case presentation capd peritonitis

7/23/2019 Case Presentation CAPD Peritonitis

http://slidepdf.com/reader/full/case-presentation-capd-peritonitis 1/18

International Society for Peritoneal Dialysis (ISPD)

• Peritoneal Dialysis-Related Infections Recommendations: 2010 Update – Initial presentation and

management of peritonitis

– Suse!uent management of peritonitis

– "#it-site and tunnel infections

–

$uture researc%



&erminology



Initial 'anagement



Initial 'anagement

• Route: IP – ig% local leel of antiiotics

– *o+er dose needed compared to e!uialent I, do

se – Possile to administer at %ome y patients

• .PD: Intermittent dosing or ontinuous dos

ing• .PD: Insufficient data on intermittent dosing

or continuous dosing for many .#

• P/ ystatin $luconaole to precent antiiotic-related fungal peritonitis



Initial 'anagement-,ancomycin

• 3%en to consider ancomycin: – istory of met%icillin-resistant Stap%ylococcus aur

eus coloniationinfection

– Seriously un+ell – istory of seere allergy to penicillins and cep%alo

sporins

– ospital %as an increased rate of met%icillin resist

ance

• o routine use of ancomycin to preent ,R"emergence



Initial 'anagement-.minoglycoside

• .minoglycoside: – S%ort term use appears to e safe

– Intermittent dosing (once-daily dosing) instead of continuous dosing (dosing in eac% e#c%ange) for not longer t%an 4 +ee5s



Suse!uent 'anagement

• .d6ust according to culture results and sensitiities



s



$ungal Peritonitis

• Suspected after recent antiiotic treatment for acterial peritonitis

• at%eter remoal immediately after fungiidentification

• andida species - most commonly identified

• "mpirical &#: an consider amp%otericin7 and flucytosine – 'ay e replaced y 8fungins9 or 8aoles9 ase

d on species identification



at%eter Remoal and Reinsertion

• 3%en to remoe cat%eter – Refractory peritonitis

– Relapsing peritonitis

– $ungal peritonitis

– 'ay e considered in ot%er cases

• Reinsertion after 2-4 +ee5s – *ater in case of fungal peritonitis

– Some patients are not ale to return to PD

case presentation capd peritonitis

Documents