ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

Abstract

Peritoneal dialysis (PD)-associated peritonitis is a serious complication of PD and prevention and treatment of such is important in reducing patient morbidity and mortality. The ISPD 2022 updated recommendations have revised and clarified definitions for refractory peritonitis, relapsing peritonitis, peritonitis-associated catheter removal, PD-associated haemodialysis transfer, peritonitis-associated death and peritonitis-associated hospitalisation. New peritonitis categories and outcomes including pre-PD peritonitis, enteric peritonitis, catheter-related peritonitis and medical cure are defined. The new targets recommended for overall peritonitis rate should be no more than 0.40 episodes per year at risk and the percentage of patients free of peritonitis per unit time should be targeted at >80% per year. Revised recommendations regarding management of contamination of PD systems, antibiotic prophylaxis for invasive procedures and PD training and reassessment are included. New recommendations regarding management of modifiable peritonitis risk factors like domestic pets, hypokalaemia and histamine-2 receptor antagonists are highlighted. Updated recommendations regarding empirical antibiotic selection and dosage of antibiotics and also treatment of peritonitis due to specific microorganisms are made with new recommendation regarding adjunctive oral N-acetylcysteine therapy for mitigating aminoglycoside ototoxicity. Areas for future research in prevention and treatment of PD-related peritonitis are suggested.

Predictive Factors, Treatment, and Outcomes of Coagulase-Negative Staphylococcal Peritonitis in Malaysian Peritoneal Dialysis Patients: A Single-Center Study

“…This study is the first comprehensive examination of the frequency, predictive factors, treatment, and clinical outcomes of CoNS peritonitis among Malaysian PD patients. The overall peritonitis rate of 0.23 episodes per patient-year of treatment achieved in the current study was lower than the target recommended by ISPD [ 1 ] and was comparable to those achieved by Japan, a developed country, which reported an overall peritonitis rate of 0.22 episodes per patient-year of treatment [ 14 ].…”

“…All patients were followed up for at least 12 months from their last episode of CoNS peritonitis. The overall rate of peritonitis was calculated for this 9-year period and expressed as the number of episodes per patient-year of treatment [ 1 ]. Relapsed and repeat peritonitis was recorded as a separate peritonitis episode.…”

“…Peritonitis was diagnosed when at least two of the following criteria were met: (i) clinical features suggesting peritonitis, that is, abdominal pain and/or cloudy peritoneal dialysate; (ii) peritoneal dialysate white cell count >100/ μ L (after a dwell time of at least 2 hours), with more than 50% polymorphonuclear neutrophils; (iii) at least 1 positive peritoneal dialysate culture. The patient was diagnosed with CoNS peritonitis when CoNS were isolated from the peritoneal dialysate samples [ 1 ]. Exit-site infection was diagnosed when there was purulent discharge, with or without erythema of the skin around the catheter-epidermal interface [ 11 ].…”

“…Peritonitis remains a major complication in peritoneal dialysis (PD) patients. Severe and prolonged peritonitis may result in structural and functional alterations of the peritoneal membrane and eventually peritoneal membrane failure [ 1 ]. It is one of the many causes of technique failure among PD patients [ 2 ].…”

“…Most of the patients with CoNS peritonitis have mild clinical symptoms and respond rapidly to antibiotic therapy [ 6 , 7 ]. Two weeks of an effective antibiotic are recommended to achieve a complete cure [ 1 ]. However, CoNS peritonitis has the highest relapsed and repeat rates compared to peritonitis caused by other organisms [ 8 ].…”