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 #CAPD #associated #peritonitis #Diagnosis #Management #InfectiousDiseases
