简介：Peritonitis remains a leading complication of peritoneal dialysis (PD). It contributes to technique failure and hospitalization, and sometimes is associated with death of the patient. Severe and prolonged peritonitis can lead to peritoneal membrane failure. Therefore, the PD community continues to focus attention on prevention and treatment of PD-related infections (1–8).
Guidelines under the auspices of the International Society for Peritoneal Dialysis (ISPD) were first published in 1983 and revised in 1989, 1993, 1996, and 2000 (9–11). The initial focus was on the treatment of peritonitis, but the more recent guidelines included sections on preventing peritonitis. In the present guidelines, the Committee has expanded the section on prevention since prevention of peritonitis is one of the keys to success with PD.
The present recommendations are organized into five sections:
1. Prevention of PD-related infections
2. Exit-site and tunnel infections
3. Initial presentation and management of peritonitis
4. Subsequent management of peritonitis (organism specific)
5. Future research
These guidelines are evidence based where such evidence exists. The bibliography is not intended to be comprehensive as there have been over 9000 references to peritonitis in PD patients published since 1966. The Committee has chosen to include articles that are considered key references. Guidelines are not based solely on randomized controlled trials, as such studies in PD patients are limited. If there is no definitive evidence but the group feels there is sufficient experience to suggest a certain approach, this is indicated as “opinion based.”
The guidelines are not meant to be implemented in every situation but are recommendations only. Each center should examine its own pattern of infection, causative organisms, and sensitivities, and adapt the protocols as necessary for local conditions.
The members of the Advisory Committee were carefully selected. First, nephrologists widely published on PD infections were chosen from around the world, with particular attention to including nephrologists from Asia, where the use of PD is growing very rapidly. Second, members were appointed with expertise in microbiology (Kuijper), pharmacotherapy (Bailie), infectious diseases (Paterson), and immunology (Holmes). The current guidelines are for adults only, as pediatric guidelines are published separately but, for coordination, a pediatrician was added to the work group (Schaefer). Third, two nurses (Bernardini and Uttley) represent the very important role of the nurse in the prevention of PD infections and care for PD patients with infections.