Peritoneal dialysis （PD） is associated with a high risk of infection of the peritoneum, subcutaneous tunnel and catheter exit site. Although quality standards demand an infection rate 〈 0.67 episodes/patient/year o...Peritoneal dialysis （PD） is associated with a high risk of infection of the peritoneum, subcutaneous tunnel and catheter exit site. Although quality standards demand an infection rate 〈 0.67 episodes/patient/year on dialy-sis, the reported overall rate of PD associated infection is 0.24-1.66 episodes/patient/year. It is estimated that for every 0.5-per-year increase in peritonitis rate, the risk of death increases by 4% and 18% of the episodes resulted in removal of the PD catheter and 3.5% re-sulted in death. Improved diagnosis, increased aware-ness of causative agents in addition to other measures will facilitate prompt management of PD associated infection and salvage of PD modality. The aims of this review are to determine the magnitude of the infection problem, identify possible risk factors and provide an update on the diagnosis and management of PD as-sociated infection. Gram-positive cocci such as Staphy-lococcus epidermidis , other coagulase negative staphy-lococcoci, and Staphylococcus aureus （S. aureus ） are the most frequent aetiological agents of PD-associated peritonitis worldwide. Empiric antibiotic therapy must cover both gram-positive and gram-negative organ-isms. However, use of systemic vancomycin and cip-rofoxacin administration for example, is a simple and efficient first-line protocol antibiotic therapy for PD peritonitis - success rate of 77%. However, for fungal PD peritonitis, it is now standard practice to remove PD catheters in addition to antifungal treatment for a minimum of 3 wk and subsequent transfer to hemodi-alysis. To prevent PD associated infections, prophylactic antibiotic administration before catheter placement, adequate patient training, exit-site care, and treatment for S. aureus nasal carriage should be employed. Mupi-rocin treatment can reduce the risk of exit site infection by 46% but it cannot decrease the risk of peritonitis due to all organisms.展开更多
Commensal enterococci with pathogenic potential often facilitate the growth of diverse pathogens,thereby exacerbating infections.However,there are few effective therapeutic strategies to prevent and intervene in enter...Commensal enterococci with pathogenic potential often facilitate the growth of diverse pathogens,thereby exacerbating infections.However,there are few effective therapeutic strategies to prevent and intervene in enterococci-mediated polymicrobial infections.Here,we find that enterococci at high density drive the expansion and pathogenicity of enteric Salmonella enterica serotype Typhimurium(S.Tm).Subsequently,we show that the driving role of enterococci in such infections is counteracted by dietary coumarin glycosides in vivo.Enterococci,which are tolerant of iron-deficient environments,produceβ-glucosidases to hydrolyze coumarin glycosides into bioactive aglycones,inhibiting S.Tm growth and ameliorating the severity of S.Tm-induced symptoms by inducing iron limitation.Overall,we demonstrate that coumarin glycosides as a common diet effectively reverse enterococci-facilitated enteric infections,providing an alternative intervention to combat polymicrobial infections.展开更多
文摘Peritoneal dialysis （PD） is associated with a high risk of infection of the peritoneum, subcutaneous tunnel and catheter exit site. Although quality standards demand an infection rate 〈 0.67 episodes/patient/year on dialy-sis, the reported overall rate of PD associated infection is 0.24-1.66 episodes/patient/year. It is estimated that for every 0.5-per-year increase in peritonitis rate, the risk of death increases by 4% and 18% of the episodes resulted in removal of the PD catheter and 3.5% re-sulted in death. Improved diagnosis, increased aware-ness of causative agents in addition to other measures will facilitate prompt management of PD associated infection and salvage of PD modality. The aims of this review are to determine the magnitude of the infection problem, identify possible risk factors and provide an update on the diagnosis and management of PD as-sociated infection. Gram-positive cocci such as Staphy-lococcus epidermidis , other coagulase negative staphy-lococcoci, and Staphylococcus aureus （S. aureus ） are the most frequent aetiological agents of PD-associated peritonitis worldwide. Empiric antibiotic therapy must cover both gram-positive and gram-negative organ-isms. However, use of systemic vancomycin and cip-rofoxacin administration for example, is a simple and efficient first-line protocol antibiotic therapy for PD peritonitis - success rate of 77%. However, for fungal PD peritonitis, it is now standard practice to remove PD catheters in addition to antifungal treatment for a minimum of 3 wk and subsequent transfer to hemodi-alysis. To prevent PD associated infections, prophylactic antibiotic administration before catheter placement, adequate patient training, exit-site care, and treatment for S. aureus nasal carriage should be employed. Mupi-rocin treatment can reduce the risk of exit site infection by 46% but it cannot decrease the risk of peritonitis due to all organisms.
基金supported by the National Key Research and Development Program of China(2022YFD1801600)National Natural Science Foundation of China(32230106).
文摘Commensal enterococci with pathogenic potential often facilitate the growth of diverse pathogens,thereby exacerbating infections.However,there are few effective therapeutic strategies to prevent and intervene in enterococci-mediated polymicrobial infections.Here,we find that enterococci at high density drive the expansion and pathogenicity of enteric Salmonella enterica serotype Typhimurium(S.Tm).Subsequently,we show that the driving role of enterococci in such infections is counteracted by dietary coumarin glycosides in vivo.Enterococci,which are tolerant of iron-deficient environments,produceβ-glucosidases to hydrolyze coumarin glycosides into bioactive aglycones,inhibiting S.Tm growth and ameliorating the severity of S.Tm-induced symptoms by inducing iron limitation.Overall,we demonstrate that coumarin glycosides as a common diet effectively reverse enterococci-facilitated enteric infections,providing an alternative intervention to combat polymicrobial infections.
