Association of Local Unit Sampling and Microbiology Laboratory Culture Practices With the Ability to Identify Causative Pathogens in Peritoneal Dialysis-Associated Peritonitis in Thailand

Talerngsak Kanjanabuch; Tanittha Chatsuwan; Nibondh Udomsantisuk; Tanawin Nopsopon; Pongpratch Puapatanakul; Guttiga Halue; Pichet Lorvinitnun; Kittisak Tangjittrong; Surapong Narenpitak; Chanchana Boonyakrai; Sajja Tatiyanupanwong; Rutchanee Chieochanthanakij; Worapot Treamtrakanpon; Uraiwan Parinyasiri; Niwat Lounseng; Phichit Songviriyavithaya; Suchai Sritippayawan; Somchai Eiam-Ong; Kriang Tungsanga; David W Johnson; Bruce Robinson; Jeffrey Perl; Thailand PDOPPS steering teams

doi:10.1016/j.ekir.2021.01.010

Association of Local Unit Sampling and Microbiology Laboratory Culture Practices With the Ability to Identify Causative Pathogens in Peritoneal Dialysis-Associated Peritonitis in Thailand

Kidney Int Rep. 2021 Feb 2;6(4):1118-1129. doi: 10.1016/j.ekir.2021.01.010. eCollection 2021 Apr.

Authors

Talerngsak Kanjanabuch^{1

2

3}, Tanittha Chatsuwan^{4

5}, Nibondh Udomsantisuk⁵, Tanawin Nopsopon⁶, Pongpratch Puapatanakul¹, Guttiga Halue⁷, Pichet Lorvinitnun⁸, Kittisak Tangjittrong⁹, Surapong Narenpitak¹⁰, Chanchana Boonyakrai¹¹, Sajja Tatiyanupanwong¹², Rutchanee Chieochanthanakij¹³, Worapot Treamtrakanpon¹⁴, Uraiwan Parinyasiri¹⁵, Niwat Lounseng¹⁶, Phichit Songviriyavithaya¹⁷, Suchai Sritippayawan¹⁸, Somchai Eiam-Ong¹, Kriang Tungsanga¹, David W Johnson^{19

20

21}, Bruce Robinson²², Jeffrey Perl²³; Thailand PDOPPS steering teams

Collaborators

Thailand PDOPPS steering teams:
Kearkiat Praditpornsilpa, Areewan Cheawchanwattana, Piyaporn Towannang, Kanittha Triamamornwooth, Nisa Thongbor, Nipa Aiyasanon, Donkum Kaewboonsert, Pensri Uttayotha, Wichai Sopassathit, Salakjit Pitakmongkol, Ussanee Poonvivatchaikarn, Bunpring Jaroenpattrawut, Somphon Buranaosot, Sukit Nilvarangkul, Warakoan Satitkan, Wanida Somboonsilp, Pimpong Wongtrakul, Ampai Tongpliw, Anocha Pullboon, Montha Jankramol, Apinya Wechpradit, Chadarat Kleebchaiyaphum, Wadsamon Saikong, Worauma Panya, Siriwan Thaweekote, Sriphrae Uppamai, Jarubut Phisutrattanaporn, Sirirat Sirinual, Setthapon Panyatong, Puntapong Taruangsri, Boontita Prasertkul, Thanchanok Buanet, Panthira Passorn, Rujira Luksanaprom, Angsuwarin Wongpiang, Metinee Chaiwut, Ruchdaporn Phaichan, Peerapach Rattanasoonton, Wanlaya Thongsiw, Narumon Lukrat, Sayumporn Thaitrng, Yupha Laoong, Niparat Pikul, Navarat Rukchart, Korawee Sukmee, Wandee Chantarungsri

Affiliations

¹ Division of Nephrology, Department of Medicine Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
² Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
³ Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
⁴ Antimicrobial Resistance and Stewardship Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁵ Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁶ Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁷ Department of Medicine, Phayao Hospital, Phayao, Thailand.
⁸ Department of Medicine, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand.
⁹ Department of Medicine, Pranangklao Hospital, Nonthaburi, Thailand.
¹⁰ Department of Medicine, Udonthani Hospital, Udon Thani, Thailand.
¹¹ Department of Medicine, Taksin Hospital, Bangkok Metropolitan Administration, Bangkok, Thailand.
¹² Department of Medicine, Chaiyaphum Hospital, Chaiyaphum, Thailand.
¹³ Department of Medicine, Sawanpracharak Hospital, Nakhon Sawan, Thailand.
¹⁴ Department of Medicine, Chaophya Abhaiphubejhr Hospital, Prachin Buri, Thailand.
¹⁵ Department of Medicine, Songkhla Hospital, Songkhla, Thailand.
¹⁶ Department of Medicine, Trang Hospital, Trang, Thailand.
¹⁷ Department of Medicine, Amnatcharoen Hospital, Amnatcharoen, Thailand.
¹⁸ Division of Nephrology, Department of Internal Medicine, Siriraj Hospital, Bangkok, Thailand.
¹⁹ Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
²⁰ Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.
²¹ Translational Research Institute, Brisbane, Queensland, Australia.
²² Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
²³ St. Michael's Hospital, Toronto, Ontario, Canada.

Abstract

Introduction: This describes variations in facility peritoneal dialysis (PD) effluent (PDE) culture techniques and local microbiology laboratory practices, competencies, and quality assurance associated with peritonitis, with a specific emphasis on factors associated with culture-negative peritonitis (CNP).

Methods: Peritonitis data were prospectively collected from 22 Thai PD centers between May 2016 and October 2017 as part of the Peritoneal Dialysis Outcomes and Practice Patterns Study. The first cloudy PD bags from PD participants with suspected peritonitis were sent to local and central laboratories for comparison of pathogen identification. The associations between these characteristics and CNP were evaluated.

Results: CNP was significantly more frequent in local laboratories (38%) compared with paired PDE samples sent to the central laboratory (12%, P < 0.05). Marked variations were observed in PD center practices, particularly with respect to specimen collection and processing, which often deviated from International Society for Peritoneal Dialysis Guideline recommendations, and laboratory capacities, capabilities, and certification. Lower rates of CNP were associated with PD nurse specimen collection, centrifugation of PDE, immediate transfer of samples to the laboratory, larger hospital size, larger PD unit size, availability of an on-site nephrologist, higher laboratory capacity, and laboratory ability to perform aerobic cultures, undertake standard operating procedures in antimicrobial susceptibilities, and obtain local accreditation.

Conclusion: There were large variations in PD center and laboratory capacities, capabilities, and practices, which in turn were associated with the likelihood of culturing and correctly identifying organisms responsible for causing PD-associated peritonitis. Deviations in practice from International Society for Peritoneal Dialysis guideline recommendations were associated with higher CNP rates.

Keywords: ISPD guideline; culture-negative peritonitis; lab practice; microbiology; peritonitis.