I had a 75 year old man who started CAPD since December in 2017. He suffered from CAPD peritonitis on 9th of Jan in 2018 and ascites culture revealed proteus mirabilis. Ceftazidime IP was given for three weeks and peritonitis totally subsided. However, he suffered from another episode of peritonitis on 18th of Feb in 2018 (ascites white blood cell 10786/uL with neurophil 94%). We collect ascites culture by blood culture bottle but this time ascites culture revealed no bacteria growth. Ceftazidime IP and cefazolin IP was given for two weeks according to ISPD guideline for culture negative peritonitis. My Question is how to define these episodes? repeat peritonitis or different peritonitis? What’s your suggestion about protocol of ascites culture collection to avoid culture negative? What’s the regimen you will give this patient for his second CAPD peritonitis? Thank you very much.

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I had a 75 year old man who started CAPD since December in 2017. He suffered from CAPD peritonitis on 9th of Jan in 2018 and ascites culture revealed proteus mirabilis. Ceftazidime IP was given for three weeks and peritonitis totally subsided. However, he suffered from another episode of peritonitis on 18th of Feb in 2018 (ascites white blood cell 10786/uL with neurophil 94%). We collect ascites culture by blood culture bottle but this time ascites culture revealed no bacteria growth. Ceftazidime IP and cefazolin IP was given for two weeks according to ISPD guideline for culture negative peritonitis. My Question is how to define these episodes? repeat peritonitis or different peritonitis? What’s your suggestion about protocol of ascites culture collection to avoid culture negative? What’s the regimen you will give this patient for his second CAPD peritonitis? Thank you very much.

2 answers

Doctor from South America September 25, 2018

You will find the answers in the ISPD guideline to peritonitis prevention and treatment 2016http://www.pdiconnect.com/content/36/5/481/T7.expansion.html

#1
Doctor (Canada) September 28, 2018

The definitions of recurrent, relapsing and repeat peritonitis are below:
Recurrent: An episode that occurs within 4 weeks of completion of therapy of a prior episode but with a different organism
Relapsing: An episode that occurs within 4 weeks of completion of therapy of a prior episode with the same organism or a sterile episode
Repeat: An episode that occurs more than 4 weeks after completion of therapy of a prior episode with the same organism
Since this was a sterile episode occurring less than 4 weeks after completion of antibiotics for the Proteus peritonitis, it would be considered a relapsing episode.
With regard to culture negative peritonitis, these should ideally represent <15% of all peritonitis episodes in any PD unit. The optimal culture technique is described in detail in the 2016 ISPD peritonitis recommendations: “Bedside inoculation of 5-10 ml effluent in 2 (aerobic and anaerobic) blood-culture bottles has a reasonable sensitivity, and the culture-negative rate is typically around 10-20%. (210,211). The yield of peritoneal fluid culture is enhanced by inoculating the fluid directly into rapid blood-culture bottle kits, centrifuging PD fluid and culturing the pellet, or the lysis centrifugation technique compared to inoculation into standard blood-culture bottles. Specifically, centrifugation of 50 mL PD effluent at 3,000 g for 15 minutes, followed by resuspension of the sediment in 3-5 mL supernatant and inoculation on solid culture media or standard blood-culture media, increases the yield by 5 to 10 times but is more cumbersome.” 

#2

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