Culture-negative peritoneal dialysis-associated peritonitis rates are decreased with water lysis but not 16S rRNA gene sequencing
Luxme Nadarajah, Ian Butler, Holly Ciesielczuk, Jonathon Lambourne, Stanley FanObjectives
A successful peritoneal dialysis (PD) programme should aim to have low peritoneal dialysis-associated peritonitis (PDAP) rates. Identification of the microbial organism enables targeted antibiotic treatment and allows for a root cause analysis to be performed. Culture-negative (CN) peritonitis presents a more challenging scenario whereby empirical treatment for Gram-positive and Gram-negative organisms is commenced for 14 days, with Gram-negative cover discontinued based upon clinical response. In accordance with ISPD recommendations, we conducted a clinical quality improvement project in 2018 to decrease our culture-negative PDAP.
Methods
From 2018 to 2021, our department had 336 cases of PDAP. The introduction of a water-lysis step and the application of 16S rRNA gene sequencing were implemented to reduce culture-negative PDAP.
Results
There were 336 cases of PDAP between 2018 and 2021. In total, 135 cases occurred prior to the initiation of the water lysis step and 201 cases occurred after the introduction of the water lysis step and 16S rRNA sequencing. The rate of culture-negative PDAP prior to our change in PD effluent culture methodology was 33% (45/135); following changes to include a water lysis step and an increase in sample volume, the rate of culture-negative PDAP significantly fell to 20% (41/201) (
Conclusions
Introduction of water lysis of peritoneal effluent significantly decreased culture-negative peritonitis rates, thus increasing organism identification and allowing for targeted antimicrobial therapy.