I just ordered a cell count, culture and gram stain for a patient. The cell count is less than 50, the patient has no abdominal pain, is not febrile and the effluent is clear. The culture did however indicate staph epidermidis. Per ISPD, this is not treated as peritonitis as the only criteria met was the culture (need 2 criteria met to be considered peritonitis). Am I correct in my statement? Thank you

Questions About PD

John S, Nurse from USA asked
I just ordered a cell count, culture and gram stain for a patient. The cell count is less than 50, the patient has no abdominal pain, is not febrile and the effluent is clear. The culture did however indicate staph epidermidis. Per ISPD, this is not treated as peritonitis as the only criteria met was the culture (need 2 criteria met to be considered peritonitis). Am I correct in my statement? Thank you

1 answer

Clinical PD Pearls April 21, 2020

In the absence of clinical features suggestive of peritonitis (abdominal pain and/or cloudy dialysate), routine effluent culture is discouraged resulting in unnecessary treatment if positive in the face of a normal effluent cell count. If PD effluent cultures are persistently positive with a normal effluent cell count it is important to consider bacteremia with secondary peritoneal seeding, possible early peritonitis or colonization/infection of the PD catheter. Only if persistently positive, we would recommend treatment even in the absence of peritoneal effluent leukocytosis. So in summary to answer the question would repeat and treat only if positive on two culture episodes otherwise would consider a contaminant 

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