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Risk factors and prevention of peritonitis in peritoneal dialysis

Author
John M Burkart, MD
Section Editor
Thomas A Golper, MD
Deputy Editor
Alice M Sheridan, MD

INTRODUCTION

Peritonitis is a major complication of peritoneal dialysis and a primary reason for patients to switch from peritoneal dialysis to hemodialysis [1]. This topic reviews the causes of peritonitis in this setting and measures to reduce the risk.

The clinical features and treatment of peritoneal dialysis-associated peritonitis are discussed elsewhere. (See "Clinical manifestations and diagnosis of peritonitis in peritoneal dialysis" and "Microbiology and therapy of peritonitis in continuous peritoneal dialysis".)

PATHOPHYSIOLOGY

Among peritoneal dialysis patients, peritonitis is caused by introduction of microbes to the usually sterile peritoneum in the setting of compromised host defenses. Both the introduction of microbes and the compromise of defenses are usually related to the dialysis procedure. We discuss the source of microbial contamination, the possible role of biofilms in preventing eradication of microbes by host defenses, and impairment of macrophages due to the peritoneal dialysis procedure.

Source of infection — Sources of peritonitis include intraluminal (or touch contamination during exchanges); periluminal contamination (or extension from exit-site or tunnel infection); transvisceral migration from a bowel or, rarely, vaginal leak; and hematogenous dissemination from a remote source, as may occur during dental procedures.

Peritonitis is most often due to contamination with pathogenic skin bacteria, with Staphylococcus epidermidis and Staphylococcus aureus accounting for the majority of cases [2]. (See "Microbiology and therapy of peritonitis in continuous peritoneal dialysis".)

                  
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Literature review current through: Nov 2017. | This topic last updated: Dec 06, 2017.
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