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CAPD Peritonitis — SCE Infectious Diseases MCQ

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HardHealthcare-Associated InfectionsCAPD PeritonitisSCE Infectious Diseases

A stable patient on peritoneal dialysis develops cloudy effluent with abdominal pain and an effluent neutrophil predominance. Which empirical route-and-spectrum strategy is appropriate while cultures are pending?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Give intraperitoneal treatment covering both Gram-positive and Gram-negative organisms with review

The best answer is “Give intraperitoneal treatment covering both Gram-positive and Gram-negative organisms with review”. Prompt intraperitoneal therapy achieves high local exposure and empirical treatment must cover both major bacterial groups; catheter removal is reserved for defined refractory, relapsing or fungal scenarios. “Give oral co-amoxiclav alone because systemic absorption ensures peritoneal penetration” is less appropriate because it does not satisfy the scenario's decisive clinical or jurisdictional requirement. “Remove the catheter before giving any antimicrobial” is less appropriate because it does not satisfy the scenario's decisive clinical or jurisdictional requirement. “Use intravenous vancomycin monotherapy in every stable episode” is less appropriate because it does not satisfy the scenario's decisive clinical or jurisdictional requirement. “Wait for species identification because empirical therapy sterilises cultures” is less appropriate because it does not satisfy the scenario's decisive clinical or jurisdictional requirement.

Reference: ISPD peritonitis guideline 2022: https://journals.sagepub.com/doi/10.1177/08968608221080586