Peritoneal dialysis catheter sepsis: a medical and surgical dilemma.

Peritoneal dialysis remains a viable and valuable alternative to hemodialysis in selected patients; however, the development of intraperitoneal sepsis should raise serious questions as to whether a particular patient should remain with this particular mode of dialysis. Six conclusions can be drawn from this retrospective review. (1) Vancomycin appears to be the first single drug of choice, especially in cases of gram-positive peritonitis. (2) In our experience, the dialysis catheter should be removed in patients who do not demonstrate major resolution of their peritoneal sepsis by 3 to 4 days. (3) If removal of the dialysis catheter does not resolve the issue within 2 to 3 days, exploratory laparotomy should be seriously considered. (4) If fungal organisms are present, exploration and debridement of the peritoneal cavity should be carried out and the patient should be aggressively treated with systemic amphotericin. This should be undertaken early in the course of the peritonitis. (5) Patients with polycystic kidney disease may be better served by hemodialysis. (6) Patients who experience multiple septic episodes should be, when feasible, electively converted to hemodialysis or should undergo transplantation.