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

Published online by Cambridge University Press:  02 January 2015

Glenn L. Cooper ,
Julie A. White ,
John A. D'Elia ,
Paola C. DeGirolami ,
Charles Arkin ,
Antoine Kaldany  and
Richard Piatt
Glenn L. Cooper*
Affiliation:
Departments of Medicine and Clinical Pathology and Hospital Epidemiology Unit, New England Deaconess Hospital, Boston, Massachusetts Division of Nephrology, Joslin Diabetes Center, Boston, Massachusetts Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Julie A. White
Affiliation:
Departments of Medicine and Clinical Pathology and Hospital Epidemiology Unit, New England Deaconess Hospital, Boston, Massachusetts Division of Nephrology, Joslin Diabetes Center, Boston, Massachusetts Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
John A. D'Elia
Affiliation:
Departments of Medicine and Clinical Pathology and Hospital Epidemiology Unit, New England Deaconess Hospital, Boston, Massachusetts Division of Nephrology, Joslin Diabetes Center, Boston, Massachusetts Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Paola C. DeGirolami
Affiliation:
Departments of Medicine and Clinical Pathology and Hospital Epidemiology Unit, New England Deaconess Hospital, Boston, Massachusetts Division of Nephrology, Joslin Diabetes Center, Boston, Massachusetts Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Charles Arkin
Affiliation:
Departments of Medicine and Clinical Pathology and Hospital Epidemiology Unit, New England Deaconess Hospital, Boston, Massachusetts Division of Nephrology, Joslin Diabetes Center, Boston, Massachusetts Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Antoine Kaldany
Affiliation:
Departments of Medicine and Clinical Pathology and Hospital Epidemiology Unit, New England Deaconess Hospital, Boston, Massachusetts Division of Nephrology, Joslin Diabetes Center, Boston, Massachusetts Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Richard Piatt
Affiliation:
Departments of Medicine and Clinical Pathology and Hospital Epidemiology Unit, New England Deaconess Hospital, Boston, Massachusetts Division of Nephrology, Joslin Diabetes Center, Boston, Massachusetts Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
*
Infectious Disease Unit, Massachusetts General Hospital, Boston, MA 02115
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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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 5 , Issue 7 , July 1984 , pp. 321 - 325
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1984

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