Treatment and outcome of Peritonitis in Automated Peritoneal Dialysis, using a Once-Daily Cefazolin-Based Regimen

Abstract

Objective We determined the effectiveness of a once-daily cefazolin-based regimen in treating automated peritoneal dialysis (APD) peritonitis. Design We carried out a retrospective analysis of all APD peritonitis episodes treated with a once-daily cefazolin protocol. Setting The study was performed in a peritoneal dialysis unit in a tertiary care hospital. Patients and Methods We studied 60 episodes of primary peritonitis in 40 patients on APD. Each patient was treated with a vancomycin-free regimen consisting of intraperitoneal cefazolin (1.5 g IP) with gentamicin IP administered in the daytime exchange. The main outcome measures were successful treatment of peritonitis, removal of peritoneal catheter, relapse of peritonitis, and patient death. Results Gram-positive infections occurred in 35 episodes (58.3%), gram-negative infections in 10 episodes (16.7%), culture-negative infections in 14 episodes (23.3%), and a yeast infection in 1 episode (1.7%). Of the 60 episodes, 47 (78.3%) were successfully treated. In 10 episodes (16.7%), catheters were removed (9 for treatment failure, 1 for yeast infection). Four patients (8%) had a relapse of infection within 4 weeks of completing antibiotic therapy. One patient (1.7%) died. Conclusions Our results demonstrate that once-daily cefazolin with gentamicin IP is an effective treatment for APD peritonitis, with the advantage of being easy to administer and enabling patients to remain on APD during treatment.