Quality Improvement in Culture Negative Peritoneal Dialysis Related Peritonitis: 5 Years Review.
Article Sidebar
Main Article Content
Abstract
Background: Culture negative peritonitis is the common in peritoneal dialysis patients which affect treatment decision and reflect quality control in peritoneal dialysis (PD) patients. In our center, the rate of culture negative peritonitis still increased in recent years. The aim of our study is to decrease rate of culture negative peritonitis in our PD patients by improved method of specimen collection and set up clinical policy follow ISPD guideline for effluent culture technique.
Methods: The research and development in our PD patients from October 2013 to September 2018.The diagnosis of PD-related peritonitis was based on standard criteria that is, the presence of 2 or 3 of these, signs of peritoneal inflammation; positive gram stain or culture of PD effluent (or both); an effluent cell count with white blood cells exceeding 100/mm3 with at least 50% polymorphonuclear neutrophilic cells after a dwell time of at least 2 hours and positive gram stain or culture of PD effluent (or both). Data was reviewed annually for PD fluid culture results, rate of culture negative peritonitis, outcome and complication before and after clinical policy adjustment for comparison.
Results: We identified 465 peritonitis episodes during 5 years. Of the 250 PD patients, 46% were male and 54% were female. The most common gram positive bacteria were Staphylococcus epidermidis and staphylococcus aureus; and the most common gram negative bacteria were Escherichia coli and Klebsiella pnumoniae respectively. The results showed significant decline of culture negative peritonitis from 58.1 % to22.2%; treatment failure from16.4 % to 12.5%; and mortality rate decreased from 15.4 % to 9.8 % after we improved the technique during effluent culture and established clinical policy in our center.
Conclusion: Effluent culture technique along ISPD guidelines lead to a decline in culture-negative peritonitis, treatment failure and mortality in peritoneal dialysis patients.
Keywords: Culture negative peritoneal dialysis related peritonitis, culture negative peritonitis
Article Details
References
2. Li PK, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE, et al. ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment. Perit Dial Int 2016;36(5):481-508.
3. Oreopoulos DG, Tzamaloukas AH. Peritoneal dialysis in the next millennium. Adv Ren Replace Ther 2000;7(4):338-46.
4. Szeto CC, Wong TY, Leung CB, Wang AY, Law MC, Lui SF, Li PK. Importance of dialysis adequacy in mortality and morbidity of chinese CAPD patients. Kidney Int 2000;58(1):400-7.
5. Szeto CC, Chow KM, Wong TY, Leung CB, Wang AY, Lui SF, Li PK. Feasibility of resuming peritoneal dialysis after severe peritonitis and Tenckhoff catheter removal. J Am Soc Nephrol 2002;13(4):1040-5.
6. Fahim M, Hawley CM, McDonald SP, Brown FG, Rosman JB, Wiggins KJ, et al. Culture-negative peritonitis in peritoneal dialysis patients in Australia: predictors, treatment, and outcomes in 435 cases. Am J Kidney Dis 2010;55(4):690-7.
7. Szeto CC, Wong TY, Chow KM, Leung CB, Li PK. The clinical course of culture-negative peritonitis complicating peritoneal dialysis. Am J Kidney Dis 2003;42(3):567-74.
8. Sewell DL, Golper TA, Hulman PB, Thomas CM, West LM, Kubey WY, et al. Comparison of large volume culture to other methods for isolation of microorganisms from dialysate. Perit Dial Int. 1990;10(1):49-52.
9. Yoon SH, Choi NW, Yun SR. Detecting bacterial growth in continuous ambulatory peritoneal dialysis effluent using two culture methods. Korean J Intern Med 2010;25(1):82-5.
10. Holley JL, Moss AH. A prospective evaluation of blood culture versus standard plate techniques for diagnosing peritonitis in continuous ambulatory peritoneal dialysis. Am J Kidney Dis 1989;13(3):184-8.