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PD Peritonitis — RACP Adult Medicine MCQ

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ModerateNephrologyPD PeritonitisRACP Adult Medicine

A 65-year-old man with type 2 diabetes and ESKD on peritoneal dialysis develops progressive cloudy dialysate effluent with abdominal pain and fever. Effluent WCC is 800 cells/µL (80% neutrophils). Gram stain shows Gram-positive cocci. What empirical antibiotic regimen is most appropriate?

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Correct answer: D — Intraperitoneal cefazolin + intraperitoneal gentamicin

PD peritonitis requires intraperitoneal antibiotics. ISPD 2022 guidelines recommend intraperitoneal cefazolin (or vancomycin if high MRSA prevalence) for Gram-positive coverage plus intraperitoneal gentamicin (or ceftazidime) for Gram-negative coverage. Most Australian centres use IP cefazolin + IP gentamicin as first-line empiric therapy for CAPD peritonitis. Catheter removal is considered for refractory or fungal peritonitis.

Reference: KHA-CARI – 2014 – PD Peritonitis Guidelines; ISPD – 2022 – Peritonitis Guidelines