Continuous Ambulatory Peritoneal Dialysis Peritonitis: Microbiology and Outcomes

• Published in: Indian journal of medical microbiology Vol. 38; no. 1; p. 72
• Main Authors: Pindi, Girisha, Kawle, Vijendra, Sunkara, Rajeshwar Rao, Darbha, Murty Satyanarayana, Garikaparthi, Sasikala
• Format: Journal Article
• Language: English
• Published: United States 01.01.2020
• Subjects: peritoneal dialysis infections; Automated blood culture; peritonitis; continuous ambulatory peritoneal dialysis; peritoneal dialysis peritonitis outcome; peritoneal dialysis
• ISSN: 1998-3646

Continuous ambulatory peritoneal dialysis (CAPD) is now a preferred mode of the treatment in patients with end-stage renal disease, but peritonitis remains to be a shortcoming of CAPD. High-culture negativity, emerging drug resistance and peritoneal dialysis (PD)-related morbidity and mortality have been a challenge to tackle. The present study was taken up to compare the the various culture methods and to identify the spectrum of organisms causing CAPD peritonitis and their outcome. A prospective, observational, cross-sectional study was conducted at a tertiary care teaching hospital in Hyderabad over a period of 1 year. Dialysate fluid from 100 episodes of clinically suspected peritonitis in 75 patients was processed by conventional centrifuging, water lysis, direct inoculation and addition of centrifuged pellet into brain-heart infusion broth and by automated blood culture system. Identification and antibiotic susceptibility of organisms was done, and the outcome of PD-related peritonitis was analysed. The categorical data and continuous data were analysed using the Chi-square test and Student's t-test, respectively. P < 0.05 was considered statistically significant. Of the 100 PD fluids, 87 were culture positive. Automated blood culture systems detected 87 episodes, whereas conventional centrifuge method detected only 53 episodes (P = 0.00001). Peritonitis due to Gram-negative organisms (62.3%) was higher than that of Gram-positive peritonitis (31.1%) and fungi (6.4%). Nineteen per cent episodes were constituted by relapse (9), refractory (4), recurrent (4) and repeat (2) peritonitis. Outcomes were analysed as recovery (77%), catheter removal (15%) and death (2.6%). Direct inoculation of peritoneal fluid into automated blood culture bottles increases the positivity rate and also aids in the early detection of CAPD peritonitis, helping reduce morbidity and mortality of PD patients.