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Peritonitis from automated peritoneal dialysis
Abstract:
Three consecutive patients undergoing automated peritoneal dialysis developed peritonitis with a nonfermenting gram-negative rod. The same organism was recovered from the dialysate produced by the machine and from its tap water supply. This is the first such outbreak in which the causative organism was also recovered from the tap water supply to the machine. The organism persisted in the machine following standard 3% formaldehyde disinfection, but was eradicated by 10% formaldehyde disinfection.
Insights
Automated peritoneal dialysis patients developed peritonitis from a gram-negative rod found in the dialysis machine and its water supply. Higher formaldehyde concentrations eradicated the persistent bacteria.
Area of Science:
- Nephrology
- Infectious Diseases
- Medical Device Contamination
Background:
- Automated peritoneal dialysis (APD) is a crucial treatment for end-stage renal disease.
- Peritonitis is a serious complication of peritoneal dialysis, requiring prompt diagnosis and treatment.
- Identifying the source of infection is vital for preventing recurrent outbreaks.
Observation:
- Three consecutive patients undergoing APD developed peritonitis caused by a nonfermenting gram-negative rod.
- The identical organism was isolated from the APD machine's dialysate and its tap water supply.
- This represents the first reported outbreak where the causative agent was traced to the machine's tap water source.
Findings:
- The nonfermenting gram-negative rod contaminated the APD system via the tap water supply.
- Standard 3% formaldehyde disinfection failed to eradicate the persistent organism from the dialysis machine.
- A higher concentration of 10% formaldehyde was effective in eliminating the bacteria.
Implications:
- Tap water sources for APD machines require rigorous monitoring to prevent infectious outbreaks.
- Standard disinfection protocols for APD machines may need revision to address resistant organisms.
- This highlights the importance of source identification in managing APD-related peritonitis.