Peritonitis

Question 1

What is Peritonitis?

Answer 1

The abdominal organs, such as the stomach and liver, are wrapped in a membrane called peritoneum (permit free movement of the internal organs during digestion).

Peritonitis = inflammation of the peritoneum

Two types:

1) spontaneous bacterial peritonitis (SBP)
- less dramatic
- can occur in patients with severe liver disease, heart disease or kidney disease. Often these diseases cause ascites (the accumulation of fluid within the abdominal cavity) which can lead to bacterial infections.

2) secondary peritonitis
Main cause = escape of pus from an infected abdominal organ, including:
- Dialysis – bacteria on continuous ambulatory peritoneal dialysis (CAPD) equipment can enter the abdominal cavity
Note: patients undergoing peritoneal dialysis presenting with cloudy effluent should be presumed to have peritonitis
- catheter induced bowel perforation

Question 2

Organisms of peritonitis in peritoneal dialysis?

Answer 2

• staphylococci
• streptococcus
• enterococcus

Question 3

Empirical therapy for peritonitis in peritoneal dialysis?

Answer 3

Non MRSA carrier:

• cephazolin
• ceftazidime

MRSA carrier:

• vanc
• ceftazidime

Duration of Tx:
Two weeks unless Staph/Pseudomonas(3 weeks)