PD RELATED INFECTIONS

• PERITONITIS

• CATHETER RELATED INFECTIONS

 EXIT SITE INFECTION (ESI)

 TUNNEL INFECTIONS
 ISPD GUIDELINES
• FIRST PUBLISHED IN 1983

• REVISED IN 1993, 1996, 2000, 2005, 2010 & 2016.

• GUIDELINES PUBLISHED UNDER 5 HEADINGS

 Peritonitis Rate
 Prevention
 Initial Presentation And Management
 Subsequent Management
 Future Research
 • Peritonitis remains the Achilles heel of
peritoneal dialysis
• Incidence

80’s and early 90’s 1.3/patient/yr

Late 90’s and beyond 1/patient/2yrs • Y set – Flush before fill
• Double bag disconnect
system
• Doubled cuff catheter

ISPD and Ad Hoc Advisory Committee on Peritoneal Dialysis Related Infections

(Piraino et al., 2005) that all centers calculate and track their peritonitis rates
PATHOGENESIS
Aetiology
Diagnosis 2/3
1. Symptoms and signs of peritoneal inflammation
2. Cloudy fluid with count > 100/mcl with PMNLs > 50%
3. Demonstration of bacteria in effluent by Gm stain or C/S

Fluid storage
< 3-5 hr
 Intermittent dosing CAPD

Per exchange once daily

Cefazolin 15 mg/kg
Ceftazidime 1-1.5 g
Amikacin 2mg/kg
Gentamycin 0.6 mg/kg
Vancomycin 15-30 mg/kg q 5-7 days
Begin to improve 12-48 hr
Repeat cell count 48 hr
Gm positive Single antibiotic
Staph epidemidis, Staph aureus, Strep
Enterococcus Ampicillin/Vanco plus Aminiglycosides
Duration 2weeks
Some add 5 day oral cephalosporin
Gram negative Duration : 3 weeks
Non pseudomonas Single
Pseudomonas Double
Catheter removal p/o or Iv for 2 weeks
Refractory

No improvement in 5 day appropriate

Abx
USG/CT/Gallium Scan Intraabdominal Abscess
Consider Catheter removal
Catheter may be reinserted 4-6 weeks
Only half will be functional.

Relapsing Peritonitis with same organism within 4

weeks of t/t
Causes • S. Epidermidis
• Gm neg
• Relapsing culture negative peritonitis
Catheter removal with or without surgical
exploration
STK, Urokinase : Trap bacteria in fibrin
Prophylactic abx in
Catheter Placement Vanco/ cefazolin
Technique break Vanco
Nasal colonisation of staph Mupirocin