PD Peritonitis - Organism

Question 1

Stenotrophomonas maltophilia

• Background / Impact
• Resistance profile
• Agent
• Duration

Answer 1

Background

• Non-fermenting G- bacilli
• obligate aerobe
• Potentially Serious peritonitis
• High intrinsic resistance
  1.Inducible beta-lactamases and cephalosporinase.
  2.Possess efflux pumps.
• Nearly all strains are resistant to imipenem and meropenem.

Treatment

1. Agent:

• MUST be two (2) agents)
  Synergistic bacterial killing
• Oral Bactrim (trimethoprim–sulfamethoxazole)
  160 mg/800 mg BD.
• IP ceftazidime 500mg x 4 bags
• Oral Fluoroquinolones
  cipro 500mg OD
  levo or
  moxi)

2.Duration:
At least 3 weeks

Question 2

Secondary prophylaxis
Fungal

• When to prescribe / indication
• Agent/dose
• Duration

Answer 2

To prevent fungal peritonitis

• Prescribe anti-fungal prophylaxis
  whenever start antibiotic course
  regardless of the indication for that antibiotic course
  Peritonitis, exit-site and tunnel infection.

Agent:

1. PO fluclonazole 200mg eod
2. PO nystatin: 500,000 units qid

Duration:
Throughout the abx course