Laboratory diagnosis of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis

Fenton, Paul

doi:10.1136/jcp.35.11.1181

Cited by 57 publications

(32 citation statements)

References 3 publications

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“…Such results are significantly more frequent when WBC counts are below 500/mm3 (36,90). There are several reasons for the lack of sensitivity of dialysate cultures (148).…”

Section: Microbiological Findingsmentioning

confidence: 92%

“…There is unanimity that the sensitivity of the Gram stain (even on centrifuged samples) and the acridine orange stain (139) is low. Because of the low concentration of microorganisms in the dialysate, tinctorial sensitivity compared with that of culture results has been reported to range only between 10 and 50% (36,68,90,115,116). Gram-positive organisms may have a higher chance of being detected on Gram stain than gram-negative ones (82).…”

Section: Microbiological Findingsmentioning

confidence: 99%

“…Investigators have found numbers of microorganisms in peritonitis that ranged from 1 CFU/ml to "too numerous to count" (36,40,82,116,136). Gram-positive organisms had higher mean counts than gram-negative rods (36,82,116). In patients without symptoms of peritonitis and counts of <100 WBC/mm3, microbial concentrations ranged from 1 to 10 CFU/dl (116), indicating an overlap in this range of counts with true pathogens.…”

Section: Cultivation Of Microorganisms General Principlesmentioning

confidence: 99%

“…Indirect methods of testing for microbial presence, such as gas-liquid chromatography (36) or the Limulus lysate test (15), have such low sensitivities that they are useless.…”

Section: Cultivation Of Microorganisms General Principlesmentioning

confidence: 99%

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Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis

1992

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The process of continuous ambulatory peritoneal dialysis has provided a useful, relatively inexpensive, and safe alternative for patients with end-stage renal disease. Infectious peritonitis, however, has limited a more widespread acceptance of this technique. The definition of peritonitis in this patient population is not universally accepted and does not always include the laboratory support of a positive culture (or Gram stain). In part, the omission of clinical microbiological findings stems from the lack of sensitivity of earlier microbiological efforts. Peritonitis results from decreased host phagocytic efficiency with depressed phagocytosis and bactericidal capacity of peritoneal macrophages. During episodes of peritonitis, fluid movement is reversed, away from the lymphatics and peritoneal membrane and toward the cavity. As a result, bloodstream infections are rare. Most peritonitis episodes are caused by bacteria. Coagulase-negative staphylococci are the most frequently isolated organisms, usually originating from the skin flora, but a wide array of microbial species have been documented as agents of peritonitis. Clinical microbiology laboratories need to be cognizant of the diverse agents so that appropriate primary media can be used. The quantity of dialysate fluid that is prepared for culture is critical and should constitute at least 10 ml. The sensitivity of the cultural approach depends on the volume of dialysate, its pretreatment (lysis or centrifugation), the media used, and the mode of incubation. The low concentration of microorganisms in dialysate fluids accounts for negative Gram stain results. Prevention of infection in continuous ambulatory peritoneal dialysis patients is associated with the socioeconomic status of the patient, advances in equipment (catheter) technology, and, probably least important, the application of prophylactic antimicrobial agents.

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“…Such results are significantly more frequent when WBC counts are below 500/mm3 (36,90). There are several reasons for the lack of sensitivity of dialysate cultures (148).…”

Section: Microbiological Findingsmentioning

confidence: 92%

Section: Microbiological Findingsmentioning

confidence: 99%

Section: Cultivation Of Microorganisms General Principlesmentioning

confidence: 99%

“…Indirect methods of testing for microbial presence, such as gas-liquid chromatography (36) or the Limulus lysate test (15), have such low sensitivities that they are useless.…”

Section: Cultivation Of Microorganisms General Principlesmentioning

confidence: 99%

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Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis

1992

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“…3 Aplastic crisis associated with HPV infection has hitherto only been described in hereditary2 [4][5][6] The isolation of campylobacter like organisms from the gastric mucosa of ferrets was first reported from Boston, USA' 6; this organism, with morphological similarities to Cpylori, was isolated from about half of the animals examined. Histological studies suggested a possible association between the presence of the campylobacter and gastric inflammation.…”

mentioning

confidence: 99%

Comparative sensitivities to antimicrobial agents of Campylobacter pylori and the gastric campylobacter like organism from the ferret.

Jeffries¹,

Buckley²,

Blower³

et al. 1987

J Clin Pathol

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1265row showed erythrobastopenia (less than 1% of erythroblasts). The presence of serum anti-HPV IgM (radioimmunoassay) suggested a recent HPV infection. Packed red cells (600 ml) were transfused. Over the next few days the symptoms disappeared and haemoglobin concentrations remained stable. Ten days after admission reticulocyte count was 150 x 109/1. Eighteen months later, the patient was quite well and all haematological investigations yielded normal results blood count, haemoglobin electrophoresis, erythrocytic enzymes (glucose-6-phosphate-deshydrogenase, glucose-phosphogluconate-deshydrogenase, hexokinase, glucose-isomerase-phosphate, glucose-pyruvate, glutathione reductase, acetyl-cholinesterase, pyrimidine-5'-nucleotidase), osmotic resistance and autohaemolysis.Our observation of HPV infection associated with aplastic crisis but without haemolysis differs from the transient erythroblastopenia seen in childhood, which often affects younger children (1 to 4 years) and occurs without HPV infection.3Aplastic crisis associated with HPV infection has hitherto only been described in hereditary2 4-6 or acquired' haemolytic anaemias. It seems that the erythroblastopenic effect of HPV is constant but goes unnoticed if the red cell life span is normal. A shortened red cell survival (haemolysis) is necessary to cause acute anaemia. Acute anaemia occurring without haemolysis due to an HPV infection is difficult to explain. In our patient only isotopic labelling of his erythrocytes could have completely excluded underlying haemolysis. Nonetheless, we wanted to record the experience to encourage doctors to ask for parvovirus serology in similar clinical circumstances.

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Peritonitis

Fried

Piraino

2009

Nolph and Gokal’s Textbook of Peritoneal Dialysis

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Laboratory diagnosis of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis

Cited by 57 publications

References 3 publications

Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis

Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis

Comparative sensitivities to antimicrobial agents of Campylobacter pylori and the gastric campylobacter like organism from the ferret.

Peritonitis

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