Peritoneal infection

my mom is in Pd for 1 yr and has recently developed peritonitics
neph has given her Vancomycin-1g repeat on every 5th day and ceftazidine inj 1.5g daily for fifteen days.we don’t have nice lab for culture so it would take appx 3-4 days for the report we know that this is very serious. it has been three days since we started the treatment and it is satisfactory inprovement.the total count cell has gradually reduced. neph adviced us that it is acceptable once in 1.5yrs, is it true?. have anybody else had same problem and what kind of treatment have u gone through.does it repeat or not what precaution should we take?


Dr. Beth Piraino has reduced the number of episodes of peritonitis much below what your doctor reports. Here’s an abstract of an article that she wrote that recommends ways to prevent peritonitis. You might want to tell your doctor about this article.

Contrib Nephrol. 2006;150:181-6.

Peritoneal dialysis infections recommendations.

Piraino B.

University of Pittsburgh, PA 15213, USA.

Peritonitis remains a serious problem in peritoneal dialysis patients accounting for technique failure and contributing to mortality. Many peritonitis episodes are due to contamination at the time of the exchange and exit site infections. Protocols can be implemented by programs to diminish the risk of infection. Careful training, especially in handwashing technique and in doing the connection, are critical for preventing contamination related peritonitis. Peritonitis due to exit site infections can be reduced by use of exit site antibiotic cream. Gentamicin as opposed to mupirocin exit site prophylaxis reduces not only S. aureus but also P. aeruginosa infections. Refractory exit site infections can be managed with simultaneous catheter replacement. Once peritonitis occurs, prompt institution of empiric antibiotics, dictated by the history of the program’s infections, should be done. Initial therapy is then modified once the culture results are known. Catheters require removal if the peritonitis fails to resolve within 5 days of appropriate antibiotic therapy or if peritonitis is relapsing. Fungal peritonitis is best treated with prompt catheter removal. Implementation of protocols to prevent peritonitis and careful attention to both the organisms causing peritonitis and the rate of infection by a peritoneal dialysis center are essential for reducing infectious complications. Once infections occur, rapid steps to treat and manage are
important to diminish the risk of mortality and subsequent peritoneal damage, areas requiring more research.

thanks for ur reply , it helped a lot.
last night my mom suddenly got severe pain in abdominal after 3hrs of dialysis. then we did the dialysis again which solved the prob.we used tazid 1.5g in fluid in last exchange of 2.5%. after 3hrs when pain occured we have again put new bag of 2.5% without antibiotic. we called neph he adviced us to put 500mg in first exchange of 1.5% and 2nd exchange 1.5% plain and last exchange 2.5%with 1g tazid. is it proper treatment for peritonitics?or we have to change our treatment for she is still suffering from light pain.


Was her bag of solution cloudy when she was having pain? I’ve heard nurses tell patients that if they can’t see through the bag well enough to see the writing on other side, it’s possible that they have peritonitis.

I don’t know what country you’re in, but when I looked up Tazid, I got an Indian website. In the U.S. nurses ask patients to bring in their cloudy drain bag so they can send it to be checked for the specific type of germ that’s causing the infection. They may start them on a certain antibiotic that works on most infections, but if the results come back that the antibiotic the patient is using is not the best one, they’ll switch the patient to an antibiotic specific to kill that germ. Tazid is a cephalosporin antibiotic. You might ask the doctor whether they do “sensitivity testing” on the drain bag to see for sure which antibiotic will be most effective.

Finally, it’s also important to find out how your mother is getting infections, if she has one. Is she following the procedure exactly as she was taught, is she preparing the supplies so she doesn’t have to reach across them, is she washing her hands well enough, is there any kind of draft in the room where she’s doing her PD exchange that could allow germs in that could get into her catheter. These are just a few of the things that might affect someone’s risk of getting peritonitis. The more infections someone has and the more severe they are, the greater the chance is that the peritoneal membrane will be damaged making PD not workable. You might want to ask the training nurse if you can problem solve this with him/her.