Controversies in the Management of Infective Complications of Peritoneal Dialysis

Abstract

Peritoneal dialysis is an effective form of renal replacement therapy. Despite improvements in connection technology, peritoneal infection is still the most important preventable cause of patient morbidity and mortality. There has been a shift in focus from treatment to prevention of infection, but wide variation in peritonitis incidence across and within peritoneal dialysis populations remains. This minireview aims to highlight current best practice, whilst discussing controversies in the diagnosis, prediction, prevention and management of peritonitis. Exit-site infection will not be discussed per se but only as it relates to peritonitis.

Relapsing Bacillus cereus peritonitis in a patient treated with continuous ambulatory peritoneal dialysis

“…For patients on PD, peritonitis is the most common cause of transition to haemodialysis, accounting for a significant morbidity and mortality ranging from 3.5 to 10 % (Odudu & Wilkie, 2011). In addition, peritonitis episodes have been implicated with loss of residual renal function, ultrafiltration failure and increased risk of encapsulating peritoneal sclerosis (Odudu & Wilkie, 2011).…”

“…In addition, peritonitis episodes have been implicated with loss of residual renal function, ultrafiltration failure and increased risk of encapsulating peritoneal sclerosis (Odudu & Wilkie, 2011). In many cases, despite the use of an appropriate antibiotic regimen, peritonitis relapses and catheter removal is often necessitated (Davenport, 2009).…”

Development of controlled release silicone adhesive&ndash;based mupirocin patch demonstrates antibacterial activity on live rat skin against <em>Staphylococcus aureus</em>

“…Peritonitis can lead to loss of capability of renal function in dialysis, such as decreased ultrafiltration, peritoneal membrane failure and leads to sclerosis. 1 , 2 There is also a higher incidence of morbidity with mortality caused by peritonitis. Peritonitis is usually caused by infection from Gram-positive and Gram-negative bacteria and sometimes by fungi.…”

“…S. aureus bacteria are present in the nose and on the skin as normal skin flora, which can increase the risk of causing exit-site infection and peritonitis from 2- to 6-fold. 1 , 2 A nasal cream is used to reduce the incidence of infection.…”

“…Although the application of MP topically at the exit site of PD patients showed a significant decrease in the incidence of ESI, peritonitis was still prevalent. 1 , 5 – 7 …”