Peritonitis Treatment: Insights and Patient Experiences

Treatment of peritonitis?

Hello Dr.
Ke, I apologize for accidentally sending the message before finishing it last time.
My mother has been on peritoneal dialysis for eleven years and is in good condition, having never experienced peritonitis.
However, from mid-December to the end of December last year, she had issues with drainage and frequently visited the hospital.
During that time, fibrin was produced, and she experienced severe pain whether the fluid was draining out or going into her abdomen.
The nurses treated her with heparin, but eventually, the pain became unbearable, and she had to go to the emergency room and was admitted to the hospital.
She stayed for 55 days.
At the beginning of her hospitalization, she was given antibiotics, but she kept vomiting bile and couldn't eat.
Ultimately, the peritoneal dialysis catheter had to be removed.
After the catheter was removed, her abdomen started to accumulate ascites, and once it became excessive, a drainage catheter was inserted.
During this period, multiple blood tests and bacterial cultures failed to yield results.
After completing the artificial vascular procedure and observing her for a few days, the doctor decided to discharge her.
On the fifth day after discharge, during a follow-up visit, the doctor noticed that the drained ascitic fluid had become cloudy and was concerned about a potential infection, so she was readmitted.
On the day of readmission, she started to have a fever, initially reaching 39 degrees Celsius, which then dropped to 37.5 degrees after a week.
However, her white blood cell count increased from 14,000 to 18,000.
She was treated with two types of antibiotics: one administered daily and the other every five days.
The doctor mentioned that the antibiotic given every five days was the last-line treatment.
During this hospitalization, a culture was taken, and a strain of Escherichia coli was identified, which the doctor noted had not been detected previously.
Therefore, they decided to treat her for this specific bacteria.
I just wanted to ask if this approach is correct, considering she has had a second infection and we are very concerned about any potential complications.
I apologize for the disturbance.
Thank you.

bye, 20~29 year old female. Ask Date: 2014/03/14

Dr. Ke Fangxu reply Surgery

Peritoneal dialysis is most concerned with peritoneal infection.
It has now been decided to switch to hemodialysis and remove the peritoneal catheter.
Following this, antibiotic treatment will be based on the results of bacterial cultures, which is the correct approach.
As long as the current medication is improving symptoms, there is no need to overthink it.
Unless the medication treatment is ineffective, abdominal surgery may be necessary.
If the current treatment is effective, then it is important to patiently continue with the treatment.

Reply Date: 2014/03/14

More Info

Peritonitis is a serious condition characterized by inflammation of the peritoneum, the lining of the abdominal cavity. It can arise from various causes, including infections, perforation of abdominal organs, or complications from procedures such as peritoneal dialysis. Your mother's experience with peritonitis, particularly following her long-term peritoneal dialysis, highlights the complexities and challenges of managing this condition.

In your mother's case, the initial symptoms of severe pain and complications with drainage suggest that she may have experienced a form of peritonitis, possibly related to her dialysis. The presence of fibrinous material and the need for heparin treatment indicate that there was significant inflammation and possibly a risk of clotting in the dialysis system. The decision to admit her to the hospital for intravenous antibiotics was appropriate, especially given her symptoms of vomiting and inability to eat, which are common in severe infections.

The prolonged hospitalization of 55 days reflects the severity of her condition. During this time, the medical team likely aimed to stabilize her condition, manage her symptoms, and prevent further complications. The use of antibiotics is crucial in treating peritonitis, and it is not uncommon for multiple antibiotics to be used, especially if the specific causative organism is not immediately identified. In your mother's case, the identification of E. coli as the causative agent was a significant step, as it allowed for targeted antibiotic therapy.

The concern about the cloudy appearance of the drained fluid is valid, as it can indicate infection or other complications. The increase in white blood cell count is also a marker of infection and inflammation. The use of a last-resort antibiotic suggests that the medical team was taking her condition seriously and was prepared to use aggressive treatment to combat the infection.

Regarding the management of her condition, it is essential to monitor her closely for any signs of recurrence or complications. The fact that she has had two episodes of infection raises the concern for potential underlying issues, such as catheter-related infections or complications from her dialysis. Regular follow-ups with her healthcare team, including nephrologists and infectious disease specialists, are crucial to ensure that her treatment plan is effective and to make any necessary adjustments.

In summary, the treatment approach your mother received appears to be appropriate given the circumstances. The use of antibiotics, monitoring of her condition, and the decision to drain fluid were all critical components of her care. However, it is essential to remain vigilant for any signs of recurrence or complications, as peritonitis can lead to severe outcomes if not managed promptly and effectively. Continuous communication with her healthcare providers will be key in navigating her ongoing treatment and ensuring her well-being.

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