UMEM Educational Pearls

Category: Pediatrics

Title: PD-associated peritonitis

Posted: 10/8/2011 by Vikramjit Gill, MD (Updated: 6/15/2024)
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Peritoneal dialysis (PD) is a commonly used form of dialysis for pediatric patients with end-stage renal disease, particularly in children less than five years of age.

One well known complication to this mode of dialysis is PD-associated peritonitis.

Children may present with fever, abdominal pain and a cloudy dialysate.

If peritonitis is suspected, obtain sample of dialysate fluid and send for cell count, Gram’s stain and culture.

Cell count in PD-associated peritonitis is usually WBC >100 with >50% neutrophils.

Both gram-positive and gram-negative organisms are involved with PD-associated peritonitis .  Keep both MRSA and Pseudomonas in mind.

In the ED, empiric therapy should cover both gram-positive and gram-negative organisms. Initiate antibiotic therapy with vancomycin and either a third-generation cephalosporin (ceftazidime) or aminoglycoside, respectively.

For PD-associated peritonitis, intraperitoneal (IP) administration of antibiotics is preferred over IV.

References

1. Li PK, et al. Peritoneal Dialysis-Related Infections Recommendations: 2010 Update. Peritoneal Dialysis International, Vol. 30, pp. 393–423.

2. Fadrowski JJ, et al. Children on long-term dialysis in the United States: findings from the 2005 ESRD clinical performance measures project. Am J Kidney Dis. 2007;50(6):958.