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Laboratory diagnosis of peritonitis in patients on continuous ambulatory peritoneal dialysis
H A Ludlam1, T N Price, A J Berry
1Department of Microbiology, St. Thomas' Hospital, London, England.
Abstract:
The clinical course and laboratory diagnosis of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis was studied in 32 consecutive episodes. Peritonitis was associated with a failure in aseptic technique in eight episodes and with an exit-site infection in four episodes. Intraperitoneal vancomycin and ceftazidime were safe, effective, and convenient. Most patients administered their antibiotics at home, and symptoms usually resolved by day 4. Culture of the deposit obtained by centrifugation of 50 ml of effluent after leukocyte lysis provided the best rate of recovery (84% culture positive) but was technically demanding. Filtration of the same volume without leukocyte lysis was simple to perform and almost as effective. Enrichment was less satisfactory (65% culture positive) owing to the presence of antibiotic or infection with fastidious microorganisms. Culture of 50 ml of effluent after concentration by a commonly used laboratory technique, centrifugation without leukocyte lysis, performed poorly (59% culture positive at 48 h), as this method caused sequestration and death of microorganisms within the leukocytes. Culture of nearly 1 liter of effluent from 33 asymptomatic patients by the same techniques yielded no microorganisms.
Insights
Continuous ambulatory peritoneal dialysis (CAPD) peritonitis is effectively treated with intraperitoneal vancomycin and ceftazidime. Diagnosis is best achieved by culturing effluent deposit after leukocyte lysis, though filtration is a simpler alternative.
Area of Science:
- Nephrology
- Infectious Diseases
- Clinical Microbiology
Background:
- Peritonitis is a serious complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Understanding the clinical course and optimizing laboratory diagnosis are crucial for effective management.
Purpose of the Study:
- To evaluate the clinical course of peritonitis in CAPD patients.
- To compare different laboratory methods for diagnosing peritonitis.
- To assess the efficacy and safety of intraperitoneal vancomycin and ceftazidime.
Main Methods:
- Study of 32 consecutive episodes of peritonitis in CAPD patients.
- Evaluation of treatment with intraperitoneal vancomycin and ceftazidime.
- Comparison of diagnostic techniques: centrifugation with/without leukocyte lysis, filtration, and enrichment.
- Analysis of effluent samples from asymptomatic patients.
Main Results:
- Peritonitis was linked to aseptic technique failures (8 episodes) and exit-site infections (4 episodes).
- Intraperitoneal vancomycin and ceftazidime demonstrated safety and efficacy, with home administration and rapid symptom resolution (by day 4).
- Centrifugation with leukocyte lysis yielded the highest recovery rate (84%), while filtration was nearly as effective and simpler.
- Enrichment (65%) and standard centrifugation without lysis (59%) were less satisfactory.
Conclusions:
- Intraperitoneal vancomycin and ceftazidime are effective and convenient treatments for CAPD peritonitis.
- Optimized laboratory diagnosis, particularly centrifugation with leukocyte lysis or filtration, improves microbial recovery.
- Standard laboratory methods without lysis may underestimate the incidence of peritonitis due to microorganism sequestration.