Routine Daily Surveillance Cultures in the Management of C.A.P.D. Patients

The authors collected 3876 daily specimens of dialysate for bacteriological culture from II patients on CAPD over a period of 155 patient treatment months. During the trial period, there were 30-culture positive episodes of peritonitis. In 16 (530;”) of the episodes there was a latent interval of 72 hours or less between the presence of organisms in the dialysate and the clinical onset of peritonitis. However, 153 positive cultures were unrelated to ari episode of peritonitis. Most asymptomatic positive cultures, therefore, do not progress to peritonitis. There were eight episodes of “recurrent” peritonitis. In six of these, although initially the dialysate was rendered sterile and the patient asymptomatic by antibiotics the pathogenic organism was isolated again from dialysate on more than one occasion, during continued antibiotic administration. In six of these cases, a second episode of peritonitis due to the same organism recurred within 20 days of discontinuing antibiotics suggesting that most episodes of “recurrent” peritonitis represent treatment failure, rather than reinfection.