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Published on: February 10, 2011
A comparison of four culture methods for diagnosing infection in continuous ambulatory peritoneal dialysis
H Ludlam1, A Dickens, A Simpson
1Department of Medical Microbiology, St Bartholemew's Hospital, London.
Abstract:
Dialysate effluent from 41 patients presenting with 54 episodes of CAPD peritonitis was examined by four culture techniques, three employing methods for the lysis of peritoneal leucocytes. The most efficient method employed a distilled water lysis-centrifugation technique (81% of episodes culture-positive). Filtration (without leucocyte lysis) was less effective (74% culture-positive). The results of a mechanical leucocyte lysis technique were less satisfactory still, the culture positive rate of 74% being compromised by the recovery of the infecting organism in low numbers, and by an association with a high incidence of plate contamination. The results of a bile-salt lysis technique were the least satisfactory (67% culture-positive).
Insights
The distilled water lysis-centrifugation technique is the most effective method for culturing peritoneal dialysis fluid, achieving an 81% positive rate for diagnosing peritonitis. Other lysis methods showed lower efficacy in detecting infections.
Area of Science:
- Nephrology
- Clinical Microbiology
Background:
- Peritonitis is a serious complication of continuous ambulatory peritoneal dialysis (CAPD).
- Accurate and timely diagnosis of CAPD peritonitis is crucial for effective treatment.
- Culture techniques for identifying causative organisms in peritoneal dialysis effluent are essential.
Purpose of the Study:
- To compare the efficiency of four different culture techniques for diagnosing CAPD peritonitis.
- To evaluate methods involving leukocyte lysis versus simple filtration.
Main Methods:
- Examined dialysate effluent from 54 episodes of CAPD peritonitis in 41 patients.
- Utilized four culture techniques: distilled water lysis-centrifugation, filtration, mechanical leukocyte lysis, and bile-salt lysis.
Main Results:
- Distilled water lysis-centrifugation yielded the highest culture-positive rate (81%).
- Filtration and mechanical leukocyte lysis showed lower positive rates (74%), with mechanical lysis also associated with low organism recovery and high contamination.
- Bile-salt lysis was the least effective, with a 67% culture-positive rate.
Conclusions:
- Distilled water lysis-centrifugation is the superior method for culturing CAPD peritonitis effluent.
- Leukocyte lysis techniques, particularly with distilled water, enhance the detection of causative organisms compared to simple filtration.
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