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    Capd Peritonitis

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    santosh subedi
    This document discusses guidelines for peritoneal dialysis (PD) related infections. It covers catheter related infections like exit site infections and tunnel infections. The ISPD guidelines for preventing and managing peritonitis were first published in 1983 and have been revised periodically. Peritonitis remains a challenge for PD patients. The guidelines recommend tracking peritonitis rates, prevention methods like flush/fill protocols, and treatment approaches based on pathogen and response to initial antibiotics over 2-3 weeks. Refractory or relapsing cases may require catheter removal and reinsertion after 4-6 weeks.

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    Capd Peritonitis

    Uploaded by

    santosh subedi
    21 views21 pages
    This document discusses guidelines for peritoneal dialysis (PD) related infections. It covers catheter related infections like exit site infections and tunnel infections. The ISPD guidelines for preventing and managing peritonitis were first published in 1983 and have been revised periodically. Peritonitis remains a challenge for PD patients. The guidelines recommend tracking peritonitis rates, prevention methods like flush/fill protocols, and treatment approaches based on pathogen and response to initial antibiotics over 2-3 weeks. Refractory or relapsing cases may require catheter removal and reinsertion after 4-6 weeks.

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    CAPD PERITONITIS

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    This document discusses guidelines for peritoneal dialysis (PD) related infections. It covers catheter related infections like exit site infections and tunnel infections. The ISPD guidelines for preventing and managing peritonitis were first published in 1983 and have been revised periodically. Peritonitis remains a challenge for PD patients. The guidelines recommend tracking peritonitis rates, prevention methods like flush/fill protocols, and treatment approaches based on pathogen and response to initial antibiotics over 2-3 weeks. Refractory or relapsing cases may require catheter removal and reinsertion after 4-6 weeks.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    21 views21 pages

    Capd Peritonitis

    Uploaded by

    santosh subedi
    This document discusses guidelines for peritoneal dialysis (PD) related infections. It covers catheter related infections like exit site infections and tunnel infections. The ISPD guidelines for preventing and managing peritonitis were first published in 1983 and have been revised periodically. Peritonitis remains a challenge for PD patients. The guidelines recommend tracking peritonitis rates, prevention methods like flush/fill protocols, and treatment approaches based on pathogen and response to initial antibiotics over 2-3 weeks. Refractory or relapsing cases may require catheter removal and reinsertion after 4-6 weeks.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 21

    PD RELATED INFECTIONS

    • PERITONITIS

    • CATHETER RELATED INFECTIONS

     EXIT SITE INFECTION (ESI)


     TUNNEL INFECTIONS
    ISPD GUIDELINES
    • FIRST PUBLISHED IN 1983

    • REVISED IN 1993, 1996, 2000, 2005, 2010 & 2016.

    • GUIDELINES PUBLISHED UNDER 5 HEADINGS

     Peritonitis Rate
     Prevention
     Initial Presentation And Management
     Subsequent Management
     Future Research
    • Peritonitis remains the Achilles heel of
    peritoneal dialysis
    • Incidence

    80’s and early 90’s 1.3/patient/yr


    Late 90’s and beyond 1/patient/2yrs • Y set – Flush before fill
    • Double bag disconnect
    system
    • Doubled cuff catheter

    ISPD and Ad Hoc Advisory Committee on Peritoneal Dialysis Related Infections


    (Piraino et al., 2005) that all centers calculate and track their peritonitis rates
    PATHOGENESIS
    Aetiology
    Diagnosis 2/3
    1. Symptoms and signs of peritoneal inflammation
    2. Cloudy fluid with count > 100/mcl with PMNLs > 50%
    3. Demonstration of bacteria in effluent by Gm stain or C/S

    Fluid storage
    < 3-5 hr
    Intermittent dosing CAPD

    Per exchange once daily


    Cefazolin 15 mg/kg
    Ceftazidime 1-1.5 g
    Amikacin 2mg/kg
    Gentamycin 0.6 mg/kg
    Vancomycin 15-30 mg/kg q 5-7 days
    Begin to improve 12-48 hr
    Repeat cell count 48 hr
    Gm positive Single antibiotic
    Staph epidemidis, Staph aureus, Strep
    Enterococcus Ampicillin/Vanco plus Aminiglycosides
    Duration 2weeks
    Some add 5 day oral cephalosporin
    Gram negative Duration : 3 weeks
    Non pseudomonas Single
    Pseudomonas Double
    Catheter removal p/o or Iv for 2 weeks
    Refractory

    No improvement in 5 day appropriate


    Abx
    USG/CT/Gallium Scan Intraabdominal Abscess
    Consider Catheter removal
    Catheter may be reinserted 4-6 weeks
    Only half will be functional.

    Relapsing Peritonitis with same organism within 4


    weeks of t/t
    Causes • S. Epidermidis
    • Gm neg
    • Relapsing culture negative peritonitis
    Catheter removal with or without surgical
    exploration
    STK, Urokinase : Trap bacteria in fibrin
    Prophylactic abx in
    Catheter Placement Vanco/ cefazolin
    Technique break Vanco
    Nasal colonisation of staph Mupirocin

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