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Microbiology and therapy of peritonitis in continuous peritoneal dialysis

John M Burkart, MD
Section Editors
Steve J Schwab, MD
Thomas A Golper, MD
Deputy Editors
Alice M Sheridan, MD
Elinor L Baron, MD, DTMH


Peritonitis is one of the major complications of peritoneal dialysis and, despite reductions in overall peritonitis rates, remains the primary reason why patients switch from peritoneal dialysis to hemodialysis [1,2]. This topic reviews the microbiology and therapy of peritonitis in continuous peritoneal dialysis. The approach to the diagnosis of peritonitis, including exclusion of predisposing intra-abdominal diseases (such as pancreatitis), is discussed separately. (See "Clinical manifestations and diagnosis of peritonitis in peritoneal dialysis".)


The reported incidence of peritonitis ranges widely [3-8]. A retrospective study of 1677 incident peritoneal dialysis patients revealed a first-year peritonitis rate of 42 per 100 patient-years [7]. Of 463 peritonitis cases, 336 (72.6 percent) occurred within the first six months of peritoneal dialysis.

Over the past 20 years, multiple innovations in peritoneal dialysis connectology and the use of prophylactic antibiotics have reduced overall peritonitis rates. Reported peritonitis rates vary widely, with reported incidence noted in one review varying from 0.06 episodes per patient-year at risk in a Taiwanese program to as high as 1.66 episodes per patient-year at risk in a pediatric program in Israel [8].


The majority of peritonitis cases are caused by bacteria; a small percentage of cases are caused by fungi, mostly Candida species. The role of viral infection is uncertain; anecdotal cases of viral peritonitis have been reported [9], and viral infection predisposes patients to bacterial peritonitis [10,11].

The epidemiology and microbiology of peritonitis among peritoneal dialysis patients has varied by location and over time [3,12-16]. As an example, a large review of 3366 patients who started continuous ambulatory peritoneal dialysis (CAPD) provided important epidemiologic information on the first episode of peritonitis [13]:

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Literature review current through: Nov 2017. | This topic last updated: Jan 21, 2016.
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