United Kingdom Survey of Culture-Negative Peritonitis and Dialysate Sampling Practice

Odudu, Aghogho; Turner, Jake; Coomer, Kirstine; Salmon, Laura; Yazdani, Farah; Leung, Janson C. H.

doi:10.3747/pdi.2014.00268

Cited by 11 publications

(6 citation statements)

References 7 publications

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“…Culture-negative peritonitis, as the name implies, is a case with clinical findings of peritonitis: abdominal pain, elevated peritoneal fluid WBCs, and peritoneal fluid cultures not growing a pathogen. Potential causes of culture-negative cases are antibiotic administration prior to peritoneal fluid cultures, suboptimal handling or processing of cultures or culture techniques, [59][60][61] or the presence of fastidious organisms, AFB, or filamentous fungi. Guidelines recommend a benchmark of less than 20% culture-negative cases.…”

Section: Culture-negative Peritonitismentioning

confidence: 99%

Peritoneal dialysis-related peritonitis: challenges and solutions

Salzer

2018

IJNRD

110

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Peritoneal dialysis is an effective treatment modality for patients with end-stage renal disease. The relative use of peritoneal dialysis versus hemodialysis varies widely by country. Data from a 2004 survey reports the percentage of patients with end-stage renal disease treated with peritoneal dialysis to be 5%–10% in economically developed regions like the US and Western Europe to as much as 75% in Mexico. This disparity is probably related to the availability and access to hemodialysis, or in some cases patient preference for peritoneal over hemodialysis. Peritoneal dialysis-related peritonitis remains the major complication and primary challenge to the long-term success of peritoneal dialysis. Fifty years ago, with the advent of the Tenckhoff catheter, patients averaged six episodes of peritonitis per year on peritoneal dialysis. In 2016, the International Society for Peritoneal Dialysis proposed a benchmark of 0.5 episodes of peritonitis per year or one episode every 2 years. Despite the marked reduction in peritonitis over time, peritonitis for the individual patient is problematic. The mortality for an episode of peritonitis is 5% and is a cofactor for mortality in another 16% of affected patients. Prevention of peritonitis and prompt and appropriate management of peritonitis is essential for the long-term success of peritoneal dialysis in all patients. In this review, challenges and solutions are addressed regarding the pathogenesis, clinical features, diagnosis, treatment, and prevention of peritoneal dialysis-related peritonitis from the viewpoint of an infectious disease physician.

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Section: Culture-negative Peritonitismentioning

confidence: 99%

Peritoneal dialysis-related peritonitis: challenges and solutions

Salzer

2018

IJNRD

110

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“…Szeto et al 2 demonstrated that higher CNP rates were associated with sampling by a nonspecialist nurse and previous antibiotic exposure. In contrast, a UK survey 19 found no correlation between center-reported CNP rates and PDE processing technique, sampling volume, or center characteristics. In our study, CNP was associated with facilities that deviated from ISPD guideline recommendations concerning PDE preparation, collection, and handling, had limited facility resources (smaller hospital with no nephrologist on site), and had low facility experience (<100 PD cases).…”

Section: Discussionmentioning

confidence: 77%

Association of Local Unit Sampling and Microbiology Laboratory Culture Practices With the Ability to Identify Causative Pathogens in Peritoneal Dialysis-Associated Peritonitis in Thailand

Kanjanabuch

Chatsuwan

Udomsantisuk

et al. 2021

Kidney International Reports

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Introduction This describes variations in facility peritoneal dialysis (PD) effluent (PDE) culture techniques and local microbiology laboratory practices, competencies, and quality assurance associated with peritonitis, with a specific emphasis on factors associated with culture-negative peritonitis (CNP). Methods Peritonitis data were prospectively collected from 22 Thai PD centers between May 2016 and October 2017 as part of the Peritoneal Dialysis Outcomes and Practice Patterns Study. The first cloudy PD bags from PD participants with suspected peritonitis were sent to local and central laboratories for comparison of pathogen identification. The associations between these characteristics and CNP were evaluated. Results CNP was significantly more frequent in local laboratories (38%) compared with paired PDE samples sent to the central laboratory (12%, P < 0.05). Marked variations were observed in PD center practices, particularly with respect to specimen collection and processing, which often deviated from International Society for Peritoneal Dialysis Guideline recommendations, and laboratory capacities, capabilities, and certification. Lower rates of CNP were associated with PD nurse specimen collection, centrifugation of PDE, immediate transfer of samples to the laboratory, larger hospital size, larger PD unit size, availability of an on-site nephrologist, higher laboratory capacity, and laboratory ability to perform aerobic cultures, undertake standard operating procedures in antimicrobial susceptibilities, and obtain local accreditation. Conclusion There were large variations in PD center and laboratory capacities, capabilities, and practices, which in turn were associated with the likelihood of culturing and correctly identifying organisms responsible for causing PD-associated peritonitis. Deviations in practice from International Society for Peritoneal Dialysis guideline recommendations were associated with higher CNP rates.

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“…Other pediatric studies report a range of culturenegative peritonitis rates from 11% to 67% (6-9). Among programs that care for adults on long-term PD, culturenegative rates range from 12% to 56%, with an average rate of 14%-16% among US centers (10)(11)(12)(13)(14)(15).…”

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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United Kingdom Survey of Culture-Negative Peritonitis and Dialysate Sampling Practice

Cited by 11 publications

References 7 publications

Peritoneal dialysis-related peritonitis: challenges and solutions

Peritoneal dialysis-related peritonitis: challenges and solutions

Association of Local Unit Sampling and Microbiology Laboratory Culture Practices With the Ability to Identify Causative Pathogens in Peritoneal Dialysis-Associated Peritonitis in Thailand

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

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