Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Kolland,M.
Diagnostic benefit of effluent cytology in peritoneal dialysis associated peritonitis
A retrospective analysis of a 10 years single-center experience
Humanmedizin; [Diplomarbeit] Medical University of Graz;2019. pp. 88
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- Autor*innen der Med Uni Graz:
- Kolland Michael
- Betreuer*innen:
- Goritschan Anna
- Rosenkranz Alexander
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- Abstract:
- Introduction Peritonitis, as complication of peritoneal dialysis (PD), is the major cause of treatment failure and deaths. For targeted antibiosis, microbiological diagnosis, performed via cultures, is obligatory. Nevertheless, this workup takes time and culture-negative results appear occasionally. Therefore, microscopical analysis might be a useful tool to compensate those weaknesses. This study tries to evaluate if this method has additional benefits in diagnosis of peritoneal dialysis associated peritonitis. Methods We performed a single-center, retrospective analysis, including all PD patients, taken care of between 01.01.2007 and 31.12.2017 at the university hospital in Graz. Microbiological examination, consisting of automated quantitative cell count, Hemacolour stain, microscopic sediment survey and Gram stain, was evaluated regarding benefits and compared to effluent culture. Results Of 253 patients taken care of at the PD department, 250 patients (68% male, mean age 56±15 years at PD start) performing PD-only were included. In 662.7 years at risk, 155 episodes of peritonitis occurred (0.234 episodes per patient year). Gram stain detected in 52% a possible germ in culture-negative peritonitis (CNP), but only in 63% of culture-positive episodes (CPP). Ten episodes out of 41 CNP primarily showed eosinophilic granulocytes, with different characteristics regarding initial effluent leucocytes (568/µl), compared to neutrophilic CNP (1820/µl; p=0.199) and CPP episodes (8346/µl; p<0.001) and switch to hemodialysis (0%), compared to neutrophilic CNP (16.1%) and CPP (15.7%). CNP with positive results in Gram’s cytology, compared to CNP with negative result, showed a trend to higher initial leucocytes (2082/µl vs 1541/µl, p=0.892), longer time until leucocytes were below 100/µl (7.92 vs. 7.15 days, p=0.545) and more frequent switch to HD (18.7% vs 13.3%, p=0.686), although statistically not significant. Conclusion Microscopical analysis of Gram’s stain, recommended by the guidelines, can be used additionally for diagnosis and germ identification in peritoneal dialysis associated peritonitis. The centrum-specific standardized colour method detected in more than a half of CNP a germ und can be used as a guide to targeted therapy. Microscopy of the Hemacolor stain distinguished between eosinophilic and neutrophilic episodes, which differ in their characteristics, and therefore not only gives anamnestic-diagnostic information, but also suggests further treatment. Further studies are recommended