Dialysis Infections
Management protocols for PD Peritonitis and Catheter-Related Bloodstream Infections (CRBSI).
ISPD 2022 Guidelines
Always obtain effluent cell count and culture BEFORE starting antibiotics.
Diagnosis
Must have at least 2 of the following:
- Clinical Features: Cloudy effluent, abdominal pain.
- Effluent Cell Count: WBC > 100/ฮผL (after 2h dwell) with > 50% PMNs.
- Positive Culture: From dialysis effluent.
Culture Technique
Inoculate 5-10mL effluent into blood culture bottles (Aerobic + Anaerobic) at bedside. Centrifuge 50mL for gram stain.
Empiric Treatment
Intraperitoneal (IP) is preferred over IV.
Gram Positive Coverage
Vancomycin (IP)15-30 mg/kg load
Cefazolin (IP)15 mg/kg load (if not MRSA risk)
Gram Negative Coverage
Ceftazidime (IP)1000-1500 mg load
Gentamicin (IP)0.6 mg/kg load (Limit use)
*Doses are for Continuous Ambulatory PD (CAPD). For APD, consult pharmacy for specific cycling dosing.
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