II. Incidence

  1. Once in 15 patient-months of Peritoneal Dialysis

III. Causes

  1. Complication of Peritoneal Dialysis
  2. Common
    1. Staphylococcus aureus
    2. Staphylococcus epidermidis
  3. Other
    1. Pseudomonas aeruginosa
    2. Candida
    3. Gram-negative bowel flora
    4. Tuberculosis
    5. Anaerobes

IV. Risk Factors

  1. Immunocompromised state
  2. Frequent daily dialysate exchanges
  3. Biofilm formation
  4. Hot and humid weather

VI. Signs

  1. Acute Abdomen with peritoneal signs may be present

VII. Labs

  1. Complete Blood Count
  2. Blood Cultures
  3. Dialysate culture
    1. Cultures typically grow Gram Positive skin flora as well as Gram Negative Bacteria
    2. Other infections include candida, Tb or Anaerobes
  4. Dilaysate exam and Gram Stain
    1. Cloudy dialysate
    2. Dialysate exam with >100 white cells and >50% PMNs

VIII. Management

  1. Start with repeated multiple rapid dialysate fluid exchanges
  2. Use Heparin 500 units/Liter dialysate with intraperitoneal antibiotic
  3. Continue antibiotics for 7 to 14 days
  4. First-line Intraperitoneal antibiotic
    1. Cephalothin 200-500 mg/L of dialysate intraperitoneal or
    2. Gentamicin 8 mg/L of dialysate intraperitoneal followed by 4 mg/L subsequent intraperitoneal infusions
      1. Pretreat with Gentamicin IM or IV
  5. MRSA suspected: Vancomycin IV and intraperitoneal (VRE risk)
    1. Vancomycin 15-25 mg/kg/L of dialysate intraperitoneal
    2. Pre-administer Vancomycin 1 gram IV load
  6. Gram-negative Bacteria suspected: Ceftazidime AND Aztreonam
    1. Ceftazidime 1 gram IV or intraperitoneal AND
    2. Aztreonam 3 grams IV or intraperitoneal
  7. Failure to improve
    1. Consider peritoneal catheter removal (consult with patient's nephrologist first)
    2. Consider adding Fluconazole if fungal infection suspected

IX. References

  1. Campana (2014) Crit Dec Emerg Med 28(4): 2-8
  2. Glauser (2013) Crit Dec Emerg Med 27(10): 2-12

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window