CAPD-associated peritonitis (Continuous Ambulatory Peritoneal Dialysis) - 5 Things To Know

Diagnosis (Two of the following):

(1) Clinical features of peritonitis (abdominal pain, cloudy effluent)

(2) Effluent >100 WBC (usually w/ PMN)

(3) Positive effluent culture 

Note that fever may be seen in only in 1/3 of patients.

Microbiology:

• 45-65% Gram positive (60% CONS, staph aureus)

• 15-35% Gram negative (E. coli, Klebsiella, Pseudomonas)

• Polymicrobial should suggest other intra-abdominal proæss (e.g. diverticulitis)

Treatment

• Empiric: vanc/cefazolin + cefepime/ceftaz/AG/aztreonam

• Intraperitoneal preferred over IV

• IV -> septic patients

• Response in 48-72H: improve SSX, less cloudy effluent, decreasing WBC on repeat fluid analysis)

• Duration: 2-3 weeks

Catheter removal

• Conncomitant catheter infection (exit site/tunnel erythema, discharge, etc)

• Refractory, relapsing, repeat peritonitis 

• Fungal/mycobacterial, polymicrobial

Others

• Culture negative peritonitis in 20% (prior abx use, fungal or mycobacterial)

• Prophylactic antibiotics given for PD patients undergoing dental, GI, GYN procedures



- WuidQ: Washington University ID Questions @WuidQ



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