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Kidney Week

Abstract: PO0993

Improving Peritoneal Dialysis Effluent Sample Collecting Techniques to Lower Culture-Negative Peritonitis Rate: A Single-Center Experience

Session Information

  • Peritoneal Dialysis
    November 04, 2021 | Location: On-Demand, Virtual Only
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Ouyang, Jie, SUNY Downstate Health Sciences University, New York City, New York, United States
  • Raghavan, Shraddha, SUNY Downstate Health Sciences University, New York City, New York, United States
  • Gruessner, Angelika C., SUNY Downstate Health Sciences University, New York City, New York, United States
  • Saggi, Subodh J., SUNY Downstate Health Sciences University, New York City, New York, United States
Background

The most common and severe complication of peritoneal dialysis (PD) is peritonitis. Patients usually present with abdominal pain and cloudy peritoneal effluent. An accurate diagnosis is critical to treatment and avoiding technique failure. Culture negative peritonitis (CNP) rate can be up to 20% with standard bedside collection. The rate among PD centers in the US was reported to be 13.4%-40%. The causes of CNP include recent antibiotic use, Gram-positive infections which fail to reach the threshold of detection, or technical imperfection. The culture techniques were highly variable across centers.

Due to a high rate of CNP at our facility, we instituted a new policy of PD effluent culture techniques on 7/30/2013 that was recommended by ISPD guideline. We conducted a quality improvement analysis to examine the outcome of this intervention.

Methods

Data were collected for patients who received PD from 2009 to 2018. The new policy required that a 50 ml of PD effluent be collected and centrifuged prior to the sediment being cultured. Diagnosis of peritonitis was analyzed with culture results before and after the policy change.

Results

This study enrolled 38 patients and total 122 visits for potential peritonitis were observed. As shown in table1, our CNP rate prior to the policy change was 41.7%. After the implementation of the new culture strategy, the rate significantly decreased to 25%. However, the false positive rate increased from 4.9% to 23.1% with a drop of the true positive rate (sensitivity) from 95.1% to 76.9%, when the peritonitis rate in our facility declined from 0.43 to 0.09 /patient year.

Conclusion

This analysis showed that the new PD effluent culture policy effectively lowered the culture negative peritonitis rate in our PD center. However, constant reinforcement of this policy and proper sterilization is required for the purpose of due diligence.

Table 1
 1/1/2009-7/29/20137/30/2013-12/31/2018
- Peritonitis with no culture growth58.3% (21/36)75% (24/32)
+ Peritonitis with no culture growth41.7% (15/36)25% (8/32)
- Peritonitis with culture growth4.9% (2/41)23.1% (3/13)
+ Peritonitis with culture growth95.1% (39/41)76.9% (10/13)