Summary of practices between centers with low versus high rates of peritonitis
| Culture Techniques | Overall N (Column %) | ≤20% Culture-Negative Peritonitis Rate, N (Column %) | >20% Culture-Negative Peritonitis Rate, N (Column %) |
|---|---|---|---|
| N, centers | 32 | 12 | 20 |
| Testing of PD effluent when suspecting peritonitis | |||
| Fluid cell count | 32 (100) | 12 (100) | 20 (100) |
| Cell differential count | 28 (88) | 10 (83) | 18 (90) |
| Gram stain | 31 (97) | 12 (100) | 19 (95) |
| Bacterial culture | 32 (100) | 12 (100) | 20 (100) |
| What media are used to culture peritoneal fluid? | |||
| Blood culture bottles | 22 (69) | 10 (83) | 12 (60) |
| Solid media (culture plates) | 19 (59) | 7 (58) | 12 (60) |
| Broth media or other | 9 (28) | 3 (25) | 6 (30) |
| Conditions performed when culturing peritoneal fluid? | |||
| Aerobic culture only | 8 (25) | 4 (33) | 4 (20) |
| Aerobic and anerobic | 14 (44) | 4 (33) | 10 (50) |
| Aerobic and fungal | 6 (19) | 2 (17) | 4 (15) |
| Aerobic, anerobic, and fungal | 4 (13) | 2 (17) | 2 (10) |
| Minimum amount of PD effluent inoculated into blood culture bottles | |||
| No minimum amount or no specific volume required | 5 (24) | 2 (20) | 3 (27) |
| ≤5 ml | 10 (48) | 5 (50) | 5 (46) |
| >5 ml | 6 (29) | 3 (30) | 3 (27) |
| How many aerobic blood culture bottles are inoculated? | |||
| 1 | 19 (86) | 8 (80) | 11 (92) |
| 2 | 3 (14) | 2 (20) | 1 (8) |
| Where are the blood culture bottles inoculated? | |||
| At the bedside | 6 (27) | 1 (10) | 5 (42) |
| In the laboratory | 15 (68) | 8 (80) | 7 (58) |
| At the bedside and in the laboratory | 1 (5) | 1 (10) | 0 (0) |
| Routinely obtain >50 ml of peritoneal fluid sample for culture | |||
| Yes, we routinely use >50 ml | 15 (47) | 7 (58) | 8 (40) |
| No, we do not routinely use 50 ml or more | 17 (53) | 5 (42) | 12 (60) |
| Do you centrifuge the PD fluid and resuspend the sediment/pellet to inoculate onto the culture media? | |||
| Yes, we centrifuge | 18 (56) | 6 (50) | 12 (60) |
| No, we do not centrifuge | 11 (34) | 4 (33) | 7 (35) |
| Not sure | 3 (9) | 2 (17) | 1 (5) |
| Is any PD fluid discarded from the catheter (wasted) before obtaining fluid that will be cultured? | |||
| No | 20 (63) | 8 (67) | 12 (60) |
| ≤10 ml | 8 (25) | 2 (17) | 6 (30) |
| >10 ml | 4 (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 dwell | 7 (22) | 2 (17) | 5 (25) |
| 30 min | 7 (22) | 2 (17) | 5 (25) |
| 1 h | 11 (34) | 5 (42) | 6 (30) |
| 2 h | 7 (22) | 3 (25) | 4 (20) |
| To maximize recovery of organisms, when peritoneal fluid is obtained for culture it is sent for culture | |||
| Within 1 h | 17 (53) | 6 (50) | 11 (55) |
| Within 6 h | 5 (15) | 1 (8) | 4 (20) |
| Within 12–24 h | 3 (9) | 2 (17) | 1 (5) |
| No time limit or not specified | 7 (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? | |||
| No | 9 (33) | 3 (27) | 6 (38) |
| Yes | 18 (67) | 8 (73) | 10 (63) |
| No response/NA | 5 (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 performed | 28 (88) | 11 (92) | 17 (85) |
| PCR is performed on culture-positive samples to facilitate organism identification | 1 (3) | 1 (8) | 0 (0) |
| PCR is performed only if requested by the physician | 1 (3) | 0 (0) | 1 (5) |
| No response recorded | 2 (6) | 0 (0) | 2 (10) |
There was no significant difference between the two groups for any variables. PD, peritoneal dialysis; NA, not applicable.