I had a pt taken off pd with catheter removal on September 26th 2019 for pantoea agglomerans and enterococcus fecalis peritonitis after fortaz , vanco later addition of gentamicin did not clear the infection over 10 days with persistently positive cell counts in pd fluid. I wanted to ask you when I can try pd again and put the catheter back . I wanted to wait 3-4 months but pt is desperate to go back to pd and wants it now

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Zubair, A, Doctor/MD from Tulsa ok asked
I had a pt taken off pd with catheter removal on September 26th 2019 for pantoea agglomerans and enterococcus fecalis peritonitis after fortaz , vanco later addition of gentamicin did not clear the infection over 10 days with persistently positive cell counts in pd fluid. I wanted to ask you when I can try pd again and put the catheter back . I wanted to wait 3-4 months but pt is desperate to go back to pd and wants it now

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Doctor (Canada) November 22, 2019

While we cannot comment on management of specific cases, the 2016 ISPD peritonitis guideline outlines the timing of PD catheter re-insertion after peritonitis below:
“We suggest that if re-insertion of a new catheter is attempted after a PD catheter is removed for refractory, relapsing, or fungal peritonitis, it be performed at least 2 weeks after catheter removal and complete resolution of peritoneal symptoms (2D).”
“Observational studies suggest that effective antibiotics should be continued for at least 2 weeks after catheter removal for refractory peritonitis…There are few data on the optimal duration between catheter removal for peritonitis and re-insertion of a new catheter. Observational studies suggest a minimum period of 2 to 3 weeks, although some would recommend later re-insertion in cases of fungal peritonitis. Re-insertion of a new catheter should be done by laparoscopic or mini-laparotomy approach so that adhesion can be directly visualized. Ultrafiltration problems are common after return to PD”.

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