Bear with my typos as I am learning touch typing.
Today talked about PD Peritonitis.
Staph Epi is the most common. Others of note include staph.aureus, strep, enterococci.
Gram negatives are not common and when they occur include E Coli, pseudomonas,acinetobacter etc.
You do not want to see pseudomonas or fungal or TB as they mean Catheter removal, as very difficult to eradicate
In PD fluid, a white cell count of > than 100 and PMN > 50 are needed for diagnosis. Occasionally it can be predominant eosinophilia.
Treatment is initially with Vanc+Gent/ceftaz till organism identified. You can give in every exchange or in 1 bag with a dwell for 6-8 hours.
Secondary peritonitis is from a primary intraabdominal problem like a perforated diverticulum or ischemic bowel etc. and it is polymicrobial in nature. So, on a gram stain if you find both gram+ and gram- think about secondary causes.
Relapse is PD peritonitis with the same organism in less than 4 weeks after finishing therapy
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