Management of culture-negative peritonitis in peritoneal dialysis

* Refer to UpToDate content on microbiology and therapy of peritonitis in peritoneal dialysis for details.

¶ Refer to UpToDate content on clinical manifestations and diagnosis of peritonitis in peritoneal dialysis for details.

Δ If a specific organism is identified on culture, the choice and duration of antimicrobial therapy should be adjusted accordingly. Refer to UpToDate content on microbiology and therapy of peritonitis in peritoneal dialysis for details.

◊ A peritoneal fluid white blood cell count >1000/mm³ on the third day of peritonitis is associated with a substantially higher likelihood of treatment failure. After 5 days of antibiotics, patients with successful treatment typically have approximately 90% or greater reduction in fluid cell count.

§ Cases of culture-negative peritonitis that rapidly improve with empiric therapy are typically caused by gram-positive organisms such as coagulase-negative staphylococci. Empiric gram-negative antibiotic coverage should not be stopped if Gram stain shows the presence of a gram-negative organism.

¥ Infection with mycobacteria, fungal pathogens, and Nocardia are indications for catheter removal; treatment of these organisms is discussed in separate UpToDate content. Tuberculosis and nontubercular mycobacteria take 2 to 8 weeks to grow using standard mycobacterial culture techniques. Cell cytology should be checked in patients with recurrent episodes of culture-negative peritonitis.

‡ Icodextrin dialysate-associated peritonitis occurs either immediately or after several months of exposure.