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Peritonitis

Inflammation of the peritoneum (tissue that lines the abdominal wall and covers most of the organs in the abdomen). Peritonitis can result from infection, injury, or certain diseases. Symptoms may include swelling of the abdomen, severe pain, and weight loss.

PubMed Health Glossary
(Source: NIH - National Cancer Institute)

What works? Research summarized

Evidence reviews

Y‐set and double bag systems offer the most protection against peritonitis during continuous ambulatory peritoneal dialysis (CAPD)

People with advanced kidney disease may be treated with CAPD where a catheter is permanently inserted into the peritoneum (lining around abdominal contents) through the abdominal wall and sterile fluid is drained in and out a few times each day. The most common serious complication is infection of the peritoneum ‐ peritonitis. This may be caused by bacteria accidentally being transferred from the catheter. This review of trials compared three types of connecting systems (used to connect the bags and the catheter) and found the Y‐set and double bag exchange systems are the most effective in preventing peritonitis.

The nasal antibiotic prophylactic mupirocin reduces exit‐site/tunnel infection and preoperative intravenous antibiotic prophylaxis reduces early peritonitis in peritoneal dialysis

People with advanced kidney disease may be treated with peritoneal dialysis where a catheter is permanently inserted into the peritoneum (lining around abdominal contents) through the abdominal wall and sterile fluid is drained in and out a few times each day. The most common serious complication is infection of the peritoneum ‐ peritonitis. This may be caused by bacteria accidentally being transferred from the catheter. This review found that nasal mupirocin reduces exit‐site/tunnel infection but not peritonitis while preoperative intravenous antibiotic prophylaxis reduces early peritonitis but not exit‐site/tunnel infection. More large scale trials are needed.

Existing trials, of poor quality, indicate that antibiotic prophylaxis reduces spontaneous bacterial peritonitis among cirrhotic patients with ascites and no gastrointestinal bleeding

Spontaneous bacterial peritonitis (infection and inflammation of the membrane lining the abdominal cavity) is a frequent complication among cirrhotic patients (patients with end‐stage liver disease marked by irreversible scarring of liver tissue) and is associated with significant morbidity and mortality. Selective intestinal decontamination, employing antibiotics, is a proposed prophylactic (preventive) measure. This systematic review of randomised clinical trials assesses whether antibiotic prophylaxis prevents spontaneous bacterial peritonitis and mortality among cirrhotic patients with ascites (excess fluid in the abdominal cavity) and no gastrointestinal bleeding. Nine trials are included in the review. The pooled rates of spontaneous bacterial peritonitis and mortality indicate that antibiotic prophylaxis reduces both. There are very few reports of adverse events. Reviewing these trials, we found poor methodology, evidence suggesting publication bias, and limited follow‐up periods. Thus, the recommendation to prescribe prophylactic antibiotics to cirrhotic patients without gastrointestinal bleeding is hampered by quality of the trials that generated the data. Due to potential hazards, both to society as a whole and the patients, as individuals, before antibiotic prophylaxis can be confidently recommended, trials of better design, well reported, and of longer follow‐up are required.

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Summaries for consumers

Y‐set and double bag systems offer the most protection against peritonitis during continuous ambulatory peritoneal dialysis (CAPD)

People with advanced kidney disease may be treated with CAPD where a catheter is permanently inserted into the peritoneum (lining around abdominal contents) through the abdominal wall and sterile fluid is drained in and out a few times each day. The most common serious complication is infection of the peritoneum ‐ peritonitis. This may be caused by bacteria accidentally being transferred from the catheter. This review of trials compared three types of connecting systems (used to connect the bags and the catheter) and found the Y‐set and double bag exchange systems are the most effective in preventing peritonitis.

The nasal antibiotic prophylactic mupirocin reduces exit‐site/tunnel infection and preoperative intravenous antibiotic prophylaxis reduces early peritonitis in peritoneal dialysis

People with advanced kidney disease may be treated with peritoneal dialysis where a catheter is permanently inserted into the peritoneum (lining around abdominal contents) through the abdominal wall and sterile fluid is drained in and out a few times each day. The most common serious complication is infection of the peritoneum ‐ peritonitis. This may be caused by bacteria accidentally being transferred from the catheter. This review found that nasal mupirocin reduces exit‐site/tunnel infection but not peritonitis while preoperative intravenous antibiotic prophylaxis reduces early peritonitis but not exit‐site/tunnel infection. More large scale trials are needed.

Existing trials, of poor quality, indicate that antibiotic prophylaxis reduces spontaneous bacterial peritonitis among cirrhotic patients with ascites and no gastrointestinal bleeding

Spontaneous bacterial peritonitis (infection and inflammation of the membrane lining the abdominal cavity) is a frequent complication among cirrhotic patients (patients with end‐stage liver disease marked by irreversible scarring of liver tissue) and is associated with significant morbidity and mortality. Selective intestinal decontamination, employing antibiotics, is a proposed prophylactic (preventive) measure. This systematic review of randomised clinical trials assesses whether antibiotic prophylaxis prevents spontaneous bacterial peritonitis and mortality among cirrhotic patients with ascites (excess fluid in the abdominal cavity) and no gastrointestinal bleeding. Nine trials are included in the review. The pooled rates of spontaneous bacterial peritonitis and mortality indicate that antibiotic prophylaxis reduces both. There are very few reports of adverse events. Reviewing these trials, we found poor methodology, evidence suggesting publication bias, and limited follow‐up periods. Thus, the recommendation to prescribe prophylactic antibiotics to cirrhotic patients without gastrointestinal bleeding is hampered by quality of the trials that generated the data. Due to potential hazards, both to society as a whole and the patients, as individuals, before antibiotic prophylaxis can be confidently recommended, trials of better design, well reported, and of longer follow‐up are required.

See all (18)

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