View source for Peritoneal dialysis-associated peritonitis

==Background==

===Microbiology===

*Gram-positive bacteria (45%)
**[[Coagulase-negative staphylococci]]
**[[Staphylococcus aureus]]
**[[Streptococci]]
**[[Diphtheroids]]
*[[Gram-negative bacteria]] (15%), especially if underlying GI pathology
*Mixed bacterial (1-2%)
*Fungal (1%), particularly [[Candida]]
*[[Tuberculosis]] (<1%)

===Pathophysiology===

*Acquired from catheter, exit site, dialysate fluid, or transmural migration

=== Epidemiology ===

* On average one episode per patient per year

==Clinical Manifestations==

*[[Peritonitis]], with diffuse abdominal pain and tenderness and cloudy or purulent dialysate
*Often afebrile
*Dialysate may have elevated WBCs >100 cells/mcL with >50% neutrophils

== Diagnosis ==

* Aspirate dialysate, then centrifuge and inoculate into blood culture bottles (for both aerobic and anaerobic organisms)

==Management==

*Empiric treatment should cover [[coagulase-negative staphylococci]] and gram-negatives, so [[vancomycin]] plus [[ceftriaxone]] or [[ceftazidime]] would be reasonable
*Intraperitoneal antibiotics are preferred unless systemic infection or bacteremia
*May attempt to salvage the catheter, especially for less virulent organisms like [[coagulase-negative staphylococci]]
*Indications for catheter removal include
**Difficult-to-treat organisms ([[Candida]], [[Staphylococcus aureus]], resistant Gram-negatives like [[Pseudomonas]] or [[Stenotrophomonas]])
**Bowel perforation
**Relapse with same organism within a month
**Clinical failure despite 5 days of appropriate antibiotics
**Exit site infection
*Duration 14 to 21 days, or 1 week after catheter removal

== Further Reading ==

* ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment. ''Perit Dial Int''. 2016;36:481. doi: [https://doi.org/10.3747/pdi.2016.00078 10.3747/pdi.2016.00078]

[[Category:Infectious syndromes]]
[[Category:Nephrology]]