Peritoneal dialysis-associated peritonitis: Difference between revisions
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===Microbiology=== |
===Microbiology=== |
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*Gram-positive bacteria (45%) |
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*[[Coagulase-negative staphylococci]] |
**[[Coagulase-negative staphylococci]] |
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*[[Staphylococcus aureus]] |
**[[Staphylococcus aureus]] |
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*[[Streptococci]] |
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*[[ |
**[[Streptococci]] |
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**[[Diphtheroids]] |
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*[[Gram-negative bacteria]], if underlying GI pathology |
*[[Gram-negative bacteria]] (15%), especially if underlying GI pathology |
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*Mixed bacterial (1-2%) |
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*Fungal (1%), particularly [[Candida]] |
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*[[Tuberculosis]] (<1%) |
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===Pathophysiology=== |
===Pathophysiology=== |
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*[[Peritonitis]], with diffuse abdominal pain and tenderness and cloudy or purulent dialysate |
*[[Peritonitis]], with diffuse abdominal pain and tenderness and cloudy or purulent dialysate |
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*Often afebrile |
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*Typically no fever |
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*Dialysate may have elevated WBCs >100 cells/mcL with >50% neutrophils |
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== Diagnosis == |
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* Aspirate dialysate, then centrifuge and inoculate into blood culture bottles (for both aerobic and anaerobic organisms) |
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==Management== |
==Management== |
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*Empiric treatment should cover [[coagulase-negative staphylococci]] and gram-negatives, so [[vancomycin]] plus [[ceftriaxone]] or [[ceftazidime]] would be reasonable |
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*Intraperitoneal antibiotics are preferred unless systemic infection or bacteremia |
*Intraperitoneal antibiotics are preferred unless systemic infection or bacteremia |
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*May attempt to salvage the catheter, especially for less virulent organisms like [[coagulase-negative staphylococci]] |
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*Indications for catheter removal include |
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**Difficult-to-treat organisms ([[Candida]], [[Staphylococcus aureus]], resistant Gram-negatives like [[Pseudomonas]] or [[Stenotrophomonas]]) |
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**Bowel perforation |
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**Relapse with same organism within a month |
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**Clinical failure despite 5 days of appropriate antibiotics |
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**Exit site infection |
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*Duration 14 to 21 days, or 1 week after catheter removal |
*Duration 14 to 21 days, or 1 week after catheter removal |
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== Further Reading == |
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* 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] |
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* ISPD Catheter-Related Infection Recommendations: 2017 Update. ''Perit Dial Int''. 2017;37:141-154. doi: [https://doi.org/10.3747/pdi.2016.00120 10.3747/pdi.2016.00120] |
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** Focuses on exit site infections |
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[[Category:Infectious syndromes]] |
[[Category:Infectious syndromes]] |
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Latest revision as of 14:14, 3 June 2021
Background
Microbiology
- Gram-positive bacteria (45%)
- 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: 10.3747/pdi.2016.00078
- ISPD Catheter-Related Infection Recommendations: 2017 Update. Perit Dial Int. 2017;37:141-154. doi: 10.3747/pdi.2016.00120
- Focuses on exit site infections
