Specimens from patients with a clinical suspicion of peritonitis were submitted to the clinical pathology service for microbiological assessment. The International Society for Peritoneal Dialysis advocates for urgent development of rapid diagnostics for PD peritonitis in its peritonitis treatment guidelines. Expert consensus dictates that the development of rapid, phenotypic antimicrobial susceptibility tests is a key pillar in managing antimicrobial resistance. Recent studies have shown the acceleration of the proliferation of antimicrobial resistance and its clinical consequences, with greater than 4 million deaths each year attributable to drug resistant infections. Cytokine based rapid detection methods (such as those measuring IL-6 and MMP8) have seen improvements for confirmation of infection, however such methods offer no prediction of antimicrobial susceptibility. Attempts have been made to utilize 16S PCR for confirmation of infection have been made, but range from between 61% and 82% sensitivity, and are plagued by unacceptably high false positive rates. Rationalizing patients to targeted effective narrow-spectrum antimicrobials rapidly is a key goal of care. Effective antimicrobial therapy is crucial to patient and technique survival in PD peritonitis patients, however dysbiosis caused by over-use of broad-spectrum antimicrobials can be equally harmful. Current pathology practice for patients with peritoneal dialysis (PD) associated peritonitis is based on microscopy (to enumerate leucocytes present in fluids) and microbial culture, is too slow to provide actionable pathology evidence in clinically relevant timelines, and it is widely accepted that as many as 20% of peritonitis cases will be culture negative and provide no useful information for guiding clinicians. We searched PubMed and medRxiv for research articles between July 6 th, 2020, and December 20 th, 2021, with no language restrictions, using the search times “peritoneal dialysis”, “peritonitis”, “rapid diagnostic”, “confirmation of infection”, “detection”, “antimicrobial susceptibility”, “AST”, and “flow cytometry”. The Lancet Regional Health – Western Pacific.The Lancet Regional Health – Southeast Asia.The Lancet Gastroenterology & Hepatology.
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