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Microbial Profile, Peritoneal Fluid White Blood Cell Count, and Outcome of Peritoneal Dialysis-Related Peritonitis at
Ro Shinta Christina Solin1, July Kumalawati1, Yusra Yusra1
1Department of Clinical Pathology, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia.
Introduction:
Peritonitis caused by peritoneal dialysis (PD) remains a common complication of continuous ambulatory PD (CAPD). The purpose of this study is to determine the microbial profile in CAPD-related peritonitis, the optimal cutoff of white blood cell (WBC) count, and the percentage of polymorphonuclear (PMN) in CAPD fluid in the prediction of CAPD-related peritonitis, together with the outcome of CAPD-related peritonitis at an Indonesian tertiary hospital. This is a retrospective cohort study of CAPD-related peritonitis patients at Indonesian tertiary hospitals from November 2020 to October 2022.
Methods:
Patients with suspected CAPD-related peritonitis who were tested for CAPD fluid culture and WBC count in CAPD fluid were eligible for this study. Patient's diagnosis and outcome obtained from medical records. Differences in clinical outcomes by category of microorganisms were analyzed with Fisher exact test. The Mann-Whitney test and receiver operating characteristic curve were used to determine optimal WBC and PMN cutoff.
Results:
This study included 58 patients and 102 episodes of CAPD-related peritonitis. CAPD-related peritonitis was caused by 29.4% Gram-negative bacteria, 21.5% Gram-positive bacteria, 7.8% fungi, and 6.9% polymicrobial bacteria. CAPD fluid WBC count >79 cells/μL and PMN percentage >50% had a sensitivity of 76.4% and a specificity of 92.9% in predicting CAPD-related peritonitis. There was a significant difference in outcome between Gram-negative and Gram-positive bacterial peritonitis.
Conclusions:
It is critical to understand the microbial profile in CAPD-related peritonitis. Lower WBC count cutoff points in CAPD fluids may improve sensitivity in predicting CAPD-related peritonitis.
Insights
Peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients is often caused by bacteria. A lower white blood cell (WBC) count cutoff may improve early detection of CAPD peritonitis.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Peritonitis is a frequent complication of continuous ambulatory peritoneal dialysis (CAPD).
- Understanding the microbial causes and diagnostic markers is crucial for effective management of CAPD-related peritonitis.
Purpose of the Study:
- To identify the microbial profile of CAPD-related peritonitis.
- To determine optimal white blood cell (WBC) and polymorphonuclear (PMN) count cutoffs in CAPD fluid for predicting peritonitis.
- To analyze the outcomes of CAPD-related peritonitis in an Indonesian tertiary hospital.
Main Methods:
- Retrospective cohort study of 102 episodes of CAPD-related peritonitis in 58 patients.
- Analysis of CAPD fluid for microbial culture and WBC/PMN counts.
- Statistical analysis including Fisher exact test, Mann-Whitney test, and ROC curve analysis.
Main Results:
- The study identified the causative agents: 29.4% Gram-negative bacteria, 21.5% Gram-positive bacteria, 7.8% fungi, and 6.9% polymicrobial infections.
- Optimal diagnostic cutoffs were determined: WBC count >79 cells/μL and PMN percentage >50%, with a sensitivity of 76.4% and specificity of 92.9%.
- Significant differences in outcomes were observed between Gram-negative and Gram-positive bacterial peritonitis.
Conclusions:
- Knowledge of the microbial landscape in CAPD peritonitis is essential for treatment strategies.
- Lowering WBC count thresholds in CAPD fluid could enhance the prediction accuracy for peritonitis.
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