Peritonitis following Endoscopy in a Patient on Peritoneal Dialysis with a Discussion of Current Recommendations on Antibiotic Prophylaxis

Abstract

Patients on peritoneal dialysis (PD) are at increased risk for peritonitis. We report a case of a patient with end-stage renal disease on continuous ambulatory PD (CAPD) who developed peritonitis within 24 h of upper endoscopy with biopsy and colonoscopy with polypectomy. He had a previous history of peritonitis unrelated to invasive procedures and eventually was transitioned to hemodialysis because of his recurrent peritonitis. The International Society for Peritoneal Dialysis (ISPD) and newly revised American Society for Gastrointestinal Endoscopy (ASGE) guidelines recommend prophylactic antibiotics for CAPD patients undergoing endoscopic procedures. Other guidelines do not address this issue, and there has been limited evidence to support recommendations.

CDC Group EO-4 and Candida tropicalis Peritonitis in a Patient on Peritoneal Dialysis after Upper Endoscopy, Colonoscopy and Coil Embolization of the Gastroduodenal Artery

“…Peritonitis may arise from transmural migration of bacteria from the bowel to the peritoneal cavity after manipulation of the gastrointestinal tract [2]. Several reports have described the development of peritonitis in PD patients who underwent GI endoscopy without prophylaxis [3, 4, 5, 6], and a retrospective study found that the risk of peritonitis after colonoscopy without antibiotic prophylaxis was 6.3% [7].…”

“…Several reports have described the development of peritonitis in PD patients who underwent GI endoscopy without prophylaxis [3, 4, 5, 6], and a retrospective study found that the risk of peritonitis after colonoscopy without antibiotic prophylaxis was 6.3% [7]. Peritoneal fluid in these patients has yielded gram-positive and gram-negative organisms [2, 8]. The CDC group EO-3 organism has been reported to cause peritonitis in a PD patient [9].…”

Guía de prevención de infecciones y uso de antibióticos profilácticos en endoscopia

“…No existen estudios que evalúen el riesgo de infección de prótesis ortopédicas en procedimientos gastrointestinales considerados de alto riesgo para bacteriemia como dilatación de estenosis esofágicas, biopsia por ultrasonido endoscópico y colangiografía retrógrada (Tabla 3); sin embargo, la frecuencia de bacteriemia es menor al 22% en estos casos en comparación con actividades de la vida diaria como cepillarse los dientes o uso de hilo dental, con una incidencia de bacteriemia de hasta el 68% 48 .…”

“…El desarrollo de peritonitis en pacientes bajo tratamiento con diálisis peritoneal continua ambulatoria (DPCA) es un evento asociado con aumento en costos de tratamiento 48 , importante morbilidad e incluso mortalidad 49,50 de hasta un 5% 51 . Cuando la peritonitis es por bacterias gramnegativas (como aquellas de origen enteral) se asocia con un peor pronóstico 49 .…”

“…Cuando la peritonitis es por bacterias gramnegativas (como aquellas de origen enteral) se asocia con un peor pronóstico 49 . Los pacientes con DPCA presentan un riesgo mayor de peritonitis posterior en caso de bacteriemia asociada a un procedimiento endoscópico en comparación con sujetos sanos, pues el riesgo de colonización del líquido peritoneal es mayor por su alto contenido de glucosa 8,[48][49][50]53 .…”