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Effluent microscopy is a useful adjuvant diagnostic tool in peritoneal dialysis-associated peritonitis
Background:
Infectious complications are the leading cause of technical failure in peritoneal dialysis (PD); however, targeted anti-infective therapy is not feasible at the onset, as effluent cultures take days and may be inconclusive. Although recommended by the guidelines, divergent positivity rates of Gram-stained effluent microscopy question the value of its usefulness. This study aimed to evaluate if microscopy of cell types serves as an additional and timely diagnostic approach.
Materials And Methods:
This single-center retrospective analysis included prevalent PD patients (n = 250) between 2007 and 2017. Automated quantitative cell count, cytological analysis of Hemacolor and Gram-stained effluent sediment, and effluent cultures were conducted during peritonitis episodes. We calculated the rate of peritonitis, positivity rate of effluent cultures, and effluent microscopy.
Results:
There were 155 at-risk cases of peritonitis in 662.7 years during the observation period. The culture positivity rate was 73.5%. In neutrophilic culture-negative peritonitis (CNP), effluent Gram staining yielded the identification of the microbial species in 51.6% cases. In 24.4% of CNP, effluent microscopy showed eosinophilic peritonitis, which occurred with less initial effluent leucocytes and showed better PD survival.
Conclusion:
In PD-associated peritonitis, Gram-stained dialysate with effluent microscopy supplements culture results in CNP. Hemacolor staining is crucial for differentiating eosinophilic peritonitis, showing a divergent clinical course and outcome.
Insights
Microscopy of peritoneal dialysis effluent aids in diagnosing peritonitis, especially in culture-negative cases. Gram staining and Hemacolor staining identify microbes and eosinophilic peritonitis, improving patient outcomes.
Area of Science:
- Nephrology
- Clinical Microbiology
Background:
- Infectious complications are a primary cause of technical failure in peritoneal dialysis (PD).
- Early diagnosis of PD-associated peritonitis is challenging due to slow and often inconclusive effluent cultures.
- The utility of Gram-stained effluent microscopy is debated due to variable positivity rates.
Purpose of the Study:
- To evaluate the diagnostic value of cell type microscopy in PD-associated peritonitis.
- To determine if effluent microscopy provides a timely diagnostic approach complementing standard cultures.
- To assess the clinical significance of eosinophilic peritonitis identified through microscopy.
Main Methods:
- Retrospective analysis of 250 prevalent PD patients from 2007-2017.
- Automated cell counts, Gram staining, and Hemacolor staining of effluent sediment during peritonitis.
- Comparison of microscopy findings with effluent culture results.
Main Results:
- A total of 155 peritonitis episodes were analyzed.
- Effluent cultures were positive in 73.5% of cases.
- Gram staining identified microbial species in 51.6% of neutrophilic culture-negative peritonitis (CNP) cases.
- Eosinophilic peritonitis was identified in 24.4% of CNP cases, associated with lower initial leukocyte counts and better PD survival.
Conclusions:
- Gram-stained effluent microscopy is a valuable adjunct to cultures for diagnosing CNP in PD-associated peritonitis.
- Hemacolor staining is essential for identifying eosinophilic peritonitis, which has a distinct clinical course and prognosis.
- Microscopy of cell types offers a timely diagnostic approach to PD peritonitis.
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