Improved Culture Positivity Rate after Modified Culture Technique of Dialysis Effluent Fluid in Peritoneal Dialysis-related Peritonitis Cases

Background and Aims: Continuous ambulatory peritoneal dialysis (CAPD) peritonitis is one of the common complications and direct causes of death in the majority of patients undergoing peritoneal dialysis. The laboratory plays an important role in the management of such patients by guiding definitive antimicrobial therapy. The purpose of the present study is to compare the culture positivity rate before and after implementation of revised International Society for Peritoneal Dialysis guidelines, 2016 as well as to study the etiology and antimicrobial susceptibility pattern of causative organisms in our center. Materials and Methods: This ambispective study was conducted in the Department of Microbiology in a tertiary care hospital in North India. A training session of laboratory staff on revised culture techniques of CAPD fluid was undertaken in March 2018. The CAPD fluids received from October 2017 to February 2018 and April to July 2018 were labeled as pre- and post-intervention groups, respectively. Results: Out of 70 samples received from the clinically suspected peritonitis episodes, 28 (40%) belonged to confirmed CAPD peritonitis cases. After the intervention, the culture negativity rate dropped from 68.7% to 8.3%. The rate of bacterial and fungal isolates was 87.5% and 12.5%, and most of the isolates showed low resistance to antimicrobials. Conclusion: The study highlights the importance of training laboratory staff on standard guidelines, which resulted in an increased culture positivity rate in CAPD fluids. Identification and antimicrobial susceptibility patterns of isolated pathogens will help the clinicians in initiating appropriate management.