PD Peritonitis — ESENeph MCQ

Correct answer: C — Use two susceptible anti-pseudomonal agents with different mechanisms for three weeks

The best answer is “Use two susceptible anti-pseudomonal agents with different mechanisms for three weeks”. ISPD recommends two active agents with different mechanisms for 21 days. Lack of response or concomitant exit-site or tunnel infection strengthens the indication for catheter removal. “Use intraperitoneal vancomycin monotherapy for two weeks after sensitivities return” is less appropriate because vancomycin does not provide adequate Pseudomonas treatment “Use oral ciprofloxacin monotherapy for three weeks after sensitivities return” is less appropriate because single short-course oral treatment is inadequate for this high-failure organism “Remove the catheter when concomitant tunnel infection is demonstrated” is less appropriate because mandatory immediate removal is not required when there is response and no associated catheter infection “Narrow treatment after clinical response and microbiological review” is less appropriate because clinical improvement does not replace the recommended treatment duration

Reference: UK Kidney Association peritoneal-dialysis guideline: https://ukkidney.org/sites/default/files/final-peritoneal-dialysis-guideline667ba231181561659443ff000014d4d8.pdf