Quality Improvement in Culture Negative Peritoneal Dialysis Related Peritonitis: 5 Years Review.

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Duangrat Tanratananon

Abstract

Background: Culture negative peritonitis is the common in peritoneal dialysis patients which affect treatment decision and reflect quality control in peritoneal dialysis (PD) patients. In our center, the rate of culture negative peritonitis still increased in recent years. The aim of our study is to decrease rate of culture negative peritonitis in our PD patients by improved method of specimen collection and set up clinical policy follow ISPD guideline for effluent culture technique.
Methods: The research and development in our PD patients from October 2013 to September 2018.The diagnosis of PD-related peritonitis was based on standard criteria that is, the presence of 2 or 3 of these, signs of peritoneal inflammation; positive gram stain or culture of PD effluent (or both); an effluent cell count with white blood cells exceeding 100/mm3 with at least 50% polymorphonuclear neutrophilic cells after a dwell time of at least 2 hours and positive gram stain or culture of PD effluent (or both). Data was reviewed annually for PD fluid culture results, rate of culture negative peritonitis, outcome and complication before and after clinical policy adjustment for comparison.
Results: We identified 465 peritonitis episodes during 5 years. Of the 250 PD patients, 46% were male and 54% were female. The most common gram positive bacteria were Staphylococcus epidermidis and staphylococcus aureus; and the most common gram negative bacteria were Escherichia coli and Klebsiella pnumoniae respectively. The results showed significant decline of culture negative peritonitis from 58.1 % to22.2%; treatment failure from16.4 % to 12.5%; and mortality rate decreased from 15.4 % to 9.8 % after we improved the technique during effluent culture and established clinical policy in our center.
Conclusion: Effluent culture technique along ISPD guidelines lead to a decline in culture-negative peritonitis, treatment failure and mortality in peritoneal dialysis patients.
Keywords: Culture negative peritoneal dialysis related peritonitis, culture negative peritonitis

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References

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