Exit-site
and tunnel infections
ü Defined
as presence of purulent drainage with or without erythema of skin at
catheter-epidermal interface.
ü Oral
antibiotic therapy is generally recommended, except MRSA
ü Pseudomonas
aeruginosa exit-site infections required two antibiotics: Oral fluoroquinolones and either IP aminoglycoside,
ceftazidime, cefepime, piperacillin, imipenem cilastatin or meropenem.
ü Continue
antibiotic therapy until exit site appears entirely normal, minimum length of
treatment time is 2 weeks. Infections caused by P. aeruginosa may need 3 weeks,
and earlier catheter removal should be considered.
Peritonitis
ü Peritoneal
dialysis patients presenting with cloudy effluent should be presumed to have
peritonitis. This is confirmed by obtaining effluent cell count, differential,
and culture.
ü Important
to initiate empiric antibiotic therapy for PD-associated peritonitis as soon as
possible to prevent serious consequences such as relapse, catheter removal,
permanent transfer to hemodialysis, and death.
ü Bacteremia
is uncommon in peritoneal dialysis-associated peritonitis. Infection is usually
localized in the peritoneum and few cell layers lining the peritoneal cavity and
intra-abominal viscera.
ü Empiric
antibiotics must cover both gram-positive and gram-negative organisms.
ü IP
administration is superior to IV dosing for treating peritonitis; intermittent
and continuous dosing of antibiotics are equally efficacious.
Indications
for catheter removal:
- Relapsing peritonitis
- Refractory peritonitis
- Refractory catheter infections
- Fungal or mycobacterial peritonitis
- Peritonitis occurring in association with intra-abdominal pathology
References:
1. ISPD
Guidelines / Recommendations. Peritoneal Dialysis-Related Infections
Recommendatins: 2010 Update.
2. UpToDate.
Microbiology and therapy of peritonitis in continuous peritoneal dialysis. http://www.uptodate.com
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