Review of Peritonitis Associated with Peritoneal Dialysis Management
Main Article Content
Abstract
One frequent and serious side effect of peritoneal dialysis (PD) is peritonitis. Following the acquisition of the necessary microbiologic specimens, empirical antibiotic therapy covering both Gram-positive and Gram-negative organisms (including Pseudomonas species) should be initiated when a patient on PD exhibits clinical signs consistent with PD-associated peritonitis. The best administration route is intraperitoneal. To stop subsequent fungal peritonitis, antifungal prophylaxis should be administered, ideally in the form of oral nystatin. Antibiotic therapy can be modified in accordance with the results of the PD effluent Gram stain or culture and sensitivity tests. The most recent ISPD guidelines include a thorough explanation of how each antibiotic should be used. Antibiotics are often used for two to three weeks, depending on the particular organisms that are being treated. For refractory, relapsing, or fungal peritonitis, catheter removal and interim hemodialysis support are advised. Following full resolution of the peritonitis, a new PD catheter may be placed in certain individuals. Refractory exit site or tunnel infections should also be taken into consideration while removing PD catheters. The use of PD as a first-line dialysis modality is supported by a global trend of declining PD-associated peritonitis rates following improvements in clinical management.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Davenport, A. (2009). Peritonitis remains the major clinical complication of peritoneal dialysis: the London, UK, peritonitis audit 2002–2003. Peritoneal Dialysis International, 29(3), 297-302.
II. Szeto, C. C., & Li, P. K. T. (2019). Peritoneal dialysis–associated peritonitis. Clinical Journal of the American Society of Nephrology: CJASN, 14(7), 1100.
III. Brown, E. A., Blake, P. G., Boudville, N., Davies, S., de Arteaga, J., Dong, J., ... & Warady, B. (2020). International Society for Peritoneal Dialysis practice recommendations: Prescribing high-quality goal-directed peritoneal dialysis. Peritoneal Dialysis International, 40(3), 244-253.
IV. Balzer, M. S., Claus, R., Haller, H., & Hiss, M. (2019). Are ISPD guidelines on peritonitis diagnosis too narrow? A 15-year retrospective single-center cohort study on PD-associated peritonitis accounting for untrained patients. Peritoneal Dialysis International, 39(3), 220-228.
V. Fiore, M., Di Franco, S., Alfieri, A., Passavanti, M. B., Pace, M. C., Kelly, M. E., ... & Leone, S. (2019). Spontaneous bacterial peritonitis caused by Gram-negative bacteria: an update of epidemiology and antimicrobial treatments. Expert Review of Gastroenterology & Hepatology, 13(7), 683-692.
VI. Berger, D., & Buttenschoen, K. (1998). Management of abdominal sepsis. Langenbeck's archives of surgery, 383, 35-43.
VII. Roosendaal, R. O. B. E. R. T., Bakker-Woudenberg, I. A., van den Berghe-van Raffe, M. A. R. I. O. N., & Michel, M. F. (1986). Continuous versus intermittent administration of ceftazidime in experimental Klebsiella pneumoniae pneumonia in normal and leukopenic rats. Antimicrobial agents and chemotherapy, 30(3), 403-408.
VIII. Johnson, C. A. (1991). Intraperitoneal vancomycin administration. Peritoneal dialysis international, 11(1), 9-11.
IX. Li, P. K. T., Chow, K. M., Cho, Y., Fan, S., Figueiredo, A. E., Harris, T., ... & Johnson, D. W. (2022). ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Peritoneal Dialysis International, 42(2), 110-153.
X. Yang, C. Y., Chen, T. W., Lin, Y. P., Lin, C. C., Ng, Y. Y., Yang, W. C., & Chen, J. Y. (2008). Determinants of catheter loss following continuous ambulatory peritoneal dialysis peritonitis. Peritoneal dialysis international, 28(4), 361-370.
XI. Piraino, B. (2000). Peritoneal infections. Advances in Renal Replacement Therapy, 7(4), 280-288.
XII. Htay, H., Cho, Y., Pascoe, E. M., Darssan, D., Hawley, C., Clayton, P. A., ... & Johnson, D. W. (2017). Outcomes of Corynebacterium peritonitis: a multicenter registry analysis. Peritoneal Dialysis International, 37(6), 619-626.