Peritoneal dialysis peritonitis — ESENeph MCQ

Correct answer: E — Culture the effluent and start empirical intraperitoneal antibiotics promptly

The best answer is “Culture the effluent and start empirical intraperitoneal antibiotics promptly”. The cell count and neutrophil fraction meet PD-peritonitis criteria. Sampling precedes therapy when this does not cause delay, and local empirical cover targets Gram-positive and Gram-negative organisms. “Provide analgesia while awaiting prompt dialysis-effluent cell count and culture” is less appropriate because delay increases membrane injury, sepsis and technique failure “Remove the catheter when refractory or complicated infection warrants removal” is less appropriate because removal is reserved for specified organisms or refractory, relapsing and associated infections “Use corticosteroids when a confirmed noninfective inflammatory cause warrants them” is less appropriate because infection must be presumed and treated until excluded “Transfer modality when infection complications preclude continued peritoneal dialysis” is less appropriate because modality transfer does not treat established infection

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