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Abstract: PO1280

Impact of Performing Cultures of Peritoneal Fluid Correctly on the Reduction of False-Positive and False-Negative Culture Rates in Patients on Peritoneal Dialysis (PD) Presenting with Peritonitis

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Sherchan, Sunil, SUNY Downstate Health Sciences University, Brooklyn, New York, United States
  • Ouyang, Jie, SUNY Downstate Health Sciences University, Brooklyn, New York, United States
  • Gruessner, Angelika C., SUNY Downstate Health Sciences University, Brooklyn, New York, United States
  • Saggi, Subodh J., SUNY Downstate Health Sciences University, Brooklyn, New York, United States
Background

Peritonitis is feared complication of PD and reason for loss of peritoneal membrane function. It negatively impacts the Quality metrics of home program performance. Preliminary observations in 2013 showed a high failure rate for treating culture negative peritonitis. Intervention based on our root cause analysis from 07/30/2013 to 12/31/2019 done to address disparities in performing proper culture techniques within hospital systems and outpatient home dialysis ambulatory clinics

Methods

Prior to 07/30/2013 (5-10 ml) of a cloudy PD fluid was injected into an aerobic and an anaerobic blood culture bottle. After 07/30/2013 we implemented a policy whereby 50 ml of PD effluent was used for centrifugation and the pellet was injected into culture bottles to preferentially concentrate the inoculum. We queried our EMR after 7 years as rates of peritonitis are low across programs. Data was extracted using diagnostic codes and laboratory request. Data was analyzed using student’s 2 sample t test, Kruswall-Wallis and Wilcoxian analysis

Results

Total of 41 observations met our inclusion criteria for retrospective analysis. We had 26 observations before and 15 observations after the policy implementation. Mean number of tests ordered after 07/30/2013 declined. Number of false positive tests declined and number of true negative tests and true positive tests increased ( p=0.02), indicating increasing specificity and a more targeted antibiotic regimen rescuing peritoneal membrane function early. No direct impact on survival nor any impact on technique failure was observed

Conclusion

A gap in proper collection of PD fluid was identified. We educated all residents, renal fellows, nursing staff and microbiology laboratory staff across the entire health care systems, and created an order sets within EMR systems to close this gap