Peritoneal dialysis-associated peritonitis - Revision history

Elcatracho: /* See Also */

2021-02-23T20:43:12Z

2021-01-27T20:10:33Z

Differential Diagnosis

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	*Specimen taken from “dry” abdomen		*Specimen taken from “dry” abdomen

	{{~~Ascites~~ DDX}}		{{DDX abdominal distention}}

	==Evaluation==		==Evaluation==

2021-01-27T20:09:33Z

Differential Diagnosis

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	==Differential Diagnosis==		==Differential Diagnosis==
	*[[Abdominal pain]] standard differential also applies to patients with peritoneal dialysis in addition to concern for peritonitis		''[[Abdominal pain]] standard differential also applies to patients with peritoneal dialysis, in addition to concern for peritonitis ''
	{{Dialysis complications DDX}}		{{Dialysis complications DDX}}

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	*Chylous effluent (rare)		*Chylous effluent (rare)
	*Specimen taken from “dry” abdomen		*Specimen taken from “dry” abdomen

			{{Ascites DDX}}

	==Evaluation==		==Evaluation==

2020-01-03T14:23:00Z

Evaluation

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	==Evaluation==		==Evaluation==
	*Send dialysate fluid for cell count, Gram stain, culture (if available)		*Send dialysate fluid for cell count, Gram stain, culture (if available)
	**Cell count >100/mm with >50% neutrophils most consistent with infection<ref>ISPD GUIDELINES/RECOMMENDATIONS http://www.ispd.org/guidelines/articles/update/ispdperitonitis.pdf</ref>		**Cell count >100/mm<sup>3</sup> with >50% neutrophils most consistent with infection<ref>ISPD GUIDELINES/RECOMMENDATIONS http://www.ispd.org/guidelines/articles/update/ispdperitonitis.pdf</ref>

	===Special Considerations===		===Special Considerations===

2019-01-18T22:01:27Z

Management

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	==Management==		==Management==
	~~===Empiric Therapy (IP)===~~		{{Peritoneal dialysis peritonitis antibiotics}}
	~~;10- to 14-day course of intraperitoneal (IP) antibiotics that are administered by the patient on an outpatient basis or IV antibiotics and intraperitoneal for admitted patients~~
	{{Peritoneal ~~Dialysis Peritonitis Antibiotics~~}}
	*Catheter removal/exchange is usually only done if IP antibiotics fail (fungal, pseudomonal), and should be done in consultation with a nephrologist<ref>Akoh JA. Peritoneal dialysis associated infections: An update on diagnosis and management. World J Nephrol. 2012 Aug 6; 1(4): 106–122.</ref>

	~~===Empiric Tharapy (IV)===~~
	Although IP antibiotics are preferred IV antibiotics can be considered with coordination with nephrology for dosing. Coverage should be the same as IP antibiotics <ref>Manley HJ, Bailie GR, Frye RF, McGoldrick MD. Intravenous vancomycin pharmacokinetics in automated peritoneal dialysis patients. Perit Dial Int 2001;21 :378-85</ref><ref>Wong et al. Intravenous Antibiotics with Adjunctive Lavage in Refractory Peritonitis. Intravenous Antibiotics with Adjunctive Lavage in Refractory Peritonitis</ref>

	==Disposition==		==Disposition==

2018-10-10T21:14:30Z

Empiric Therapy (IP)

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	;10- to 14-day course of intraperitoneal (IP) antibiotics that are administered by the patient on an outpatient basis or IV antibiotics and intraperitoneal for admitted patients		;10- to 14-day course of intraperitoneal (IP) antibiotics that are administered by the patient on an outpatient basis or IV antibiotics and intraperitoneal for admitted patients
	{{Peritoneal Dialysis Peritonitis Antibiotics}}		{{Peritoneal Dialysis Peritonitis Antibiotics}}
	*Catheter removal/exchange is usually only done if IP antibiotics fail, and should be done in consultation with a nephrologist<ref>Akoh JA. Peritoneal dialysis associated infections: An update on diagnosis and management. World J Nephrol. 2012 Aug 6; 1(4): 106–122.</ref>		*Catheter removal/exchange is usually only done if IP antibiotics fail (fungal, pseudomonal), and should be done in consultation with a nephrologist<ref>Akoh JA. Peritoneal dialysis associated infections: An update on diagnosis and management. World J Nephrol. 2012 Aug 6; 1(4): 106–122.</ref>

	===Empiric Tharapy (IV)===		===Empiric Tharapy (IV)===

2018-10-10T21:10:07Z

Management

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	;10- to 14-day course of intraperitoneal (IP) antibiotics that are administered by the patient on an outpatient basis or IV antibiotics and intraperitoneal for admitted patients		;10- to 14-day course of intraperitoneal (IP) antibiotics that are administered by the patient on an outpatient basis or IV antibiotics and intraperitoneal for admitted patients
	{{Peritoneal Dialysis Peritonitis Antibiotics}}		{{Peritoneal Dialysis Peritonitis Antibiotics}}
			*Catheter removal/exchange is usually only done if IP antibiotics fail, and should be done in consultation with a nephrologist<ref>Akoh JA. Peritoneal dialysis associated infections: An update on diagnosis and management. World J Nephrol. 2012 Aug 6; 1(4): 106–122.</ref>

	===Empiric Tharapy (IV)===		===Empiric Tharapy (IV)===

2018-01-10T21:03:12Z

Disposition

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	==Disposition==		==Disposition==
	*~~Consultation~~ with nephrology service		*In consultation with nephrology service:
	*Depending on patient reliability and level of illness outpatient peritoneal antibiotics or inpatient therapy ~~are therapy options~~		**Depending on patient reliability and level of illness, outpatient peritoneal antibiotics vs. inpatient therapy

	==See Also==		==See Also==

2018-01-10T21:02:11Z

Evaluation

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	===Special Considerations===		===Special Considerations===
	There must be dialysis fluid "dwelling" within the patient for adequate fluid collection. If the patient is not "dwelling" then coordination with nephrology is required to infuse fluid to be used to sample the peritoneum. Fluid may be required to "dwell" for a few hours prior to collection.		There must be dialysis fluid "dwelling" within the patient for adequate fluid collection. If the patient is not "dwelling" then coordination with nephrology is required to infuse fluid to be used to sample the peritoneum. Fluid may be required to "dwell" for a few hours prior to collection.

			===CT Abdominal Scan===
			''Perform only if necessary as part of the [[abdominal pain]] workup, to rule-out other (secondary) causes of peritonitis''
			*CT WITHOUT IV contrast
			**Patients are dependent on small amounts of residual renal function and thus risk of contrast outweighs benefits

	==Management==		==Management==

2016-10-05T05:06:17Z

Cloudy Effluent Differential

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	*Infectious peritonitis with sterile cultures		*Infectious peritonitis with sterile cultures
	*Chemical peritonitis		*Chemical peritonitis
	*Eosinophilia of the effluent		*[[Eosinophilia]] of the effluent
	*Hemoperitoneum		*Hemoperitoneum
	*Malignancy		*Malignancy

← Revisión anterior		Revisión del 20:43 23 feb 2021
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	*[[Dialysis complications]]		*[[Dialysis complications]]
	*[[Spontaneous bacterial peritonitis]]		*[[Spontaneous bacterial peritonitis]]
			*[[In-Training Exam Review]]

	==External Links==		==External Links==