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REVIEWS AND ORIGINAL ARTICLES |
From the Renal Unit, Withington Hospital, Manchester, U.K.
The authors collected 3876 daily specimens of dialysate for bacteriological
culture from II patients on CAPD over a period of 155 patient treatment
months. During the trial period, there were 30-culture positive episodes of
peritonitis. In 16 (530;") of the episodes there was a latent
interval of 72 hours or less between the presence of organisms in the
dialysate and the clinical onset of peritonitis. However, 153 positive
cultures were unrelated to ari episode of peritonitis. Most asymptomatic
positive cultures, therefore, do not progress to peritonitis. There were eight
episodes of "recurrent" peritonitis. In six of these, although
initially the dialysate was rendered sterile and the patient asymptomatic by
antibiotics the pathogenic organism was isolated again from dialysate on more
than one occasion, during continued antibiotic administration. In six of these
cases, a second episode of peritonitis due to the same organism recurred
within 20 days of discontinuing antibiotics suggesting that most episodes of
"recurrent" peritonitis represent treatment failure, rather than
reinfection. Infective peritonitis is the major complication of continuous
ambulatory peritoneal dialysis (CAPD). Greater success in the treatment of
peritonitis will come from early identification of the casual organisms and
their antibiotic sensitivities. We have investigated the possibility of
obtaining this information from daily cultures of dialysis fluid.
KEY WORDS: CAPD; Peritonitis; Surveillance cultures.
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