Department of Clinical Microbiology, Osmania General Hospital, Hyderabad, Telangana, India.
Indian J Med Microbiol. 2020 Jan-Mar;38(1):72-77. doi: 10.4103/ijmm.IJMM_20_251.
Continuous ambulatory peritoneal dialysis (CAPD) is now a preferred mode of the treatment in patients with end-stage renal disease, but peritonitis remains to be a shortcoming of CAPD. High-culture negativity, emerging drug resistance and peritoneal dialysis (PD)-related morbidity and mortality have been a challenge to tackle.
The present study was taken up to compare the the various culture methods and to identify the spectrum of organisms causing CAPD peritonitis and their outcome.
A prospective, observational, cross-sectional study was conducted at a tertiary care teaching hospital in Hyderabad over a period of 1 year.
Dialysate fluid from 100 episodes of clinically suspected peritonitis in 75 patients was processed by conventional centrifuging, water lysis, direct inoculation and addition of centrifuged pellet into brain-heart infusion broth and by automated blood culture system. Identification and antibiotic susceptibility of organisms was done, and the outcome of PD-related peritonitis was analysed.
The categorical data and continuous data were analysed using the Chi-square test and Student's t-test, respectively. P < 0.05 was considered statistically significant.
Of the 100 PD fluids, 87 were culture positive. Automated blood culture systems detected 87 episodes, whereas conventional centrifuge method detected only 53 episodes (P = 0.00001). Peritonitis due to Gram-negative organisms (62.3%) was higher than that of Gram-positive peritonitis (31.1%) and fungi (6.4%). Nineteen per cent episodes were constituted by relapse (9), refractory (4), recurrent (4) and repeat (2) peritonitis. Outcomes were analysed as recovery (77%), catheter removal (15%) and death (2.6%).
Direct inoculation of peritoneal fluid into automated blood culture bottles increases the positivity rate and also aids in the early detection of CAPD peritonitis, helping reduce morbidity and mortality of PD patients.
连续不卧床腹膜透析（CAPD）现在是治疗终末期肾病患者的首选模式，但腹膜炎仍然是 CAPD 的一个缺点。高培养阴性率、新兴耐药性以及与腹膜透析（PD）相关的发病率和死亡率一直是亟待解决的挑战。
本研究旨在比较各种培养方法，并确定导致 CAPD 腹膜炎的病原体谱及其结果。
这是在海得拉巴的一家三级护理教学医院进行的一项前瞻性、观察性、横断面研究，持续时间为 1 年。
对 75 名患者的 100 例疑似临床腹膜炎的透析液通过常规离心、水裂解、直接接种以及将离心沉淀加入脑心浸液肉汤和自动化血培养系统进行处理。对病原体进行鉴定和药敏试验，并分析 PD 相关腹膜炎的结果。
使用卡方检验和学生 t 检验分别对分类数据和连续数据进行分析。P<0.05 被认为具有统计学意义。
在 100 份 PD 液体中，有 87 份培养阳性。自动化血培养系统检测到 87 例，而常规离心法仅检测到 53 例（P=0.00001）。革兰氏阴性菌引起的腹膜炎（62.3%）高于革兰氏阳性菌（31.1%）和真菌（6.4%）引起的腹膜炎。19%的病例由复发（9 例）、难治性（4 例）、复发性（4 例）和重复（2 例）腹膜炎组成。结果分析为恢复（77%）、导管移除（15%）和死亡（2.6%）。
直接将腹膜液接种到自动化血培养瓶中可提高阳性率，并有助于早期发现 CAPD 腹膜炎，有助于降低 PD 患者的发病率和死亡率。
