CARI-Australia
November 2003 |
- Use of oral nystatin should be considered at the time of antibiotic administration to reduce the occurrence of fungal peritonitis. (Level II)
- Patients with diagnosis of peritonitis should commence with a combination of intraperitoneal antibiotics that cover gram-positive and gram-negative organisms. (Level II)
- No specific antibiotics; aminoglycosides should be avoided when possible. (Opinion) |
10. Treatment of peritoneal dialysis-associated fungal peritonitis
13. Treatment of peritoneal dialysis associated peritonitis in adults
Appendix 2 : Therapy combinations.
Appendix 4 : ISPD recommended antibiotic doses.
For rationale, each time read below the guidelines. |
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EBPG-Europe
2005 |
Confer to the ISPD-guidelines endorsed by EBPG (Evidence)
- Culture-negative peritonitis should not be greater than 20% of episodes.
- Minimum therapy duration for peritonitis is 2 weeks, more severe infections 3 weeks. (Opinion)
- S Aureus, gram-negative or enterococcal peritonitis are more severe: 3-week treatment. (Opinion)
- Patients with extremely cloudy effluent may benefit from addition of heparin to the fluid (Evidence)
- Cloudy effluent on day 4 or 5 points to refractory infection: the catheter should be removed. (Opinion)
- Catheter removal for relapsing peritonitis, refractory peritonitis, fungal peritonitis and refractory catheter infections. (Opinion)
- Empiric therapy must cover both gram-positive and gram-negative organisms, center-specific selection of therapy. (Evidence)
- Gram-positive organisms may be covered by vancomycin or a cephalosporin, and gram-negative by a third-generation cephalosporin or aminoglycoside. (Evidence
- For patients with residual renal function, the dose should be increased by 25% if antibiotics are renally excreted. (Opinion)
- Empirically a minimum period of 2-3 weeks between catheter removal and insertion is recommended. |
ISPD Guidelines/recommendations
For summary, see table 9, p 119: Indications for catheter removal for peritoneal dialysis- related infections.
For summary, see table 6, p 117: Intraperitoneal dose recommendations for CAPD patients
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Standard technique is blood-culture bottles but culturing after centrifuging of effluent is ideal
Opinion
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UK-Renal Association
Module 3B: Peritoneal Dialysis
2007 |
- Exit site infection is suggested by pain, swelling, crusting, erythema and serous discharge; purulent discharge always indicates infection. Swabs should be taken for culture and initial empiric therapy should be with oral antibiotics that will cover S. aureus and P. aeruginosa
- Methicillin resistant organisms (MRSA) will require systemic treatment (e.g vancomycin) and will need to comply with local infection control policies.
- Initial treatment regimens for peritonitis should include cover for bacterial Gram positive and Gram negative organisms until result of culture and antibiotic sensitivities are obtained.
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Infectious Complications: Treatment |
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