Reply to: ISPD 2022 recommendations for identification of causative organisms in peritonitis.

We thank Drs Bhave and Golper for their comments regarding the 2022 ISPD peritonitis guideline recommendations. As stated, for the diagnosis of peritoneal dialysis-associated peritonitis, the preferred culture method is direct inoculation of 5–10 mL of effluent into aerobic and anaerobic blood culture bottles at the bedside. This method generally has a high yield of culture-positive results as described in Table 1 of Dr Bhave and Golper’s letter. Both the BACTEC (Becton, Dickinson) and the BacT/Alert (bioMerieux) automated blood culture systems were used in the described studies. There are no data to suggest that any particular automated system is superior to others. Regarding alternative techniques to increase culture yield, we agree that the optimal method is centrifugation of 50 mL PD effluent at 3000 g for 15 min, followed by resuspension of the sediment in 3–5 mL supernatant and inoculation into blood culture bottles used in automated systems, as demonstrated in both the BACTEC (Becton, Dickinson) system and BacT/Alert (bioMerieux) system. We agree that culturing re-suspended sediment on solid media or liquid media that is not a component of an automated system is inferior and not a recommended method and hope the wording of our statement hasn’t caused confusion for other readers. This is a legacy of prior versions of the guideline in 2005, 2010 and 2016 and will be amended in future. Declaration of conflicting interests