A peritoneal dialysis patient with fatal culture‐negative peritonitis

Johnson, David W.; Gray, Nicholas A; Snelling, Paul

doi:10.1046/j.1440-1797.2003.00119.x

Cited by 11 publications

(6 citation statements)

References 43 publications

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“…While it is not required for the diagnosis, the key to management lies in the identification of the organism. In up to 22% of cases, PD fluid cultures prove to be negative and thus the patient with culture-negative cloudy dialysate becomes a diagnostic and management dilemma (2)(3)(4)(5). These patients are referred to as having aseptic, culturenegative, or sterile peritonitis.…”

mentioning

confidence: 99%

Sterile Peritonitis in the Peritoneal Dialysis Patient

Freitas

Gokal

2005

Perit Dial Int

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Peritonitis is a serious and common problem in the peritoneal dialysis (PD) population. Abdominal pain, fever, and cloudy PD fluid usually heralds the onset of infective peritonitis. However, in up to 20% of cases, no organism is identified. In these situations, diagnosis can be made only by excluding a microbiological cause and performing a cytological examination of the PD fluid to determine the cellular or noncellular constituents. This review examines the differential diagnosis of sterile peritonitis and uses cytological examination to facilitate the appropriate diagnosis.

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mentioning

confidence: 99%

Sterile Peritonitis in the Peritoneal Dialysis Patient

Freitas

Gokal

2005

Perit Dial Int

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“…We believe that within our cohort, culture-negative peritonitis was unlikely due to noninfectious causes or difficult to culture organisms, such as Mycobacterium or fungus (24). A recent study of the collaborative showed a comparatively high rate (8% of infections) of fungal peritonitis (28).…”

Section: Discussionmentioning

confidence: 77%

“…Only two thirds (22) of the centers reported a goal of processing the PD effluent within 6 hours, and only 67% of the centers instruct families to refrigerate the fluid if there will be a delay in transporting the sample. A delay in time to culture is a known risk factor for culture-negative peritonitis, related to bacterial death and phagocytosis of the bacteria by neutrophils (24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

Variability in Culture-Negative Peritonitis Rates in Pediatric Peritoneal Dialysis Programs in the United States

Davis

Bryant

Rodean

et al. 2021

CJASN

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Background and objectivesInternational guidelines suggest a target culture-negative peritonitis rate of <15% among patients receiving long-term peritoneal dialysis. Through a pediatric multicenter dialysis collaborative, we identified variable rates of culture-negative peritonitis among participating centers. We sought to evaluate whether specific practices are associated with the variability in culture-negative rates between low– and high–culture-negative rate centers.Design, setting, participants, & measurementsThirty-two pediatric dialysis centers within the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) collaborative contributed prospective peritonitis data between October 1, 2011 and March 30, 2017. Clinical practice and patient characteristics were compared between centers with a ≤20% rate of culture-negative peritonitis (low-rate centers) and centers with a rate >20% (high-rate centers). In addition, centers completed a survey focused on center-specific peritoneal dialysis effluent culture techniques.ResultsDuring the 5.5 years of observation, 1113 patients had 1301 catheters placed, totaling 19,025 patient months. There were 620 episodes of peritonitis in 378 patients with 411 catheters; cultures were negative in 165 (27%) peritonitis episodes from 125 (33%) patients and 128 (31%) catheters. Low-rate centers more frequently placed catheters with a downward-facing exit site and two cuffs (P<0.001), whereas high-rate centers had more patients perform dialysis themselves without the assistance of an adult care provider (P<0.001). The survey demonstrated that peritoneal dialysis effluent culture techniques were highly variable across centers. No consistent practice or technique helped to differentiate low- and high-rate centers.ConclusionsCulture-negative peritonitis is a frequent complication of maintenance peritoneal dialysis in children. Despite published recommendations for dialysis effluent collection and culture methods, great variability in culture techniques and procedures exists among individual dialysis programs and respective laboratory processes.

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“…Therefore, culturenegative peritonitis poses a significant diagnostic and therapeutic dilemma. 3,9,10 We report a case that was initially treated as a CAPD-related peritonitis with a turbid dialysate and minimal symptoms, but was finally diagnosed as appendicitis with perforation.…”

Section: Introductionmentioning

confidence: 99%

Evolving appendicitis presenting as culture-negative peritonitis with minimal symptoms in a patient on continuous ambulatory peritoneal dialysis

et al. 2010

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Culture-negative peritonitis, which results from a variety of etiologies, such as problems in culture techniques, prior use of antibiotics, infection caused by unusual organisms, and noninfectious causes, accounts for up to 20% of cases of peritonitis in peritoneal dialysis patients and sometimes poses diagnostic and therapeutic dilemmas. A 62-year-old woman on continuous ambulatory peritoneal dialysis (CAPD) presented with minimal abdominal pain and a turbid dialysate. Under the impression of infectious peritonitis, empirical intraperitoneal (IP) antibiotic treatment was administered. All cultures from the effluent were negative, although the white blood cell count in the effluent was elevated. Despite initial clinical improvement and resolution of abdominal pain, mild fever persisted, even after removal of the CAPD catheter. The first CT scan before removal of the catheter demonstrated no evidence of intra-abdominal pathology, except for the possibility of peritonitis, but a follow-up CT scan after removal of the catheter demonstrated a perforated appendix with a peri-appendiceal abscess. The patient recovered completely after removal of the appendix and the abscess. This case suggests that a follow-up CT scan and/or surgical exploration should be considered to identify the intra-abdominal pathology in patients with culture-negative refractory peritonitis, even after removal of CAPD catheter.

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A peritoneal dialysis patient with fatal culture‐negative peritonitis

Cited by 11 publications

References 43 publications

Sterile Peritonitis in the Peritoneal Dialysis Patient

Sterile Peritonitis in the Peritoneal Dialysis Patient

Variability in Culture-Negative Peritonitis Rates in Pediatric Peritoneal Dialysis Programs in the United States

Evolving appendicitis presenting as culture-negative peritonitis with minimal symptoms in a patient on continuous ambulatory peritoneal dialysis

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