Gel clot LAL assay in the initial management of peritoneal dialysis patients with peritonitis: A retrospective study Academic Article uri icon

abstract

  • ebocyte lysate assay may indicate the presence of fungus. This justifies early empiric antifungal treatment This may be avoided by improved diagnosis at pre- sentation. The Limulus amoebocyte lysate assay is a recommended. convenient test detecting bacterial endotoxins or fungal beta glucans. This study evaluates a qualitative Limulus Keywords: fungus; Gram-negative bacteria; Gram- amoebocyte lysate test as a diagnostic tool used positive bacteria; Limulus amoebocyte lysate (LAL) at presentation of a peritoneal dialysis patient with assay; peritoneal dialysis; peritonitis peritonitis. Methods. One-hundred and eleven episodes of periton- itis in peritoneal dialysis patients have been analysed Introduction retrospectively. Limulus amoebocyte lysate results at presentation were compared with culture results. A Peritonitis is the most frequent complication of periton- Limulus amoebocyte lysate assay was performed using eal dialysis (PD). Drop-outs from PD due to peritonitis a commercial kit by incubating a mixture of dialysate have been reduced by improved connection techniques. effluent and Limulus amoebocyte lysate reagent at Early and effective treatment of peritonitis preserves 37°C. The development of a stable solid clot was the peritoneum and prevents the development of considered positive. The specificity and sensitivity of fibrosis and adhesions eventually leading to dialysis the test were calculated. failure. Uncontrolled use of broad-spectrum antibiotics Results. The specificity of the Limulus amoebocyte may, however, have unwanted long-term effects such lysate assay was found to be 98% and the sensitivity as ototoxicity and reduction of residual renal function 74%. Limulus amoebocyte lysate assay was false- by aminoglycosides, or the development of resistant negative in 13 cases of Gram-negative peritonitis bacterial strains such as the vancomycin-resistant (22%). Limulus amoebocyte lysate was positive in three strains of Enterococci ( VRE) (1). The significance of of seven cases of fungal peritonitis. The study included an accurate diagnosis of the organism, therefore, goes one case each with false-positive Limulus amoebocyte beyond the immediate benefit for the patient presenting lysate and with culture-negative peritonitis. with peritonitis. Conclusions. The Limulus amoebocyte lysate assay is The early diagnosis of peritonitis is traditionally a convenient and valuable diagnostic tool for excluding based on clinical signs of peritoneal irritation, the Gram-positive peritonitis in peritoneal dialysis appearance of a cloudy peritoneal effluent or an patients. This allows more specific antibiotic treatment increased leucocyte count in the fluid. Antibiotic treat- at presentation and may avoid the development of ment has to be initiated before an accurate diagnosis bacterial resistance. A negative Limulus amoebocyte has been established based on bacterial culture of the lysate test is not reliable for the exclusion of Gram- dialysate effluent. Hence, treatment protocols initially negative peritonitis. In the absence of a positive culture recommend a combination of antibiotics covering both result 48 h after presentation, accompanied by a Gram-negative and Gram-positive organisms (2). delayed response to treatment, a positive Limulus amo- Reported sensitivities of Gram-staining vary between 9 and 80% in dialysate effluents and are, therefore, not

publication date

  • January 1, 2000