Peritoneal Dialysis International, Vol. 30, pp. doi:10.3747/pdi.2009.00241 0896-8608/10 $3.00 + .00 Copyright © 2010 International Society for Peritoneal Dialysis 1 DISCORDANT PD CATHETER AND EFFLUENT CULTURE RESULTS. THE LIMITED CLINICAL RELEVANCE OF CULTURING PD CATHETERS Tom Cornelis, 1 Joanne M. Bargman, 1 Maggie Chu, 1 Antigone Oreopoulos, 2 Saimah Khan, 1 and Dimitrios G. Oreopoulos 1 Division of Nephrology, 1 University Health Network, University of Toronto, Toronto, Ontario; School of Public Health, 2 University of Alberta, Edmonton, Alberta, Canada Correspondence to: T. Cornelis, Division of Nephrology, University Health Network, University of Toronto, 200 Eliza- beth Street, Toronto, Ontario, M5G 2C4 Canada. tomcor77@gmail.com Received 28 November 2009; accepted 3 May 2010. ♦♦ ♦♦ ♦ Objectives: To determine if discordance in culture results between the effluent and the tip of the peritoneal catheter had an effect on outcome in patients whose peritoneal dialy- sis (PD) catheter was removed mostly for nonresolving peri- tonitis. Reasons for and outcomes of PD catheter removal were also analyzed. ♦♦ ♦♦ ♦ Methods: We retrospectively reviewed the charts of all PD patients with recent peritonitis for which the PD catheter was removed between 1 January 2003 and 30 April 2009. Data including basic demographics, the organism isolated from ef- fluent and from the PD catheter, reason for catheter removal, duration of hospitalization, and development of intra-ab- dominal collection were extracted as well as mortality within 8 weeks post removal and return to PD after catheter removal. ♦♦ ♦♦ ♦ Results: Fungal peritonitis was the most common reason for PD catheter removal. 20% of the patients developed an intra-abdominal collection. Mortality related to PD catheter removal was low (3/53; 5.6%). The patients (n =53) were divided into 3 groups: group 1 (n = 20) had the same culture result of effluent and catheter tip; group 2 (n = 19) had a negative culture of the catheter tip; and group 3 (n = 14) had different organism(s) growing from effluent and catheter tip. We found no remarkable differences in duration of PD, cath- eter age, peritonitis rate, or mortality. Patients in group 1 had significantly more fungal peritonitis than the other 2 groups. In only 4 of the 53 patients (7.5%), the anti-infec- tious management was changed according to the catheter culture result. ♦♦ ♦♦ ♦ Conclusions: Discordant results between catheter tip cul- ture and effluent culture did not have a significant impact on patient outcome. Sending PD catheters for culture has lim- ited clinical importance. Perit Dial Int 2010; 30:xx–xxx www.PDIConnect.com epub ahead of print: doi:10.3747/pdi.2009.00241 KEY WORDS: Outcome; peritonitis; peritoneal catheter removal. P eritonitis in patients on peritoneal dialysis (PD) is the leading cause of technique failure (1). It has been shown that 10% – 15% of peritonitis episodes necessi- tate PD catheter removal due to a variety of reasons (2,3). It has been suggested that, sometimes, early re- moval of the catheter during severe peritonitis to pre- vent denudation of the peritoneum might be an important measure to preserve membrane function and hence reduce the risk of encapsulating peritoneal scle- rosis (4). Risk factors for PD catheter removal and out- come of patients with peritonitis needing PD catheter removal have been studied previously (5,6). We have observed different results of catheter tip culture and ef- fluent culture in some of our patients that underwent catheter removal. We were interested to see whether this finding of different culture results had an impact on pa- tient outcome. MATERIALS AND METHODS We retrospectively reviewed the charts of all patients on PD with recent peritonitis for which the PD catheter was removed between 1 January 2003 and 30 April 2009 and for which the PD catheter was sent for culture. From those charts we extracted basic demographic data (age, gender, PD modality, presence of diabetes, cause of end- stage renal disease, duration of PD, and peritonitis rate), the organism isolated from effluent and from the PD catheter, the presence of coexistent exit-site infection (ESI), the reason for catheter removal, and the duration and choice of anti-infectious treatment. Our empirical antibiotic treatment for PD peritonitis included cefazolin and ceftazidime if the patient had residual urine out- put, and cefazolin–tobramycin if the patient did not have residual urine output. This empirical regime was subse- Page 1 of 6 Peritoneal Dialysis International PDI in Press. Published on June 17, 2010. doi:10.3747/pdi.2009.00241 by on October 17, 2011 www.pdiconnect.com Downloaded from