Enterococcal peritonitis in patients on peritoneal dialysis: Antibiotic selection

* The initial empiric antibiotic regimen covers both gram-positive and gram-negative organisms, and should be narrowed after a specific susceptible organism is identified. Refer to UpToDate content on microbiology and therapy of peritonitis in peritoneal dialysis for details.

¶ There is no consensus on the optimal timing and duration of antifungal prophylaxis. We administer antifungal prophylaxis if antibiotics are administered for longer than 3 days; other experts do so for any course longer than 1 day. The duration of antifungal prophylaxis varies: prophylaxis is continued for the full antibiotic course, but we generally extend the duration by an additional week. Refer to UpToDate content on fungal peritonitis in peritoneal dialysis for details.

Δ For patients whose catheter is removed due to infection, we administer systemic (oral or intravenous) therapy. We ensure at least 14 days of antibiotics are administered from the date of catheter-removal and at least 21 total days of antibiotics are received.

◊ For isolates that are susceptible to ampicillin, we still favor intraperitoneal vancomycin. Limited in vitro data suggest that ampicillin's activity against Enterococcus spp in peritoneal fluid may be reduced. Although oral amoxicillin may be more convenient than intraperitoneal vancomycin, we favor intraperitoneal antibiotic administration to achieve reliably high levels in peritoneal fluid. Cephalosporins have no activity against Enterococcus spp.