Variability in Culture-Negative Peritonitis Rates in Pediatric Peritoneal Dialysis Programs in the United States

Background and objectives International guidelines suggest a target culture-negative peritonitis rate of,15% amongpatients receiving long-termperitoneal dialysis. Through apediatricmulticenterdialysis collaborative, we identified variable rates of culture-negative peritonitis among participating centers. We sought to evaluate whether specific practices are associated with the variability in culture-negative rates between low- and high-culture-negative rate centers. Design, setting, participants,& measurements Thirty-twopediatric dialysis centerswithin the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) collaborative contributed prospective peritonitis data between October 1, 2011 and March 30, 2017. Clinical practice and patient characteristics were compared between centers with a #20% rate of culture-negative peritonitis (low-rate centers) and centers with a rate.20% (high-rate centers). In addition, centers completed a survey focused on center-specific peritoneal dialysis effluent culture techniques. ResultsDuringthe 5.5years of observation, 1113patients had1301 catheters placed, totaling19,025patientmonths. There were 620 episodes of peritonitis in 378 patients with 411 catheters; cultures were negative in 165 (27%) peritonitis episodes from 125 (33%) patients and 128 (31%) catheters. Low-rate centers more frequently placed catheterswith a downward-facing exit site and two cuffs (P,0.001), whereas high-rate centers hadmore patients performdialysis themselveswithout the assistance of an adult care provider (P,0.001). The survey demonstrated that peritoneal dialysis effluent culture techniques were highly variable across centers. No consistent practice or technique helped to differentiate low- and high-rate centers. ConclusionsCulture-negative peritonitis is a frequent complication ofmaintenance peritoneal dialysis in children. Despite published recommendations for dialysis effluent collection and culture methods, great variability in culture techniques and procedures exists among individual dialysis programs and respective laboratory processes.