The Diagnostic Value of Gram Stain for Initial Identification of the Etiologic Agent of Peritonitis in Capd Patients

• DOI: 10.1177/089686089701700310
• Publication Date: 2020-02-24T11:18:14Z
• Authors: Dinoráh A. Bezerra; Mario B. Silva; Jaqueline S.T. Ca...; Maria F. Sugizaki; Teruê Sadatsune; Augusto C. Montelli; Pasqual Barretti
• Keywords: gram positive bacterium; retrospective study; bacterium culture; continuous ambulatory peritoneal dialysis; bacterial growth; Peritonitis; Sensitivity and Specificity; bacterial peritonitis; 03 medical and health sciences; Peritoneal Dialysis, Continuous Ambulatory; Evaluation Studies; Humans; human; Gram-Positive Bacterial Infections; Retrospective Studies; 0303 health sciences; nonhuman; Staining and Labeling; 303; major clinical study; 3. Good health; priority journal; Evaluation Studies as Topic; Gram stain; Continuous Ambulatory; Phenazines; diagnostic accuracy; Gentian Violet; diagnostic value; gram staining; Gram-Negative Bacterial Infections; gram negative bacterium; Peritoneal Dialysis

Objective To evaluate the effectiveness of the Gram stain in the initial diagnosis of the etiologic agent of peritonitis in continuous ambulatory peritoneal dialysis (CAPD). Design Retrospective study analyzing the sensitivity (S), specificity (SS), positive predictive value (+PV), and negative predictive value (-PV) of the Gram stain relating to the results of cultures in 149 episodes of peritonitis in CAPD. The data were analyzed in two studies. In the first, only the cases with detection of a single agent by Gram stain were taken (Study 1). In the second, only the cases with two agents in Gram stain were evaluated (Study 2). Setting Dialysis Unit and Laboratory of Microbiology of a tertiary medical center. Patients Sixty-three patients on regular CAPD who presented one or more episodes of peritonitis from May 1992 to May 1995. Results The positivity of Gram stain was 93.2% and the sensitivity was 95.7%. The values of S, SS, +PV, and -PV were respectively: 94.9%, 53.5%, 68.3%, and 90.9% for gram -positive cocci and 83.3%, 98.8%, 95.2%, and 95.6% for gram-negative bacilli. The association of grampositive cocci plus gram -negative bacilli were predictive of growth of both in 6.8%, growth of gram -positive cocci in 13.7%, and growth of gram -negative bacilli in 72.5%. Conclusions The Gram stain is a method of great value in the initial diagnosis of the etiologic agent of peritonitis in CAPD, especially for gram-negative bacilli.