Peritoneal Dialysis (PD) Peritonitis
Peritoneal dialysis (PD) is a cost-effective, home-based treatment option for patients with end-stage renal disease; however, PD is declining in many countries. A major reason for this is peritonitis, which commonly leads to technique failure and has led to negative perceptions of PD by clinicians and patients - Samantha Warne
HWN Suggests
Peritonitis in Peritoneal Dialysis Patients: The Case for Rapid Diagnosis, Targeted Treatment, and Monitoring to Improve Outcomes
Currently, the assessment of infection has not advanced substantially since the times of Anton van Leeuwenhoek, Robert Koch, and Louis Pasteur, with reliance on microscopy and culture of patient specimens to confirm the diagnosis and guide appropriate treatment. This outdated approach has left the medical community with high incidences of culture-negative peritonitis in some units and relatively slow turnaround times. As a consequence, clinicians continue to rely on broad-spectrum empirical therapies, exposing patients to potentially unnecessary treatments with potential side effects, including the development and spread of antimicrobial resistance and high rates of long-term technique failure.
Articles of Interest
EM@3AM: Peritoneal Dialysis Emergencies
Peritonitis is common, occurring nearly annually for PD patients. Peritonitis predisposes PD patients to a myriad of further infections and mechanical complications.
Evaluation of the Empiric Treatment of Peritoneal Dialysis-Related Peritonitis
Intraperitoneal cefazolin plus intraperitoneal ceftazidime is an appropriate empiric antibiotic regimen for the treatment of peritoneal dialysis-related peritonitis at our hospital. There were no episodes of fungal peritonitis, therefore it is appropriate to continue our current practice of providing fluconazole prophylaxis at the discretion of the prescriber based on the patient’s risk factors for fungal peritonitis.
Incidence and clinical features of patients with peritoneal dialysis peritonitis complicated by bacteremia
For patients with PD peritonitis complicated by bacteremia, traditional management (intraperitoneal antibiotics combined with elective removal of the infected intraperitoneal catheter) may be inadequate.
Peritoneal Dialysis–Associated Peritonitis: Suggestions for Management and Mistakes to Avoid
Dual antibiotic regimens are recommended for empiric peritonitis treatment and include vancomycin or a first-generation cephalosporin to cover Gram-positive organisms and a third-generation cephalosporin or an aminoglycoside to cover Gram-negative organisms (including antipseudomonal activity).
Treatment for peritoneal dialysis‐associated peritonitis - Cochrane
Evidence was insufficient to identify the optimal agent, route or duration of antibiotics to treat peritonitis. No specific antibiotic appears to have superior efficacy for preventing treatment failure or relapse of peritonitis, but evidence is limited to few trials. The role of routine peritoneal lavage or urokinase is uncertain.
Resources
Kidney Research UK
There have been major improvements in the design of the tubing and connections used to deliver peritoneal dialysis fluid, but we still need better ways to prevent bacteria getting into the peritoneal cavity during PD exchanges.
