Médico General

Peritoneal Dialysis International, Vol. 30, pp. 393–423
doi:10.3747/pdi.2010.00049

0896-8608/10 $3.00 + .00
Copyright © 2010 International Society for Peritoneal Dialysis

ISPD GUIDELINES/RECOMMENDATIONS

PERITONEAL DIALYSIS-RELATED INFECTIONS
RECOMMENDATIONS: 2010 UPDATE

Philip Kam-Tao Li,1 Cheuk Chun Szeto,1 Beth Piraino,2 Judith Bernardini,2 Ana E. Figueiredo,3
Amit Gupta,4 DavidW. Johnson,5 Ed J. Kuijper,6 Wai-Choong Lye,7
William Salzer,8 Franz Schaefer,9 and Dirk G. Struijk10
Department of Medicine and Therapeutics,1 Prince of Wales Hospital, The Chinese University of Hong Kong,
Hong Kong; University of Pittsburgh School of Medicine,2 Pittsburgh, PA, USA; Faculdade de Enfermagem,
Nutrição e Fisioterapia,3 Pontifícia Universidade Católica do Rio Grande do Sul,Brazil; Sanjay Gandhi
Postgraduate Institute of Medical Sciences,4 Lucknow, India; Department of Nephrology,5 Princess Alexandra
Hospital, and School of Medicine, University of Queensland, Brisbane, Australia; Department of Medical
Microbiology,6 Leiden University Medical Center, Leiden, The Netherlands; Centre for Kidney Diseases,7
Mount Elizabeth Medical Centre, Singapore; Section of InfectiousDisease,8 Department of Internal Medicine,
University of Missouri-Columbia School of Medicine, Columbia, MO, USA; Pediatric Nephrology
Division,9 University Children’s Hospital, Heidelberg, Germany; Dianet Dialysis Centers,10
Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

P

eritonitis remains a leading complication of peritoneal dialysis (PD). Around 18% ofthe infection-related
mortality in PD patients is the result of peritonitis. Although less than 4% of peritonitis episodes result in
death, peritonitis is a “contributing factor” to death in
16% of deaths on PD. In addition, severe and prolonged
peritonitis can lead to peritoneal membrane failure and
peritonitis is probably the most common cause of technique failure in PD. Peritonitis remainsa major cause of
patients discontinuing PD and switching to hemodialysis. Therefore, the PD community continues to focus attention on prevention and treatment of PD-related
infections (1–9). Peritonitis treatment should aim for
rapid resolution of inflammation and preservation of
peritoneal membrane function.
Recommendations under the auspices of the International Society for PeritonealDialysis (ISPD) were first
published in 1983 and revised in 1989, 1993, 1996, 2000,
and 2005 (10–13). The previous recommendations inThe authors are members of the ISPD Ad Hoc Advisory Committee on Peritoneal Dialysis Related Infections.

cluded sections on treatment as well as prevention of
peritonitis. In the present recommendations, the Committee focused on the treatment of peritonitis;prevention of PD-related infections will be covered in a separate
ISPD position statement.
The present recommendations are organized into five
sections:
1.
2.
3.
4.

Reporting of peritonitis rate
Exit-site and tunnel infections
Initial presentation and management of peritonitis
Subsequent management of peritonitis (organism
specific)
5. Future research
Perit Dial Int 2010; 30:393–423www.PDIConnect.com
doi:10.3747/pdi.2010.00049

Correspondence to: P.K.T. Li, Department of Medicine and
Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
philipli@cuhk.edu.hk
Received 12 February 2010; accepted 27 April 2010.
393

LI et al.

Although many of the general principles could be applied to pediatric patients, recommendationsoutlined
here focus on PD-related infections in adult patients.
Clinicians who take care of pediatric PD patients
should refer to other sources for detailed treatment regimens and dosages.
These recommendations are evidence based where
such evidence exists. The bibliography is not intended
to be comprehensive as there have been nearly 10 000
references to peritonitis in PD patients published...