Abstract: SA-PO458
Predictive Value of Gram Stain in Peritoneal Dialysis-Associated Peritonitis: Preliminary Results of a Single-Center Pilot Study
Session Information
- Home Dialysis - 2
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Chatragadda, Bhavya, University of Rhode Island, Kingston, Rhode Island, United States
- Raker, Christina A., Lifespan Health System, Providence, Rhode Island, United States
- Hu, Susie L., Brown University Warren Alpert Medical School, Providence, Rhode Island, United States
- Shah, Ankur, Brown University Warren Alpert Medical School, Providence, Rhode Island, United States
Background
Peritoneal dialysis-associated peritonitis (PDAP) is a common and serious complication in patients undergoing peritoneal dialysis (PD). Early diagnosis and appropriate treatment are crucial for optimal patient outcomes. Gram stain is a rapid diagnostic tool that may help guide initial treatment decisions. This pilot study aims to evaluate the ability of gram stain to predict culture results in PDAP.
Methods
This single-center, retrospective observational study included all adult patients with PDAP at our institution over a 5-year period (*** to (*** ). Electronic medical records were reviewed to collect data on peritoneal fluid gram stain and culture results at the time of peritonitis. Gram stain results were categorized as gram-positive, gram-negative, or no organisms seen. Culture results were considered the gold standard for diagnosis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of gram stain were calculated.
Results
A total of 56 patients with PDAP (n = 87 episodes) were included. The mean age was 54 years, and 62.5% were male. Median time on peritoneal dialysis was 1.2 years. Gram stain results showed 29.9% gram-positive, 16.1% gram-negative, 6.8% yeast/polymicrobial, and 47.1% no organisms seen. Culture results were positive in 69.3% of cases, with the most common organisms being coagulase-negative staphylococci (28.8%), Staphylococcus aureus (10.2%), and Klebsiella pneumoniae (10.2%). The overall sensitivity and specificity of gram stain for predicting culture results were 72.9% and 92.3%, respectively. The sensitivity for gram-positive was 79.3%, and for gram-negative, 63.2%. The PPV was 88.5% for gram-positive and 92.3% for gram-negative. The NPV was 89.8% for gram-positive and 90.3% for gram-negative organisms.
Conclusion
While we demonstrate a high sensitivity, specificity, PPV, and NPV of gram stain in predicting culture results it is important to exercise caution when interpreting gram stain results, as inappropriately narrowing antibiotic coverage based solely on gram stain findings can result in undertreatment. Our study provides preliminary information to support larger, multicentric trials to evaluate the potential of gram stain to decrease antibiotic exposure.