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Abstract: FR-PO501

Microbiology Laboratory Practices Influences a Capacity of Pathogen Identification from Peritoneal Effluent in PD Patient with Peritonitis: A Result from the Thailand PDOPPS

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Kanjanabuch, Talerngsak, Medicine, Pathumwan, Thailand
  • Puapatanakul, Pongpratch, Chulalongkorn University, Bangkok, Thailand
  • Tungsanga, Kriang, King Chulalong Memorial lHospital, Bangkok, Thailand

Group or Team Name

  • Thailand PDOPPS Steering group
Background

Effective treatment of peritonitis relies mostly on the identification of pathogenic organisms from the PD effluent. However, culture-negative peritonitis is common in Thailand, a country with “PD First” policy.

Methods

This prospective case-cohort study was conducted in 21 PDOPPS centers in Thailand during May 2016 to October 2017. All cloudy PD bag prior to starting antibiotic from consented PD participants who had peritonitis were submitted to local and central laboratories. Facility practices regarding culture technique and microbiology laboratory practices were collected via survey of microbiology laboratory directors in each facility.

Results

During the cohort period, there were 360 peritonitis episodes (241 participants). The crude peritonitis rate was 0.40 episodes/year. Only 202 episodes (169 participants) had specimen submitted to both laboratories. By local laboratory result, Gram-positive bacteria were accounting for 26.2% of episodes followed by Gram-negative bacteria (23.4%), polymicrobial infection (2.5%), and fungal infection (5.0%). Of note culture negative rates was 42.5%. Central laboratory culture additionally identified organisms in 26 episodes whose local laboratory culture was negative, increasing positive culture rate to 70.3%. Central laboratory culture provided additional yield mainly in fungal, mycobacterium, and polymicrobial infections. Only 1 facility had complete equipment, reagents, and media to culture mold and mycobacteria while obligate anaerobe could be isolated from 4 facilities. None but one performed large volume culture.

Conclusion

Microbiology laboratory practices influence a capacity of pathogen identification from the PD effluent in PD patient with peritonitis and should warrant a competency assessment program.

Funding

  • Other U.S. Government Support