Role of Polymerase Chain Reaction in Peritoneal Dialysis Patients with Nonbacterial Peritonitis

Introduction: Culture-positive peritoneal dialysis (PD)-related peritonitis depends on proper sample collection and culture technique. Patients are investigated for fungal and tubercular peritonitis once the initial peritoneal effluent grows no bacteria and the patient is unresponsive to antimicrobials. However, they are diagnosed late in the course of illness and lead to irreversible peritoneal damage preventing reinsertion of PD catheter. The aim of the study was to assess the role of polymerase chain reaction (PCR) in diagnosis of fungal and Mycobacterium tuberculosis (MTB)-related peritonitis in patients on PD who presented with features of peritonitis. Materials and Methods: This was a prospective study and included patients who were diagnosed to have PD-related peritonitis as per the International Society of PD guidelines. All patients underwent panfungal and MTB complex (MTC) PCR of PD effluent on day 1 of admission. Results: Eighty-five patients with PD-related peritonitis were included in the study. In patients with no bacterial growth on PD fluid, panfungal PCR was positive in 22 (25.8%) patients and 2 (2.4%) patients had positive MTC PCR. Fungal organism could be isolated in 10 (11.7%) patients. Nine percent of patients with fungal peritonitis died. Conclusion: The use of PCR in patients with PD-related peritonitis will help in early diagnosis and management of fungal and tubercular peritonitis. It will also help in reducing mortality in these patients.