Peritonitis During Continuous Ambulatory Peritoneal Dialysis

Rubin, Jack; Wa, Rogers; Hm, Taylor; Everett, E. Dale; Bf, Prowant; Lv, Fruto; Kd, Nolph

doi:10.7326/0003-4819-92-1-7

Cited by 394 publications

(145 citation statements)

References 11 publications

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“…In one study, uninfected patients showed PMN counts of 0 to 40% (mean, 12% ± 2%) whereas infected patients showed PMN counts of 50 to 100% (mean, 85.5% + 2.2%) (39). Occasionally, the number of eosinophils may increase, as in patients with etiologically unclear "eosinophilic peritonitis" (46) (which resolves spontaneously within days to weeks) or fungal peritonitis (3,55,60,128,133), or in those who have had intraperitoneal administration of antibiotics (116). In mycobacterial peritonitis, lymphocytosis is rarely observed (76,101); most dialysates show a predominance of PMNs (67,79).…”

Section: Cell Count and Turbiditymentioning

confidence: 99%

“…There is unanimity that the sensitivity of the Gram stain (even on centrifuged samples) and the acridine orange stain (139) is low. Because of the low concentration of microorganisms in the dialysate, tinctorial sensitivity compared with that of culture results has been reported to range only between 10 and 50% (36,68,90,115,116). Gram-positive organisms may have a higher chance of being detected on Gram stain than gram-negative ones (82).…”

Section: Microbiological Findingsmentioning

confidence: 99%

“…In a further study, 28 uninfected patients, on 137 separate occasions, had WBC counts ranging from 0 to 191/mm3 (mean, 13 + 2), while 43 infected patients had counts of between 10 and 104/mm3 (mean, 2,311 ± 645) (39). Cell counts are independent of the causative microbiological agent (116).…”

Section: Cell Count and Turbiditymentioning

confidence: 99%

“…In mycobacterial peritonitis, lymphocytosis is rarely observed (76,101); most dialysates show a predominance of PMNs (67,79). Cell counts return to normal within 3 to 5 days after initiation of treatment (116).…”

Section: Cell Count and Turbiditymentioning

confidence: 99%

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Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis

1992

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The process of continuous ambulatory peritoneal dialysis has provided a useful, relatively inexpensive, and safe alternative for patients with end-stage renal disease. Infectious peritonitis, however, has limited a more widespread acceptance of this technique. The definition of peritonitis in this patient population is not universally accepted and does not always include the laboratory support of a positive culture (or Gram stain). In part, the omission of clinical microbiological findings stems from the lack of sensitivity of earlier microbiological efforts. Peritonitis results from decreased host phagocytic efficiency with depressed phagocytosis and bactericidal capacity of peritoneal macrophages. During episodes of peritonitis, fluid movement is reversed, away from the lymphatics and peritoneal membrane and toward the cavity. As a result, bloodstream infections are rare. Most peritonitis episodes are caused by bacteria. Coagulase-negative staphylococci are the most frequently isolated organisms, usually originating from the skin flora, but a wide array of microbial species have been documented as agents of peritonitis. Clinical microbiology laboratories need to be cognizant of the diverse agents so that appropriate primary media can be used. The quantity of dialysate fluid that is prepared for culture is critical and should constitute at least 10 ml. The sensitivity of the cultural approach depends on the volume of dialysate, its pretreatment (lysis or centrifugation), the media used, and the mode of incubation. The low concentration of microorganisms in dialysate fluids accounts for negative Gram stain results. Prevention of infection in continuous ambulatory peritoneal dialysis patients is associated with the socioeconomic status of the patient, advances in equipment (catheter) technology, and, probably least important, the application of prophylactic antimicrobial agents.

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Section: Cell Count and Turbiditymentioning

confidence: 99%

Section: Microbiological Findingsmentioning

confidence: 99%

Section: Cell Count and Turbiditymentioning

confidence: 99%

Section: Cell Count and Turbiditymentioning

confidence: 99%

See 2 more Smart Citations

Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis

1992

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“…Many types of microorganisms may cause PD peritonitis. The most frequent pathogens are Staphylococcus aureus, Gram-positive organisms and S. Epidermidis [4]. A large review of 3366 patients Unauthenticated Download Date | 5/12/18 7:21 AM showed that almost 50% of infections were due to Grampositive organisms and 15% to Gram-negative organisms, 20% were culture negative (sterile peritonitis), only 4% were polymicrobial infections while fungal infection occurred in less than 2% of cases [5].…”

Section: Discussionmentioning

confidence: 99%