RETROSPECTIVE REVIEW OF CULTURE-NEGATIVE PERITONITIS AT WESTERN RENAL SERVICES
Mr Jadon Yang1, Dr Jurgita Juone2,3, Dr Kamal Sud4,5,6, Dr Lukas Kairaitis1,4, Dr Katrina Chau1,4
1School of Medicine, Western Sydney University, Campbelltown, Australia, 2Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania, 3Vilnius University Faculty of Medicine, Vilnius, Lithuania, 4Regional Dialysis Centre, Blacktown Hospital, Blacktown, Australia, 5Nepean Kidney Research Centre, Department of Renal Medicine, Nepean Hospital, Kingswood, Australia, 6Nepean Clinical School, Faculty of Medicine & Health, The University of Sydney, Kingswood, Australia
Aim: To review the incidence, diagnosis, treatment, and outcomes in patients with culture-negative peritonitis.
Background: Culture-negative peritonitis (CNP) rates have been consistently higher than the recommended ISPD guideline rate of 15% at this large peritoneal dialysis (PD) centre. An audit was conducted to determine the possible reasons for increased rates of CNP and assess its outcomes.
Methods: All cases of peritonitis at Western Renal Services in 2023 were reviewed. Data collected included treatment regimen, timing of antibiotics, microbiological profile, clinical symptoms, white cell count and outcomes.
Results: There were 21 (19.6%) cases of CNP out of a total of 107 cases of peritonitis in 2023, with 5 cases being misidentified as peritonitis. From the remaining 16 cases, 3 (18.8%) cases were unable to be retrospectively verified against the ISPD diagnostic criteria due to inadequate documentation and 8 (50%) cases had documented antibiotic administration prior to peritoneal fluid sample collection. The treatment given for 14 (87.5%) cases was intraperitoneal cefazolin and gentamicin. All patients were also given antifungal prophylaxis. 11 (68.8%) cases required hospitalisation and none required PD catheter removal or transfer to haemodialysis. All CNP episodes resolved following antibiotic treatment.
Conclusions: Due to insufficient documentation, some cases were unable to be confirmed as episodes of peritonitis based on ISPD criteria and the true rate of CNP may fall within ISPD guideline recommendations. CNP was commonly associated with prior antibiotic administration. Improved processes for care of patients with suspected peritonitis should include peritoneal fluid sample collection before antibiotic therapy whenever possible and documentation of any recent antibiotic administration. Patients with CNP had high rates of hospitalisations but good outcomes.
Biography:
Jadon is a fourth year medical student studying at Western Sydney University who is interested in nephrology.