 80 patients with end-stage chronic renal failure who were on constant outpatient peritoneal dialysis, in whom the first episode of dialysis peritonitis was recorded, for which standard antibacterial therapy was carried out (K. Gurevich et al., 2003). Subsequently, in 14 patients the development of recurrent peritonitis and in 16 - repeated dialysis peritonitis was observed. A bacteriological study of confluent peritoneal dialysate was carried out according to generally accepted methods with determination of the level of bacterial contamination, the species composition of pathogens and their biological properties: plasmocoagulase, fibrinolytic, hemolytic activities according to generally accepted methods, sensitivity to antibiotics (Skala L.Z. et al., 2004), anti activity (Bukharin O.V. et al., 1999) and anti-complementary activity (Brudastov Yu.A., 1992). In all cases, causative agents of peritonitis were representatives of the genus Staphylococcus (S. aureus, S. epidermidis, S. haemolyticus, S. hominis, S. warnerii).

In order to establish the information content of a number of properties of bacterial pathogens in predicting the likelihood of developing recurrent or repeated dialysis dialytic peritonitis, we studied the correlation dependence (S. Glants, 1998) between the frequency of development of these peritonitis and a number of bacteriological indicators (Table 1).

The presence of a pronounced direct correlation dependence of the frequency of development of repeated and recurring dialysis peritonitis with the value of the antilysocyme activity of pathogens made it possible to use this indicator as a criterion for predicting these peritonitis.

Table 1. Correlation of some bacteriological parameters with the frequency of development of repeated and recurring dialysis peritonitis. Bacteriological criteria Spearman's rank correlation coefficient Bacterial contamination 0.42 * Antilysocyme activity of pathogens 0.71 ** Antibiotic resistance marker 0.42 * Anti-complementary activity 0.39 * Plasma-coagulase activity 0.35 * Fibrinolytic activity 0.44 * Hemolytic activity 0.51 * ** - strong correlation * - correlation medium strength

The results shown in table 2 indicate a high level of antilysocyme activity of staphylococci, pathogens of the first episode of dialysis peritonitis (simple), which (staphylococci) were subsequently causative agents of recurrent or repeated peritonitis.

table 2 Comparative analysis of the antilysocyme activity of staphylococci isolated in patients with various forms of dialysis peritonitis (indicated the number of strains in the corresponding ranges of ALA values, absolute amount /%) Ranges of antilysocyme activity of staphylococci (μg / ml OD) Type of dialysis peritonitis 0.81-1.0 1.01-1.2 1.21-1.4 1.41-1.6 1.61-1.8 1.81-1.9 1.91-2.0 2.01-2.2 Simple, n = 50 37/74% 5/12% 5/10% 1/2% 1/2% 1/2% Recurrent, n = 14 1 / 7.2% 5 / 35.7% 5 / 35.7% 3 / 21.4% Repeated, n = 16 1 / 6.25% 7 / 43.75% 6 / 37.5% 2 / 12.5% Prognostic indicator threshold 1,0 1,2 1.4 1,6 1.8 1.9 2.0 Error predicting recurrent or repeated peritonitis 16.25% 11.25% 6.25% 5% 11.5% 22.5% 33.75%

In general, the established differences determine the possibility of obtaining the correct prediction result for the development of recurrent or repeated dialysis peritonitis with a 5% error probability if staphylococcus is found in drain dialysis fluid with an ALA level above 1.6 μg / ml OD. Changing the prognostic threshold of an indicator above or below a specified value is impractical due to an increase in forecasting errors (table 2). Timely prediction of the likelihood of developing recurrent or repeated dialysis peritonitis in patients with end-stage chronic renal failure makes it possible to optimize antibacterial therapy and further patient management tactics in a timely manner, and to improve patient treatment results.

The method is as follows.

1. A pure culture of the pathogen is isolated from the peritoneal dialysate, and its identification is initiated.

2. In the case of isolation of staphylococcus from the studied material from an isolated pure culture of a microorganism, antilysocyme activity by a known method.

3. If the level of severity of antilysocyme activity is more than 1.6 μg / ml of OD, the development of recurrent or repeated dialysis peritonitis is predicted; and with an ALA level of 1.6 μg / ml OD and lower, a favorable course of simple dialysis peritonitis is predicted.

Case Studies

Example 1: Patient R., 47 years old, has been on peritoneal dialysis since 2005 for chronic renal failure. In January 2008, the patient developed the first episode of dialysis peritonitis. During bacteriological examination of the fused peritoneal dialysate using a standard set of bacteriological media and biochemical tests, the pathogen S. epidermidis was identified, its level of antilysocyme activity was 1.8 μg / mlOD. Evaluation of the obtained data: staphylococcus with an ALA level> 1.6 μg / mlOD was isolated, which allowed us to predict the development of recurrent or repeated dialysis peritonitis according to the formula of the proposed method.

The further course of the disease confirmed the correctness of the prognostic conclusion made using the proposed method. Within a month, the patient developed a relapse of dialysis peritonitis, which required the use of additional therapeutic measures (Gurevich K.Ya. et al., 2003).

Example 2. Patient M., 35 years old, has been on peritoneal dialysis since 2005 due to chronic renal failure. In January 2007, the patient developed the first episode of dialysis peritonitis. In a bacteriological study of fused peritoneal dialysate using a standard set of bacteriological media and biochemical tests, the pathogen S. aureus was identified with an ALA level of 2.1 μg / ml OD. Evaluation of the data: staphylococcus with an ALA level> 1.6 μg / ml OD was isolated, according to the formula of the proposed method, it was possible to predict the development of recurrent or repeated dialysis peritonitis. The further course of the disease confirmed the correctness of the prognostic conclusion made using the proposed method. Two months later, the patient developed a repeated case of dialysis peritonitis, which required the use of additional therapeutic measures (K. Gurevich et al., 2003).

This method of predicting the nature of the course of dialysis peritonitis is modern, objective, easily reproducible. When a patient with the first episode of dialysis peritonitis enters, it is possible to timely and correctly assess the likelihood of developing recurrent or repeated dialysis peritonitis and to correct the further management of the patient, improve the quality of treatment and improve its results.

Literature

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Claims (1)

A method for predicting the development of recurrent and re-dialysis peritonitis of staphylococcal etiology, including determining the type of pathogen and its antilysocyme activity, characterized in that a pure culture of the pathogen isolated from the fused peritoneal dialysate is identified and its antilysocyme activity is determined and when the level of staphylococcus is detected as the pathogen activities> 1.6 μg / mlOD predict the development of recurrent or re-dialysis peritonitis.