Table 3.

Summary of practices between centers with low versus high rates of peritonitis

Culture TechniquesOverall N (Column %)≤20% Culture-Negative Peritonitis Rate, N (Column %)>20% Culture-Negative Peritonitis Rate, N (Column %)
N, centers321220
Testing of PD effluent when suspecting peritonitis
 Fluid cell count32 (100)12 (100)20 (100)
 Cell differential count28 (88)10 (83)18 (90)
 Gram stain31 (97)12 (100)19 (95)
 Bacterial culture32 (100)12 (100)20 (100)
What media are used to culture peritoneal fluid?
 Blood culture bottles22 (69)10 (83)12 (60)
 Solid media (culture plates)19 (59)7 (58)12 (60)
 Broth media or other9 (28)3 (25)6 (30)
Conditions performed when culturing peritoneal fluid?
 Aerobic culture only8 (25)4 (33)4 (20)
 Aerobic and anerobic14 (44)4 (33)10 (50)
 Aerobic and fungal6 (19)2 (17)4 (15)
 Aerobic, anerobic, and fungal4 (13)2 (17)2 (10)
Minimum amount of PD effluent inoculated into blood culture bottles
 No minimum amount or no specific volume required5 (24)2 (20)3 (27)
 ≤5 ml10 (48)5 (50)5 (46)
 >5 ml6 (29)3 (30)3 (27)
How many aerobic blood culture bottles are inoculated?
 119 (86)8 (80)11 (92)
 23 (14)2 (20)1 (8)
Where are the blood culture bottles inoculated?
 At the bedside6 (27)1 (10)5 (42)
 In the laboratory15 (68)8 (80)7 (58)
 At the bedside and in the laboratory1 (5)1 (10)0 (0)
Routinely obtain >50 ml of peritoneal fluid sample for culture
 Yes, we routinely use >50 ml15 (47)7 (58)8 (40)
 No, we do not routinely use 50 ml or more17 (53)5 (42)12 (60)
Do you centrifuge the PD fluid and resuspend the sediment/pellet to inoculate onto the culture media?
 Yes, we centrifuge18 (56)6 (50)12 (60)
 No, we do not centrifuge11 (34)4 (33)7 (35)
 Not sure3 (9)2 (17)1 (5)
Is any PD fluid discarded from the catheter (wasted) before obtaining fluid that will be cultured?
 No20 (63)8 (67)12 (60)
 ≤10 ml8 (25)2 (17)6 (30)
 >10 ml4 (13)2 (17)2 (10)
What is the minimum time for a new exchange to dwell before withdrawing fluid to perform a culture?
 No minimum dwell time or not applicable because always prescribe a day dwell7 (22)2 (17)5 (25)
 30 min7 (22)2 (17)5 (25)
 1 h11 (34)5 (42)6 (30)
 2 h7 (22)3 (25)4 (20)
To maximize recovery of organisms, when peritoneal fluid is obtained for culture it is sent for culture
 Within 1 h17 (53)6 (50)11 (55)
 Within 6 h5 (15)1 (8)4 (20)
 Within 12–24 h3 (9)2 (17)1 (5)
 No time limit or not specified7 (22)3 (25)4 (20)
If PD fluid obtained for culture cannot be transported to the laboratory within 6 h, do you instruct patient/family to refrigerate sample?
 No9 (33)3 (27)6 (38)
 Yes18 (67)8 (73)10 (63)
 No response/NA5 (16)1 (8)4 (20)
Approximately what percentage of patients receive antibiotics prior to collecting PD fluid for culture if peritonitis is suspected?
 <10%28 (88)11 (92)17 (85)
 10%–25%2 (6)0 (0)2 (10)
 >25%2 (6)1 (8)1 (5)
What is the use of PCR testing on peritoneal fluid samples?
 PCR is not performed28 (88)11 (92)17 (85)
 PCR is performed on culture-positive samples to facilitate organism identification1 (3)1 (8)0 (0)
 PCR is performed only if requested by the physician1 (3)0 (0)1 (5)
 No response recorded2 (6)0 (0)2 (10)
  • There was no significant difference between the two groups for any variables. PD, peritoneal dialysis; NA, not applicable.