Treatment of peritonitis in continuous ambulatory peritoneal dialysis
De Fremont, J.F.; Schmit, J.L.; Thomas, D.; Coevoet, B.; Eb, F.; Laurence, G.; Orfila, J.; Fournier, A.
Pathologie-Biologie 30(6 Part 2): 581-584
1982
ISSN/ISBN: 0369-8114 PMID: 6750528 Document Number: 189932
Thirty patients were treated with continuous ambulatory peritoneal dialysis during 313 patients months. 26 episodes of peritonitis defined by a cloudy dialysate with more than 100 cells/mm1 and more than 50 p. cent of polynuclear were observed. The organisms initially responsible were Gram-positive in 11 cases (6 Staphylococcus aureus, 1 Staphylococcus albus, 4 Streptococcus viridans), a gram negative in 3 cases (1 Klebsiella, 1 serratio, one unidentified), a Candida in 2 cases. In 10 cases, the culture was negative, Initial treatment was peritoneal lavage (40 l/day) with in situ antibiotics: in the absence of Candida, the association sulfamethoxazole (SMZ) (80 mg/l) and trimethoprim (TMP) (16 mg/l) was used; when Candida was present amphotericin B (5 mg/l) was used. The association SMZ + TMP led to cure of PT in 17 cases, in 7 +/- 4 days. In 5 cases, this initial treatment was changed at the 48th hour because of initial resistance in one case or secondary resistance of Candida surinfection (2 cases). Candida surinfection occurred later in 2 other cases. For these 6 primary or secondary Candida peritonitis, the catheter was changed within 48 hours. Nevertheless, death occurred in 3 cases and cure was obtained after 51 +/- 11 days in the 3 other cases. 1) The initial treatment by SMZ + TMP appears quite effective in most cases (73%). 2) The severity and the high incidence of Candida surinfection suggest that its systematic prophylaxis may be appropriate.