Lack of Utility of Routine Screening Tests for Early Detection of Peritonitis in Patients Requiring Intermittent Peritoneal Dialysis

Abstract

A prospective study was undertaken to examine the clinical presentation of peritonitis in patients maintained on intermittent peritoneal dialysis and to determine the value of qualitative and quantitative dialysate cultures, gram stain, neutrophil counts, and a semiquantitative leukocyte test strip for case detection. Seven cases of peritonitis developed among 30 patients who underwent 553 dialyses. In most cases, neutrophil counts, cultures, and leukocyte test strip determinations were done within 48 hours prior to the clinical onset of peritonitis and in all instances failed to provide clues for incipient infection. Peritonitis was associated with a dialysate neutrophil count of >500/mm3 and leukocyte test strips were highly sensitive and specific for the detection of this quantity of neutrophils. A total of 16 dialysate cultures was positive in asymptomatic patients who did not have peritonitis. None of these patients subsequently developed peritonitis with the same organism. Dialysate gram stains, cultures, neutrophil counts or leukocyte test strips did not provide an early diagnosis of peritonitis and their use in the absence of symptoms is therefore not recommended.

Laboratory indices of clinical peritonitis: total leukocyte count, microscopy, and microbiologic culture of peritoneal dialysis effluent

“…Our results (Table 1) confirmed previous observations (3,5,7,22) of an overlap in cell count between dialysates collected either during or in the absence of peritonitis. This was attributed, in part, to nonspecific increases in cell count that we observed (Table 4) in patients on intermittent dialysis (11) if the effluent was collected at the start of dialysis (3).…”

“…Dialysate leukocytosis has also been associated with noninfectious conditions, such as eosinophilia (13,25), which has already been discussed. These nonspecific rises in effluent cell count have been differentiated by others (3,11,13,22) from a true inflammatory response to infection by performance of a differential count. Polymorphonuclear leukocytes predominate during peritonitis, whereas in the absence of infection, the normal cellular response is monocytic (7,10).…”

“…This pattern of growth was suggestive of higher colony counts for microorganisms associated with peritonitis, compared with isolates of the peritonitis-unrelated class. Differences in bacterial counts between these two classes of isolates have been demonstrated, although there may be considerable overlap in numbers (3,22). Recovery of all organisms from dialysates was affected by the growth medium used ( Table 3).…”

Calcium Ion Channels: Roles in Infection and Sepsis Mechanisms of Calcium Channel Blocker Benefits in Immunocompromised Patients at Risk for Infection

“…However, if only one of the diagnostic pointers were present, there might be some time before a second or third would appear. Our prospective study to determine whether frequent culture of peritoneal dialysis effluent fluid might yield an early warning prior to the clinical syndrome did not produce positive culture results worthy of the extensive expense [ 32 ]. At the height of an incursion of illicit distribution of cocaine into the New England sector of the USA, we found the availability of clean needles did not protect diabetic dialysis patients from life-threatening cellulitis, abscess formation, and sepsis [ 33 ] All the instances of visceral infection occurred in the setting of cocaine intake.…”

Value of the urine strip test in the early diagnosis of bacterial peritonitis

“…Brahm used the urine strip test every day to check peritonitis in CPD outpatients with or without clinical signs and symptoms in the latter study 11 . Cooper and colleagues reported that the predictive value of a positive strip for a cell count of 500/mm 3 was 70%, while the predictive value of a negative test strip for a count of <500 mm 3 was 100% through an old generation urine strip test in inpatients with full clinical symptoms 12 . Farmer et al .…”