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Conservative management of polymicrobial peritonitis complicating peritoneal dialysis--a series of 140 consecutive

Cheuk-Chun Szeto1, Kai-Ming Chow, Teresa Yuk-Hwa Wong

  • 1Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China. ccszeto@cuhk.edu.hk

The American Journal of Medicine
|January 9, 2003
PubMed
Abstract

Insights

Antibiotic therapy is effective for dialysis-related polymicrobial peritonitis, often avoiding surgery. Careful organism identification helps guide treatment and catheter management in peritoneal dialysis patients.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Gastroenterology

Background:

  • Polymicrobial peritonitis in peritoneal dialysis (PD) patients is often attributed to bowel perforation, leading to surgical exploration.
  • Emerging evidence suggests antibiotic therapy as a potentially safe alternative to surgery.

Purpose of the Study:

  • To evaluate the efficacy of antibiotic therapy as a primary treatment for dialysis-related polymicrobial peritonitis.
  • To determine predictors of treatment response and identify patients who may require Tenckhoff catheter removal or surgical intervention.

Main Methods:

  • A retrospective study of 140 consecutive episodes of dialysis-related polymicrobial peritonitis from January 1995 to June 2001.
  • Primary treatment involved intraperitoneal antibiotics; Tenckhoff catheter removal was performed for non-responders, with laparotomy reserved for suspected surgical pathology.

Main Results:

  • 64% of patient-episodes (90/140) responded to antibiotics alone within 10 days.
  • 40% (56/140) achieved complete cure without relapse within 4 months.
  • Laparotomy was performed in 8 patients, revealing underlying surgical disease in only 3. Predictors of poor response included age, and presence of fungi, anaerobes, or Pseudomonas species.

Conclusions:

  • Most patients with dialysis-related polymicrobial peritonitis can be successfully treated with antibiotics.
  • Surgical exploration is infrequently required, and Tenckhoff catheter removal is reserved for non-responders.
  • Identification of specific organisms in dialysis fluid aids in predicting treatment outcomes and guiding management decisions.

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