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Peritoneal Infections in Peritoneal Dialysis (PD Peritonitis)

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Nolph and Gokal's Textbook of Peritoneal Dialysis

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Abstract

Peritoneal dialysis (PD)-related infections include PD peritonitis, an important cause of morbidity, mortality, and failure of PD technique leading to a switch to hemodialysis in patients with end-stage renal disease. Others include catheter exit site infection (ESI) and tunnel infections (TI). Incidence of PD peritonitis varies per center characteristics and geography. PD fluid cell count and culture are essential for accurate diagnosis and identification of pathogens. Gram positive bacteria are the most common cause and enter the peritoneal cavity via touch contamination, followed by Gram negative bacteria and culture negative peritonitis. Fungal and atypical pathogens are less common. Bowel perforation must be ruled out in polymicrobial PD peritonitis. Empiric antibiotics should cover both Gram positive and Gram negative pathogens, preferably administered intra-peritoneally and based on institutional anti-biogram. Emerging drug resistance poses challenges as there is a paucity of pharmacokinetic and -dynamic data on newer antimicrobials. PD catheter removal is necessary for difficult to treat pathogens, tunnel infection, and refractory, recurrent, or serious infections. Prevention of infection by nasal decolonization of methicillin-resistant S. aureus, education on sterile technique and early recognition of symptoms and signs of PD peritonitis, implemented via a curriculum-based training, and continuous quality improvement efforts are important. We review epidemiology, microbiology, pathophysiology, clinical features, diagnosis, treatment, and prevention of PD peritonitis.

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Authors and Affiliations

  1. Department of Medicine – Divisions of Infectious Diseases and Pulmonary & Critical Care Medicine, University of Missouri, Columbia, MO, USA

    Hariharan Regunath

  2. Clinical Microbiology Lab, University of Missouri Hospital and Clinics, Columbia, MO, USA

    Hariharan Regunath

  3. Clinical Pharmacy Specialist – Medical Intensive Care Unit, University of Missouri Hospital and Clinics, Columbia, MO, USA

    Kyle Ludwig

  4. School of Medicine Department of Medicine, Division of Nephrology, Health Sciences Center, Columbia, MO, USA

    Ramesh Khanna

  5. Department of Pulmonary and Critical Care Medicine, University of Maryland-Baltimore Washington Medical Center, Glen Burnie, MD, USA

    Hariharan Regunath

Authors
  1. Hariharan Regunath
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  2. Kyle Ludwig
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  3. Ramesh Khanna
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Correspondence to Hariharan Regunath .

Editor information

Editors and Affiliations

  1. University of Missouri, Columbia, MO, USA

    Ramesh Khanna

  2. Dept. Medicine Div. Nephrology, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands

    Raymond T. Krediet

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Regunath, H., Ludwig, K., Khanna, R. (2023). Peritoneal Infections in Peritoneal Dialysis (PD Peritonitis). In: Khanna, R., Krediet, R.T. (eds) Nolph and Gokal's Textbook of Peritoneal Dialysis. Springer, Cham. https://doi.org/10.1007/978-3-030-62087-5_49

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  • DOI: https://doi.org/10.1007/978-3-030-62087-5_49

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  • Online ISBN: 978-3-030-62087-5

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