Related Experiment Video
Updated: May 6, 2026
A Retrograde Implantation Approach for Peritoneal Dialysis Catheter Placement in Mice
Published on: July 20, 2022
Peritoneal dialysis associated infections: An update on diagnosis and management
1Jacob A Akoh, South West Transplant Centre, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth PL6 8DH, United Kingdom.
Abstract:
Peritoneal dialysis (PD) is associated with a high risk of infection of the peritoneum, subcutaneous tunnel and catheter exit site. Although quality standards demand an infection rate < 0.67 episodes/patient/year on dialysis, the reported overall rate of PD associated infection is 0.24-1.66 episodes/patient/year. It is estimated that for every 0.5-per-year increase in peritonitis rate, the risk of death increases by 4% and 18% of the episodes resulted in removal of the PD catheter and 3.5% resulted in death. Improved diagnosis, increased awareness of causative agents in addition to other measures will facilitate prompt management of PD associated infection and salvage of PD modality. The aims of this review are to determine the magnitude of the infection problem, identify possible risk factors and provide an update on the diagnosis and management of PD associated infection. Gram-positive cocci such as Staphylococcus epidermidis, other coagulase negative staphylococcoci, and Staphylococcus aureus (S. aureus) are the most frequent aetiological agents of PD-associated peritonitis worldwide. Empiric antibiotic therapy must cover both gram-positive and gram-negative organisms. However, use of systemic vancomycin and ciprofloxacin administration for example, is a simple and efficient first-line protocol antibiotic therapy for PD peritonitis - success rate of 77%. However, for fungal PD peritonitis, it is now standard practice to remove PD catheters in addition to antifungal treatment for a minimum of 3 wk and subsequent transfer to hemodialysis. To prevent PD associated infections, prophylactic antibiotic administration before catheter placement, adequate patient training, exit-site care, and treatment for S. aureus nasal carriage should be employed. Mupirocin treatment can reduce the risk of exit site infection by 46% but it cannot decrease the risk of peritonitis due to all organisms.
Insights
Peritoneal dialysis (PD) infections are common, increasing mortality risk. Prompt diagnosis and management, alongside preventative measures like antibiotic prophylaxis and S. aureus nasal carriage treatment, are crucial for patient outcomes and preserving PD.
Area of Science:
- Nephrology
- Infectious Diseases
- Medical Microbiology
Background:
- Peritoneal dialysis (PD) is frequently complicated by infections affecting the peritoneum, subcutaneous tunnel, and catheter exit site.
- PD-associated infections pose significant risks, including increased mortality, PD catheter removal, and failure of the dialysis modality.
- Current infection rates often exceed established quality standards, highlighting a critical area for clinical improvement.
Purpose of the Study:
- To assess the prevalence and impact of PD-associated infections.
- To identify key risk factors contributing to these infections.
- To provide an updated overview of diagnostic and management strategies for PD infections.
Main Methods:
- Review of literature on PD-associated infections, focusing on epidemiology, causative agents, and treatment outcomes.
- Analysis of reported infection rates and their correlation with patient mortality and PD modality survival.
- Evaluation of current diagnostic approaches and therapeutic regimens, including antibiotic protocols and preventative measures.
Main Results:
- Gram-positive cocci, particularly Staphylococcus epidermidis and Staphylococcus aureus, are the predominant pathogens causing PD peritonitis.
- Empiric antibiotic therapy combining vancomycin and ciprofloxacin demonstrates a 77% success rate for PD peritonitis.
- Fungal peritonitis necessitates catheter removal and antifungal treatment, often leading to a switch to hemodialysis.
Conclusions:
- Effective management of PD-associated infections requires improved diagnostics and heightened awareness of causative agents.
- Preventative strategies, including prophylactic antibiotics, patient education, meticulous exit-site care, and S. aureus nasal carriage treatment (e.g., mupirocin), are essential.
- While mupirocin reduces exit-site infection risk by 46%, it does not universally prevent peritonitis from all organisms, underscoring the need for comprehensive infection control.
Related Concept Videos
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications
01:25Peritoneal Dialysis III: Nursing Management
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:30Peritoneal Dialysis I: Introduction and Procedure
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:17Urinary Tract Infection IV: Nursing Management