II. Incidence
- Once in 15 patient-months of Peritoneal Dialysis
III. Causes
- Complication of Peritoneal Dialysis
- Common
- Staphylococcus epidermidis (most common)
- Staphylococcus aureus
- Gram-negative bowel flora
- Other
- Pseudomonas aeruginosa
- Candida
- Tuberculosis
- Anaerobes
IV. Risk Factors
- Immunocompromised state
- Frequent daily dialysate exchanges
- Biofilm formation
- Hot and humid weather
V. Symptoms
VI. Signs
- Acute Abdomen with peritoneal signs may be present
VII. Labs
- Complete Blood Count
- Blood Cultures
- Dialysate culture
- Cultures typically grow Gram Positive skin flora as well as Gram Negative Bacteria
- Other infections include candida, Tb or Anaerobes
- Dilaysate exam and Gram Stain
- Cloudy dialysate
- Dialysate exam with >100 white cells and >50% PMNs
VIII. Management
- Start with repeated multiple rapid dialysate fluid exchanges
- Use Heparin 500 units/Liter dialysate with intraperitoneal Antibiotic
- Continue Antibiotics for 7 to 14 days
- First-line Intraperitoneal Antibiotic
- Cephalothin 200-500 mg/L of dialysate intraperitoneal or
- Gentamicin 8 mg/L of dialysate intraperitoneal followed by 4 mg/L subsequent intraperitoneal infusions
- Pretreat with Gentamicin IM or IV
-
MRSA suspected: Vancomycin IV and intraperitoneal (VRE risk)
- Vancomycin 15-25 mg/kg/L of dialysate intraperitoneal
- Pre-administer Vancomycin 1 gram IV load
-
Gram-Negative Bacteria suspected: Ceftazidime AND Aztreonam
- Ceftazidime 1 gram IV or intraperitoneal AND
- Aztreonam 3 grams IV or intraperitoneal
- Failure to improve
- Consider peritoneal catheter removal (consult with patient's nephrologist first)
- Consider adding Fluconazole if fungal infection suspected
IX. References
- Campana (2014) Crit Dec Emerg Med 28(4): 2-8
- Glauser (2013) Crit Dec Emerg Med 27(10): 2-12