Recurrent PD Peritonitis Modality Switch — ESENeph MCQ

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HardPeritoneal DialysisRecurrent PD Peritonitis Modality SwitchESENeph

A peritoneal-dialysis patient has a third episode of peritonitis caused by the same organism within 4 weeks of completing appropriate therapy. What catheter strategy should be considered?

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Correct answer: E — Timely catheter removal for relapsing peritonitis

The best answer is “Timely catheter removal for relapsing peritonitis”. ISPD recommends considering timely catheter removal for relapsing, recurrent or repeat peritonitis. Reinsertion timing depends on organism, response and clearance of infection. “Continue repeated antibiotics indefinitely while retaining the catheter” is less appropriate because biofilm can prevent durable eradication and repeated exposure increases harm “Switch to prophylactic antifungal monotherapy as definitive bacterial treatment” is less appropriate because antifungal prophylaxis does not eradicate bacterial catheter biofilm “Shorten every dwell without addressing infection source” is less appropriate because prescription changes do not eradicate relapsing infection “Stop dialysis while leaving infected fluid in situ” is less appropriate because kidney replacement and infection source control must both be managed

Reference: ISPD 2022 peritonitis guideline: https://pubmed.ncbi.nlm.nih.gov/35264029/