It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.

Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the infectious diseases society of America

Patients with chronic kidney disease (CKD) are at high risk for developing critical illness and for admission to intensive care units (ICU). ‘Critically ill CKD patients' frequently develop an acute w

/pdf/management-of-chronic-kidney-disease-patients-in-the-384tadrdud.pdf

Management of Chronic Kidney Disease Patients in the Intensive Care Unit: Mixing Acute and Chronic Illness

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 Infectious Disease,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

https://journals.sagepub.com/doi/pdf/10.3747/pdi.2010.00049

Peritoneal dialysis-related infections recommendations: 2010 update

Peritonitis is a common and serious complication of peritoneal dialysis (PD). Although less than 5% of peritonitis episodes result in death, peritonitis is the direct or major contributing cause of death in around 16% of PD patients (1-6). In addition, severe or prolonged peritonitis leads to structural and functional alterations of the peritoneal membrane, eventually leading to membrane failure. Peritonitis is a major cause of PD technique failure and conversion to long-term hemodialysis (1,5,7,8). Recommendations under the auspices of the International Society for Peritoneal Dialysis (ISPD) were first published in 1983 and revised in 1993, 1996, 2000, 2005, and 2010 (9-14). The present recommendations are organized into 5 sections: 1. Peritonitis rate 2. Prevention of peritonitis 3. Initial presentation and management of peritonitis 4. Subsequent management of peritonitis 5.

/pdf/ispd-peritonitis-recommendations-2016-update-on-prevention-28ki6os9ax.pdf

Ispd peritonitis recommendations: 2016 update on prevention and treatment

https://www.kidney-international.org/article/S0085-2538(15)54984-3/pdf

Drug dosing consideration in patients with acute and chronic kidney disease-a clinical update from Kidney Disease: Improving Global Outcomes (KDIGO).

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.

/pdf/peritoneal-dialysis-related-infections-recommendations-2005-4vvkk63f9w.pdf

Peritoneal dialysis-related infections recommendations: 2005 update

Editor: We appreciate Drs. Bonadio and Diaz-Buxo drawing attention to the definitions for peritonitis in the 2005 guidelines for peritoneal dialysis-related infections (1). Considerable discussion by the ISPD Ad Hoc Advisory Committee on Peritoneal Dialysis Related Infections was focused on the development of these definitions. The goal was to make sure that, in papers published on peritonitis, there would be clear distinction between the different potential outcomes of peritonitis. The authors of the letter seem to be confused by the latest definitions and propose a correction. In this reply we outline the rationale for our terms and the definitions applied to them. Peritonitis that is treated with appropriate antibiotic therapy, appears to resolve, and yet returns with the same organism, or as sterile peritonitis, within 4 weeks (“relapsing”) is different than an episode of peritonitis that occurs within 4 weeks of a prior episode but with a different organism (defined as “recurrent”). Reappearance of cloudy effluent requires appropriate microbiological investigation, with bacterial species identification and, if available, molecular typing techniques. Antimicrobial resistance may develop during treatment, resulting in an early relapse with an identical species but with different susceptibility pattern after completion of the treatment. Alternatively, the source of the relapse may be the catheter, either through biofilm or tunnel infection. For relapsing peritonitis, most experts in the f ield would recommend catheter removal, unless the susceptibility pattern of the organism has changed, indicating that further antibiotic therapy may be warranted. Webster’s defines “relapsing” as “to fall back or revert to an earlier state” (2). This definition fits exactly what the Committee meant by the use of the term and is consistent with the recommendation of removing the catheter in most instances. “Relapsing” linguistically conveys exactly the seriousness of the event in question and hence is the appropriate term to retain. Webster’s defines “recurrent” as “occurring or appearing again.” This definition also fits the meaning the Committee chose. In recurrent peritonitis, the patient’s immunity may be impaired by the first episode, leading in some cases to an episode of peritonitis from a completely different organism, implying a different cause. These episodes can frequently be successfully treated without catheter removal. “Repeating” peritonitis is considered present when peritonitis caused by the same organism as the previous episode occurs more than 4 weeks after completion of therapy. In their landmark paper, Finkelstein and colleagues demonstrated the importance of episodes of peritonitis due to the same organism occurring at intervals of more than 4 weeks (3). Their data, which show that replacing the catheter prevents further episodes from that particular organism, strongly impute that the catheter is involved, with the organism sequestered in the biofilm. Most of these repeat episodes were due to Staphylococcus. “Refractory” peritonitis is defined as an episode with failure of the effluent to clear at 5 days. The Toronto group showed that this was an important predictor of failure of antibiotic therapy alone (4). At this point, the clinicians should consider catheter removal. The Work Group does not agree that refractory peritonitis could be considered present if symptoms are still present after only 48 hours of therapy. In the final analysis, when a term is clearly defined by a guideline committee, alternate linguistic interpretations become irrelevant. The Committee chose the above outlined definitions for relapsing, recurrent, and refractory peritonitis to eliminate confusion. Bonadio and Diaz-Buxo would have been right if no definition had been offered. Hence, the terms relapsing, recurrent, and repeat as used by the Committee are appropriate. Confusion among practitioners is best addressed by education and not by changing the terminology. Close attention to the outcomes of peritonitis, as defined by the guidelines, should lead to a better understanding of the course of peritonitis.

Response to Bonadio and Diaz-Buxo

An introduction to the 2005 peritoneal dialysis-related infections recommendations : Peritoneal dialysis-related infections recommendations: 2005 update

Wai-Choong Lye

Papers

Peritoneal dialysis-related infections recommendations: 2010 update

Peritoneal dialysis-related infections recommendations: 2005 update

Response to Bonadio and Diaz-Buxo

An introduction to the 2005 peritoneal dialysis-related infections recommendations : Peritoneal dialysis-related infections recommendations: 2005 update