Peritonitis in peritoneal dialysis

19 Aug

Etiology

Due to contamination with pathogenic skin bacteria or catheter-related infection;

less commonly secondary peritonitis due to underlying GI tract pathology (cholecystitis, appendicitis, etc.)

 

Presentation

  • Abdominal pain (79-88%),
  • cloudy peritoneal effluent (84%),
  • fever (29-53%),
  • nausea (31-51%)

Patient with secondary peritonitis are more likely to have systemic manifestations of sepsis

 

Laboratory Findings

Peritoneal fluid cell count > 100 cells/mm3

*approximately 10% of patients with bacterial peritonitis have WBC counts below 100…among this group, >50% PMN strongly suggests peritonitis, independent of the WBC

Peripheral WBC often elevated as well

80-95% of cases have positive peritoneal fluid cultures, blood cultures are generally negative

 

Treatment

Typical organisms:

  • E. coli (43%)
  • Other strep (19%)
  • Klebsiella pneumonia (11%)
  • Miscellaneous (10%)
  • Streptococcus pneumonia (9%)

Antibiotic of choice = cefotaxime 2g IV q 8 hours (or other third generation cephalosporin)

Second line = Levofloxacin (doesn’t penetrate into ascites fluid to the same extent)

 

Submitted by Kelly Estes.

 

Reference: uptodate.com; picture

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