Predicting outcomes of peritoneal-dialysis-associated peritonitis based on dialysate white blood cell count

Mark D Faber

This article has no abstract so we have provided the first paragraph of the full text.

Empiric antibiotic treatment of peritonitis in patients receiving peritoneal dialysis requires broad gram-positive and gram-negative coverage until culture results are available.¹ Although most patients will recover uneventfully with antibiotic therapy alone, an unfortunate subset will require catheter removal or even succumb to their infection or its underlying abdominal pathology. The critical challenge facing clinicians managing peritoneal-dialysis-related peritonitis is the early identification of patients who require additional intervention, beside antibiotic therapy, to optimize their clinical outcome. The initial step is to recognize that a particular patient is at increased risk of serious morbidity or mortality. As reviewed recently,² such recognition often starts with the initial clinical presentation (e.g. hypotension, sepsis syndrome, lactic acidosis, purulent exit site drainage, or localized abdominal pain). The presence of 'surgical disease' on abdominal CT, elevated dialysate amylase level, or high suspicion of localized abdominal disease on physical examination, should trigger an emergent laparoscopy or laparotomy in the setting of hemodynamic instability. Even when additional studies do not show definite intra-abdominal disease, exploration is indicated after 24 h in seriously unstable patients who fail to show clear hemodynamic improvement, unless an extra-abdominal source is clearly identified.

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