Peritoneal Infections in Peritoneal Dialysis (PD Peritonitis)

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 curriculumbased training, and continuous quality improvement efforts are important. We review epidemiology, microbiology, pathophysiology, clinical features, diagnosis, treatment, and prevention of PD peritonitis.