Staphylococcal peritonitis in patients on peritoneal dialysis: Antibiotic selection

IgE: immunoglobulin E; S. aureus: Staphylococcus aureus.

* 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 Coagulase-negative staphylococci that are not tested should be treated as if they are resistant to methicillin and cephalosporins.

◊ Type 1 allergic reactions are acute IgE-mediated allergies that typically manifest as various combinations of hives (urticaria), pruritus, angioedema, bronchospasm (eg, wheezing), or hypotension. The majority of patients with reported beta-lactam allergies do not have type 1 allergies and can take a cephalosporin. Refer to UpToDate content on penicillin allergies for details.

§ For S. aureus infections, some experts add a rifamycin (eg, rifampin) for the first 5 to 7 days of therapy. Other experts add a rifamycin if there is inadequate response to initial therapy.

¥ For patients whose catheter is removed due to infection, we administer systemic (oral or intravenous) therapy. For first episodes of coagulase-negative staphylococcal infection, we administer 14 days of therapy from the date of catheter removal. For S. aureus and recurrent coagulase-negative staphylococcal infections, 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.