bacterial peritonitis associated with peritoneal dialysis

Etiology

• peritonitis associated with CAPD usually occurs secondary to unsterile exchange technique

Management

• most episodes are mild & may be treated on an outpatient basis
• hospitalization is indicated for patients with
  • sepsis
  • resistant or recurrent infections
  • suspicion of organ perforation or abscess formation
• peritoneal lavage/exchange
  • 2 rapid exchanges - dextrose solution only
  • exchanges every 1-2 hours until pain stops
  • antimicrobials + heparin 500 U/L
  • 4 exchanges QID for 14 days
  • antimicrobials + heparin 500 U/L
• peritoneal antimicrobials (in peritoneal lavage/exchange)
  • vancomycin 2 g. 1 dose/week.

+

• ceftazidime
  • loading dose of 500 mg/L
  • maintenence dose of 125 mg/L with each exchange

or

• aminoglycoside (doses for gentamicin)
  • 20 mg/L 1st exchange of day
  • 4-8 mg/L all other exchanges

More general terms

• secondary bacterial peritonitis (including tuberculous peritonitis)

Additional terms

• peritoneal dialysis; continuous abdominal/ambulatory (cycling) peritoneal dialysis (CAPD, CCPD)