Peritoneal dialysis associated infections: An update on diagnosis and management
Open Access
- 1 January 2012
- journal article
- review article
- Published by Baishideng Publishing Group Inc. in World Journal of Nephrology
- Vol. 1 (4), 106-22
- https://doi.org/10.5527/wjn.v1.i4.106
Abstract
Peritoneal dialysis (PD) is associated with a high risk of infection of the peritoneum, subcutaneous tunnel and catheter exit site. Although quality standards demand an infection rate < 0.67 episodes/patient/year on dialysis, the reported overall rate of PD associated infection is 0.24-1.66 episodes/patient/year. It is estimated that for every 0.5-per-year increase in peritonitis rate, the risk of death increases by 4% and 18% of the episodes resulted in removal of the PD catheter and 3.5% resulted in death. Improved diagnosis, increased awareness of causative agents in addition to other measures will facilitate prompt management of PD associated infection and salvage of PD modality. The aims of this review are to determine the magnitude of the infection problem, identify possible risk factors and provide an update on the diagnosis and management of PD associated infection. Gram-positive cocci such as Staphylococcus epidermidis, other coagulase negative staphylococcoci, and Staphylococcus aureus (S. aureus) are the most frequent aetiological agents of PD-associated peritonitis worldwide. Empiric antibiotic therapy must cover both gram-positive and gram-negative organisms. However, use of systemic vancomycin and ciprofloxacin administration for example, is a simple and efficient first-line protocol antibiotic therapy for PD peritonitis - success rate of 77%. However, for fungal PD peritonitis, it is now standard practice to remove PD catheters in addition to antifungal treatment for a minimum of 3 wk and subsequent transfer to hemodialysis. To prevent PD associated infections, prophylactic antibiotic administration before catheter placement, adequate patient training, exit-site care, and treatment for S. aureus nasal carriage should be employed. Mupirocin treatment can reduce the risk of exit site infection by 46% but it cannot decrease the risk of peritonitis due to all organisms.Keywords
This publication has 99 references indexed in Scilit:
- Peritoneal dialysis-associated peritonitis: clinical features and predictors of outcomeInternational Journal of Infectious Diseases, 2010
- The role of virulence factors in the outcome of staphylococcal peritonitis in CAPD patientsBMC Infectious Diseases, 2009
- Optimising intraperitoneal gentamicin dosing in peritoneal dialysis patients with peritonitis (GIPD) studyBMC Nephrology, 2009
- Mupirocin for preventing exit-site infection and peritonitis in patients undergoing peritoneal dialysisNephrology Dialysis Transplantation, 2009
- Coagulase Negative Staphylococcal Peritonitis in Peritoneal Dialysis PatientsClinical Journal of the American Society of Nephrology, 2008
- Methicillin-resistant Staphylococcus aureus carriage, infection and transmission in dialysis patients, healthcare workers and their family membersNephrology Dialysis Transplantation, 2007
- Risk factors for peritonitis in pediatric peritoneal dialysis: a single-center studyPediatric Nephrology, 2005
- Merit of the cuff-shaving procedure in children with tunnel infectionPediatric Nephrology, 2004
- Frequent involvement of the internal cuff segment in CAPD peritonitis and exit-site infection--an ultrasound studyNephrology Dialysis Transplantation, 1996
- Staphylococcus aureus Nasal Carriage and Infection in Patients on Continuous Ambulatory Peritoneal DialysisThe New England Journal of Medicine, 1990