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[Peritonitis in continuous ambulatory peritoneal dialysis. Culture of peritoneal dialysate fluid]
1Klinisk mikrobiologisk afdeling, Arhus Kommunehospital.
Abstract:
Conventional aerobic and anaerobic culture of peritoneal dialysate effluent from patients in continuous peritoneal dialysis (CAPD) was compared to culture in a semiautomated blood culture system. During a two-year period 78 of 79 consecutive episodes of peritonitis among 45 Danish CAPD patients were cultured and the etiology of the infection found in 73 (94%). The sensitivity of the blood culture system was 88%, whereas the sensitivity of the conventional culture of the dialysate effluent was 81%. This difference is not significant (McNemar test; 0.5 > p > 0.3). The majority of isolates were Gram-positive bacteria dominated by coagulase-negative staphylococci (38%). In comparison, only 2% of the cultures of peritoneal dialysate effluent taken within the same period from patients without clinical signs of peritonitis were positive. All the Gram-positive aerobic bacteria were sensitive to vancomycin whereas 97% of the Gram-negative aerobic bacteria were sensitive to gentamicin. An initial empiric treatment of peritonitis with a combination of vancomycin and gentamicin is recommended.
Insights
A semiautomated blood culture system showed slightly higher sensitivity than conventional methods for diagnosing peritonitis in continuous peritoneal dialysis (CAPD) patients. This aids in identifying bacterial causes of infection for effective treatment.
Area of Science:
- Nephrology
- Infectious Diseases
- Clinical Microbiology
Context:
- Continuous peritoneal dialysis (CAPD) is a common treatment for end-stage renal disease.
- Peritonitis is a serious complication in CAPD patients, requiring timely diagnosis and treatment.
- Accurate microbiological diagnosis is crucial for effective peritonitis management.
Purpose:
- To compare the diagnostic sensitivity of a semiautomated blood culture system versus conventional culture methods for peritoneal dialysate effluent in CAPD patients with peritonitis.
- To identify the common etiological agents responsible for CAPD peritonitis.
- To guide empirical antibiotic therapy recommendations.
Summary:
- A two-year study cultured 78 peritonitis episodes from 45 CAPD patients.
- The semiautomated blood culture system demonstrated 88% sensitivity, compared to 81% for conventional dialysate effluent culture (not statistically significant).
- Gram-positive bacteria, particularly coagulase-negative staphylococci, were the most frequent isolates (38%).
Impact:
- The study suggests a semiautomated blood culture system is a viable and slightly more sensitive method for diagnosing CAPD peritonitis.
- Identified common pathogens and their antibiotic sensitivities inform empirical treatment strategies.
- Recommends vancomycin and gentamicin as initial empiric therapy for CAPD peritonitis based on isolate sensitivities.