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PD Peritonitis — ESENeph MCQ

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ModeratePeritoneal DialysisPD PeritonitisESENeph

A 70-year-old man on peritoneal dialysis for 3 years presents with abdominal pain, cloudy effluent, and a temperature of 37.9°C. PD fluid white cell count is 450/mm3 with 85% neutrophils. Gram stain shows Gram-positive cocci. What is the appropriate empirical intrabiotic treatment route and class?

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Correct answer: B — Intraperitoneal Vancomycin

This is PD peritonitis (cloudy effluent, WCC >100/mm3 with >50% neutrophils). ISPD 2022 guidelines (endorsed by UKKA) recommend intraperitoneal antibiotics as the primary route. Empirical regimen should cover both Gram-positives and Gram-negatives. Gram stain shows Gram-positive cocci, but empirical cover for Gram-negatives is also advised until culture results are available. IP Vancomycin covers Gram-positives including MRSA. A second agent for Gram-negative cover (e.g. IP Gentamicin or Ceftazidime) should also be added.

Reference: https://guidelines.ukkidney.org