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Correspondence to Author:  Subodh J. Saggi;

Department of Medicine, Division of Nephrology, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA.

Abstract:

Background : Peritonitis remains the most feared complication of End Stage Renal Disease (ESRD) patients on peritoneal dialysis (PD), but cultures are often negative. Our study was aimed to determine if improving the collection techniques of peritoneal fluid would reduce the rates of Culture Negative Peritonitis (CNP) as recommended in the 2020 ISPD guidelines.

Methods : We implemented a policy to standardize the collection techniques of PD effluent by introducing an additional step thatincreased the concentration of organisms in the PD effluent. This additional step consisted of culturing resuspended pellet obtained from 50 cc of centrifuged peritoneal fluid onto agar plates in addition to routinely culturing 5-10 cc of their peritoneal fluid in aerobic and anerobic blood culture bottles. We analyzed the differences in the rates of CNP from 01/01/2009 to 07/30/2013 representing patients prior to the new policy and compared it the CNP rates from 08/01/2013 to 12/31/2018 representing patients in the post policy period.

Results : We noticed a remarkable decline in the number of CNP rate from 0.40 (CI 95% 0.37-0.42) to 0.20 (CI 95% (0.19- 0.22) and a total decline in all cases of peritonitis from 0.87 (CI 95% 0.83-0.92) to 0.24 (CI 95% 0.22-0.25) in the post policy period even though patients in the post policy period had more comorbidities [60.9% versus 94.1%], p=0.02. In both the eras, most patients were black and of female gender.

Conclusion : Our study validated the effectiveness of the new PD fluid culture policy based on the 2010 ISPD guidelines.

Citation:

Subodh J. Saggi. Improving Peritoneal Dialysis Effluent Sample CollectionTechniquestoLowerCulture-Negative Peritonitis Rate: A Single-Center Experience. The Journal of Nephrology 2024.