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. 2021 Feb 2;6(4):1118-1129.
doi: 10.1016/j.ekir.2021.01.010. eCollection 2021 Apr.

Association of Local Unit Sampling and Microbiology Laboratory Culture Practices With the Ability to Identify Causative Pathogens in Peritoneal Dialysis-Associated Peritonitis in Thailand

Talerngsak Kanjanabuch  1   2   3 , Tanittha Chatsuwan  4   5 , Nibondh Udomsantisuk  5 , Tanawin Nopsopon  6 , Pongpratch Puapatanakul  1 , Guttiga Halue  7 , Pichet Lorvinitnun  8 , Kittisak Tangjittrong  9 , Surapong Narenpitak  10 , Chanchana Boonyakrai  11 , Sajja Tatiyanupanwong  12 , Rutchanee Chieochanthanakij  13 , Worapot Treamtrakanpon  14 , Uraiwan Parinyasiri  15 , Niwat Lounseng  16 , Phichit Songviriyavithaya  17 , Suchai Sritippayawan  18 , Somchai Eiam-Ong  1 , Kriang Tungsanga  1 , David W Johnson  19   20   21 , Bruce Robinson  22 , Jeffrey Perl  23 ; Thailand PDOPPS steering teams
Collaborators, Affiliations

Association of Local Unit Sampling and Microbiology Laboratory Culture Practices With the Ability to Identify Causative Pathogens in Peritoneal Dialysis-Associated Peritonitis in Thailand

Talerngsak Kanjanabuch et al. Kidney Int Rep. .

Abstract

Introduction: This describes variations in facility peritoneal dialysis (PD) effluent (PDE) culture techniques and local microbiology laboratory practices, competencies, and quality assurance associated with peritonitis, with a specific emphasis on factors associated with culture-negative peritonitis (CNP).

Methods: Peritonitis data were prospectively collected from 22 Thai PD centers between May 2016 and October 2017 as part of the Peritoneal Dialysis Outcomes and Practice Patterns Study. The first cloudy PD bags from PD participants with suspected peritonitis were sent to local and central laboratories for comparison of pathogen identification. The associations between these characteristics and CNP were evaluated.

Results: CNP was significantly more frequent in local laboratories (38%) compared with paired PDE samples sent to the central laboratory (12%, P < 0.05). Marked variations were observed in PD center practices, particularly with respect to specimen collection and processing, which often deviated from International Society for Peritoneal Dialysis Guideline recommendations, and laboratory capacities, capabilities, and certification. Lower rates of CNP were associated with PD nurse specimen collection, centrifugation of PDE, immediate transfer of samples to the laboratory, larger hospital size, larger PD unit size, availability of an on-site nephrologist, higher laboratory capacity, and laboratory ability to perform aerobic cultures, undertake standard operating procedures in antimicrobial susceptibilities, and obtain local accreditation.

Conclusion: There were large variations in PD center and laboratory capacities, capabilities, and practices, which in turn were associated with the likelihood of culturing and correctly identifying organisms responsible for causing PD-associated peritonitis. Deviations in practice from International Society for Peritoneal Dialysis guideline recommendations were associated with higher CNP rates.

Keywords: ISPD guideline; culture-negative peritonitis; lab practice; microbiology; peritonitis.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Patient flow diagram and summary of peritonitis episodes. Remitting peritonitis was defined as a combination of relapsing peritonitis within 3 months from the same or different organisms.
Figure 2
Figure 2
Culture negativity rate for each participating peritoneal dialysis (PD) centers by culture negativity percentage with the International Society for Peritoneal Dialysis (ISPD) cutoff.
Figure 3
Figure 3
Concordant and discordant organism identifications between central laboratory and local laboratories.
See this image and copyright information in PMC

References

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