Clinical Pearls: PD-related peritonitis

One of the most common complications of peritoneal dialysis is peritonitis. Things to remember:

  • Diagnosis: Peritoneal fluid with >100 nucleated cells (usually >50% PMNs)
  • Pathophysiology: Skin-related (usually gram positive) vs. Secondary (enteric, usually gram-negative and polymicrobial)
  • Empiric treatment: Should cover gram positive and negative organisms. A frequently used combination is a first-generation cephalosporin (i.e. cefazolin) plus an anti-pseudomonal cephalosporin (i.e. cefepime). If the patient or population has a high frequency of methicillin-resistant organisms, vancomycin is a reasonable choice for gram-positive coverage.
  • Drug delivery: Intra-peritoneal (IP) preferred to intravenous (IV) route due to increased local concentration with IP. Vancomycin, aminoglycosides and cephalosporins can be mixed with dialysate solution and achieve therapeutic blood levels (must monitor closely)
  • Indications for catheter removal:

Screen Shot 2015-09-22 at 10.11.03 AM

Information based on ISPD 2005 guidelines for PD-related peritonitis