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The laboratory diagnosis of peritonitis during continuous ambulatory peritoneal dialysis
Abstract:
In 24 episodes of continuous ambulatory peritoneal dialysis associated peritonitis occurring in 21 patients, all dialysis fluids were cloudy and contained at least 100 cells mm-3, mostly polymorphs. Gram-positive cocci were seen in centrifuge deposits from only nine of the fluids, but enrichment of 5 ml in liquoid and glucose broth yielded bacteria for all episodes, namely Staphylococcus epidermidis (seven episodes), Staph. aureus (six), Streptococcus mitior (one), Moraxella spp (four), Acinetobacter spp (three), Enterobacteria (two) and Pseudomonas testosteroni (one). Comparison of washed with unwashed centrifuge deposits gave positive cultures in 11 and 10 fluids respectively; pre-treatment with triton X increased this yield to 19 and 21 positives, respectively. Storage of specimens for 4-12 h at 4 degrees C did not decrease the 100% positive-culture rate. All isolates were sensitive to either gentamicin or vancomycin. Of the 24 dialysis bags from 24 symptomless CAPD patients, none contained more than 60 cells mm-3 and bacteria were not detected by microscopy, culture of the centrifuge deposits, or by enrichment in liquoid or glucose broths.
Insights
Microbial analysis of continuous ambulatory peritoneal dialysis (CAPD) peritonitis revealed bacteria in all cases, with enrichment cultures improving detection. All identified bacteria were sensitive to gentamicin or vancomycin, suggesting effective treatment options.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Peritonitis is a significant complication of continuous ambulatory peritoneal dialysis (CAPD).
- Early and accurate diagnosis of CAPD-associated peritonitis is crucial for effective management.
- Microbial culture techniques are essential for identifying causative pathogens.
Purpose of the Study:
- To investigate the microbial etiology of CAPD-associated peritonitis.
- To evaluate the effectiveness of different diagnostic methods for bacterial detection in dialysis fluid.
- To determine the antibiotic susceptibility of isolated pathogens.
Main Methods:
- Analysis of dialysis fluid from 24 episodes of CAPD peritonitis.
- Microscopy, direct culture, and enrichment culture of dialysis fluid.
- Evaluation of pre-treatment methods (washing, Triton X) and storage conditions on culture yield.
- Antibiotic susceptibility testing of all bacterial isolates.
Main Results:
- All peritonitis episodes showed cloudy dialysis fluid with elevated cell counts (≥100 cells/mm³).
- Enrichment cultures detected bacteria in all cases, identifying Staphylococcus epidermidis, Staphylococcus aureus, and others.
- Triton X pre-treatment significantly increased positive culture rates.
- All isolates were susceptible to gentamicin or vancomycin.
Conclusions:
- Enrichment culture techniques are vital for diagnosing CAPD-associated peritonitis.
- Common pathogens include Staphylococci, with sensitivity to gentamicin and vancomycin.
- Proactive diagnostic approaches enhance the identification of causative agents in CAPD peritonitis.