Kidney Week 2025 Early Program - Home Dialysis: Expanding Access to Home Therapies in 2025 and Beyond-Preventing and Managing Infections in Peritoneal Dialysis: A Case-Based Approach

Video Transcription

Video Summary

Jeff Perl presents a case-based talk on preventing and managing peritoneal dialysis (PD) infections, focusing on peritonitis. A new PD patient with cloudy effluent and high neutrophils prompts discussion of empiric antibiotics: vancomycin vs cefazolin should depend on local methicillin-resistance rates (often using ~10% as a “threshold”) and patient history; if cultures show methicillin-sensitive organisms, therapy should be narrowed to a cephalosporin because continuing vancomycin may worsen outcomes.<br /><br />When cultures reveal methicillin-resistant coagulase-negative staph (CNST), he recommends switching to vancomycin even if the patient improves, due to high relapse rates with cephalosporins. He emphasizes antifungal prophylaxis (e.g., nystatin) for any antibiotic course to reduce antibiotic-associated fungal peritonitis.<br /><br />He reviews “wet contamination” (PD fluid exposed to the outside world) and encourages rapid, practical antibiotic management to improve reporting and prevention. For recurrent/relapsing CNST, biofilm is likely; after repeated episodes (“three strikes”), catheter removal with simultaneous reinsertion can avoid temporary hemodialysis if infection is fully resolved before the procedure.<br /><br />A later enterococcal peritonitis case highlights when to consider CT imaging (especially enteric organisms, systemic symptoms, nonresponse), but antibiotics must not be delayed for imaging. Refractory peritonitis with persistent positive cultures by day 5–10 generally requires catheter removal. Finally, returning to PD after catheter removal is often feasible, with outcomes similar to staying on hemodialysis, guided by shared decision-making.

Asset Subtitle

Jeffrey Perl

Meta Tag

Module DIAL

Speaker Jeffrey Perl

Keywords

peritoneal dialysis

peritonitis

empiric antibiotics

vancomycin

cefazolin

methicillin-resistant coagulase-negative staphylococci

antifungal prophylaxis

PD catheter removal and reinsertion