Box 2.

Initial management of suspected peritoneal dialysis (PD)-related peritonitis

First steps:
  • Carry out clinical evaluation

  • Examine PD catheter exit site and tunnel for evidence of infection

  • Ask patient, if possible, to drain out fluid

  • Send dialysis effluent for urgent white cell count and differential, Gram stain and culture

  • Contact local renal unit

If evidence of PD-peritonitis:
  • Start treatment immediately once samples are sent

  • If intra-peritoneal antibiotics cannot be administered, commence intravenous antibiotics

  • Ensure Gram-positive and -negative cover

  • If using intraperitoneal antibiotics, allow to dwell for 6 hours

  • Arrange urgent transfer to local renal unit