Usefulness of the endotoxin test for assessing CAPD peritonitis by gram-negative organisms

The endotoxin (ET) in cloudy peritoneal fluid was measured, and the usefulness of the method was examined. Thirteen continuous ambulatory peritoneal dialysis (CAPD) patients with an episode of peritonitis from December, 1993 to December, 1995 were studied. The peritoneal fluid was collected without contamination from the bags and divided into two batches. The ET was measured in one of them with the limulus amebocyte lysate (LAL) assay, and the other was cultured for bacteria. Among the 13 patients ET was positive in 7 Gram-negative bacteria were identified in all 7 cases. Two of these patients were transferred to hemodialysis. On the other hand, gram-positive bacteria were cultured in only four episodes of the 6 ET-negative patients, all of which were treated successfully with vancomycin. Microbiological culture of the dialysate is still necessary for the treatment of peritonitis. But it takes 24-48 hours to obtain microbiological results. The result of the ET test can be given within one and one half hours (and it has 100% sensitivity and specificity for gram-negative peritonitis) at presentation in the episodes. Therefore, the ET test of the dialysate is very effective for the therapy of peritonitis in CAPD.