Ishizaki M, Oikawa K, Miyashita E
Usefulness of endotoxin test for assessing CAPD
peritonitis by gram-negative organisms
XVIth Annual CAPD Conference
Perit Dial Int Suppl 2
(Feb) 16:S40 1996
These investigators measured endotoxin levels in spent dialysate with the
Limulus assay in 11
peritonitis episodes. 5/11 dialysate samples were endotoxin positive, and in
each case the
peritonitis was due to a gram negative infection. In the remaining 6
patients dialysate endotoxin
samples were negative. Two had Streptococcus cultured from the fluid
and were 4
culture-negative. Patients were all treated with appropriate protocols
depending on the endotoxin
results. All were treated successfully.
Comment: The usefulness of this approach is questionable. The authors
at best saved 2 days
of unnecessary second antibiotic before the microbiological tests were
available. The Limulus
assay for endotoxin is a relatively costly assay and I would not recommend it
to replace
microbiological cultures. The value of serial endotoxin tests to evaluate
the success of therapy of
gram negative peritonitis is not convincingly demonstrated in the abstract.
(Stephen I. Vas, M.D.)
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XVIth Annual CAPD Conference
Basic peritoneal dialysis :
Peritonitis and exit-site infection