title: Early diagnosis of gram-negative peritonitis in continuous ambulatory peritoneal dialysis patients with the Lymulus amebocyte lysate assay.
abstract: The treatment of peritonitis in continuous ambulatory peritoneal dialysis patients is empiric until the bacteriological results are available. The Lymulus amebocyte lysate assay (LAL) is a very sensitive method for the detection of endotoxin, a structural component of gram-negative bacteria. We performed the LAL assay in a prospective study in 36 consecutive episodes of peritonitis. The LAL assay was positive in all 10 episodes of gram-negative peritonitis (100% specificity). Treatment directed specifically against gram-negative or -positive infection was started based on the LAL assay result. In 26 episodes with LAL-negative test, a gram-positive bacterium was cultured in 23 episodes, in 1 there was fungal infection and 2 were sterile. In summary: the LAL assay is a rapid (1 h) and sensitive method for the differentiation of gram-positive or -negative peritonitis and enables starting an immediate and more appropriate antibiotic therapy.
authors.affiliation: Department of Nephrology, Ichilov Hospital, Tel Aviv, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Peer
authors.forename: I
authors.initials: I
authors.lastname: Serban
authors.forename: M
authors.initials: M
authors.lastname: Blum
authors.forename: S
authors.initials: S
authors.lastname: Cabili
authors.forename: A
authors.initials: A
authors.lastname: Iaina
mesh_terms: D004731:Endotoxins / Q000032:analysis*; D005260:Female; D006090:Gram-Negative Bacteria; D006094:Gram-Positive Bacteria; D006801:Humans; D008033:Limulus Test; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D010538:Peritonitis / Q000175:diagnosis* / Q000382:microbiology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D004731:Endotoxins