Peritonealdialyse assoziierte Peritonitis

ZUSAMMENFASSUNG

Im Jahr 2022 wurden die neuen Leitlinien der International Society for Peritoneal Dialysis (ISPD) zur Diagnostik, Prophylaxe und Therapie der Peritonitis publiziert. Die maximal tolerierbare Peritonitisrate pro Zentrum wurde auf 0,4 Episoden/ Jahr herabgesenkt, wobei weniger als 15 % der Peritonitisfälle kulturnegativ sein sollten. Es wird empfohlen, auch die Peritonitisfälle, die vor Beginn der Peritonealdialyse (PD) auftreten, separat zu analysieren. Eine antibiotische Prophylaxe wird vor Katheterimplantation sowie vor Kolonoskopien und invasiven gynäkologischen Prozeduren empfohlen. Besondere hygienische Maßnahmen sind erforderlich, wenn Haustiere vorhanden sind. Anstelle einer Kombinationstherapie kann zur Abdeckung des gramnegativen und grampositiven Keimspektrums auch eine Monotherapie mit einem Cephalosporin der 4. Generation verwendet werden. Bei Wahl eines Aminoglykosids wird eine additive Therapie mit N-Azetylcystein zur Verhinderung der Ototoxizität empfohlen. Sollte 48 h nach Therapiebeginn keine Besserung eintreten, müssen weitere diagnostische Maßnahmen wie etwa die Abnahme neuerlicher Kulturen und Computertomografie des Abdomens durchgeführt werden.

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