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PD Peritonitis — RACP Adult Medicine MCQ

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EasyNephrologyPD PeritonitisRACP Adult Medicine

A 50-year-old woman on peritoneal dialysis presents with cloudy PD effluent, abdominal pain, and fever. PD fluid WCC is 450 cells/μL (>90% neutrophils). Gram stain shows gram-positive cocci in clusters. What is the most likely diagnosis and initial treatment?

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Correct answer: E — PD peritonitis — IP vancomycin + IP gentamicin

Cloudy PD effluent with WCC >100/μL (>50% neutrophils), abdominal pain, and fever is PD peritonitis. Gram-positive cocci (likely S. aureus or coagulase-negative Staph) is the commonest cause. ISPD 2022 guidelines recommend empirical intraperitoneal (IP) antibiotics covering both gram-positive (vancomycin or cefazolin) and gram-negative (gentamicin or ceftazidime). IP administration achieves higher peritoneal concentrations than IV.

Reference: ISPD – 2022 – PD Peritonitis Guidelines; KHA-CARI 2024