A 62-year-old woman undergoing peritoneal dialysis (PD) for kidney failure due to IgA nephropathy presented to the PD clinic with a 1-day history of severe abdominal pain and cloudy PD fluid. Seven days prior, she inadvertently broke aseptic technique when tightening a leaking connection of her PD catheter tubing. On presentation, she was afebrile and had normal vital signs. Physical examination revealed diffuse abdominal tenderness. Cloudy fluid that was drained from her PD catheter was sent for laboratory analysis (Table 1).
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A. Administer empirical broad-spectrum intraperitoneal antibiotics
PD-associated peritonitis occurs in approximately 30% to 40% of patients during their course of PD treatment1,2 and develops when infectious organisms gain access to the peritoneal cavity. Infection can occur through “touch contamination,” involving a breach in aseptic technique that introduces infectious organisms in the PD catheter, PD catheter exit site or tunnel infection with skin organisms that migrate into the peritoneal cavity, translocation of organisms from the gastrointestinal or genitourinary tract, or, in less than 1% of cases, hematogenous spread to the peritoneal cavity. After organisms enter the peritoneal cavity, polymorphonuclear leukocytes (PMNs) induce an inflammatory cascade, causing abdominal pain and cloudy dialysate.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Jeffrey Perl, MD, SM, Division of Nephrology, St Michael’s Hospital, University of Toronto, 61 Queen St E, Ninth Floor, Toronto, ON, M5C 2T2, Canada (Jeffrey.firstname.lastname@example.org).
Published Online: November 10, 2022. doi:10.1001/jama.2022.21289
Conflict of Interest Disclosures: Dr Perl reported receiving grants from the Agency for Healthcare Research and Quality; personal fees from Baxter Healthcare, Fresenius Medical Care, Amgen Canada, US Renal Care, Bayer Canada, Otsuka Canada, LiberDi, DaVita Healthcare, AstraZeneca, Pfizer, and GlaxoSmithKline; and salary support from Arbor Research Collaborative for Health outside the submitted work. Dr Nessim reported receiving personal fees from Baxter Healthcare, Otsuka, and AstraZeneca outside the submitted work. No other disclosures were reported.
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