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Peritonitis, an infectious complication of peritoneal dialysis, continues to account for much of the morbidity associated with this techniques. The clinical presentation and laboratory data used in diagnosis the peritonitis, as well as its differential diagnosis will be reviewed in this article. The distribution of pathogens is an important outcome determinant, Gram-negative infections being associated with greater rates of catheter loss and higher death rates. Among the five routes of peritoneal contamination, intraluminal and periluminal contamination account for most of the infections. Due to the two prevention methods implemented in the care of the PD population, the incidence of peritonitis has decreased over the last two decades. The recommendations for empiric treatment of peritonitis have changed over the years, as more was learnt about antibiotic resistance and drug toxicity. Future research to address enteric peritonitis, as well as biocompatible dialysis solution or biocompatible catheter materials is needed to further reduce the incidence of PD peritonitis.
Peritonitis, an infectious complication of peritoneal dialysis, continues to account for much of the morbidity associated with this techniques. The clinical presentation and laboratory data used in diagnosis the peritonitis, as well as its differential diagnosis will be reviewed in this article. The distribution of pathogens is an important outcome determinant, Gram-negative infections being associated with greater rates of catheter loss and higher death rates. Among the five routes of peritoneal contamination, intraluminal and periluminal contamination account for most of the infections. Due to the two prevention methods implemented in the care of the PD population, the incidence of peritonitis has decreased over the last two decades. The recommendations for empiric treatment of peritonitis have changed over the years, as more was learnt about antibiotic resistance and drug toxicity. Future research to address enteric peritonitis, as well as biocompatible dialysis solution or biocompatible catheter materials is needed to further reduce the incidence of PD peritonitis.
Six consecutive patients treated with intraperitoneal vancomycin for catheter infections developed cloudy dialysate in the exchange to which the drug was added. In all six patients, the dialysate was clear before the addition of vancomycin. All had elevated dialysate leukocyte and polymorphonuclear counts after the intraperitoneal vancomycin. All had sterile cultures. Two continued to have cloudy dialysate while continuing on 500 mg vancomycin per one exchange per day. In one of these patients, the catheter did not appear infected when removed. All episodes occurred after we had changed from Lilly's Vancocin to Lederle's Vancoled. During this time, the per cent of peritonitis episodes with sterile cultures rose from 0% in the previous 3 months to 50%. In all episodes with sterile cultures Vancoled had been administered via the dialysate. Fourteen patients had received intraperitoneal Vancocin in the previous nine months for the same indications; none developed cloudy dialysate. We believe that these cases represent chemical peritonitis due to Vancoled.
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