Editorial

Surgical Intervention for Peritoneal Dialysis Associated Refractory Pseudomonas Peritonitis: Using Water to Put Out a Forest Fire

Authors: Srinivas Subramanian, MD, Soumita Bagchi, MD, DM (Nephro)

Abstract

Peritonitis due to Pseudomonas species is a serious complication of peritoneal dialysis (PD).1 It is a relatively uncommon cause of peritonitis, but can be more common in certain parts of the world like Hong Kong.2 Pseudomonas peritonitis is associated with higher likelihood of catheter loss and transfer to hemodialysis. In addition,Pseudomonas is often resistant to multiple antibiotics. Prompt catheter removal and use of two anti-pseudomonal antibiotics are associated with better outcomes.3 The above factors make it an uncommon but important clinical problem for those involved in the care of PD patients. Recent International Society for Peritoneal Dialysis guidelines state that in the case of Pseudomonas infection, "if catheter infection is present or has preceded peritonitis, catheter removal is necessary. Antibiotics must be continued for two weeks while the patient is on hemodialysis." The guidelines also state that two antibiotics should always be used to treat P. aeruginosa peritonitis.4Peritoneal lavage has been used for a long time to treat severe peritonitis.5 Its use in more recent times has been less frequent with the advent of effective antibiotics.

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References

1. Juergensen PH, Finkelstein FO, Brennan R, et al. Pseudomonas peritonitis associated with continuous ambulatory peritoneal dialysis: a six-year study. Am J Kidney Dis 1988;11:413-417.
 
2. Szeto CC, Chow KM, Leung CB, et al. Clinical course of peritonitis due to Pseudomonas species complicating peritoneal dialysis: a review of 104 cases. Kidney Int 2001;59:2309-2315.
 
3. Siva B, Hawley CM, McDonald SP, et al. Pseudomonas peritonitis in australia: predictors, treatment, and outcomes in 191 cases. Clin J Am Soc Nephrol 2009;4:957-964.
 
4. Li PK, Szeto CC, Piraino B, et al. ISPD guidelines/recommendations peritoneal dialysis related infections: 2010 update. Perit Dial Int 2010;30:393-423.
 
5. Burnett WE, Brown GR Jr, Rosemond GP, et al. The treatment of peritonitis using peritoneal lavage. Ann Surg 1957;145:675-681.
 
6. Chang CS, Chen HH, Liu HC, et al. Early surgical intervention of peritoneal dialysis catheter-related Pseudomonas peritonitis. South Med J 2011;104:373-374.
 
7. Jimenez MF, Marshall JC. International Sepsis Forum. Source control in the management of sepsis. Intensive Care Med 2001;27(suppl 1):S49-S62.