DIET & NUTRITION 
PATIENT EDUCATION 
OBESITY/WEIGHT MANAGEMENT 
EXERCISE/TRAINING 
LEGAL MATTERS 
GUIDELINES/RECOMMENDATIONS The 2024 ISPD pediatric peritoneal dialysis infection guidelines bring the first major update since 2012. Revised antibiotic therapy recommendations, new mycobacterial peritonitis guidance, updated benchmarks, and antibiotic stewardship principles reflect a decade of international registry data from IPPN and the SCOPE Collaborative.
Clinical Considerations
- Cefazolin now preferred over vancomycin for MSSA peritonitis: IPPN data show 98% PD continuation with cefazolin versus 91% with other beta-lactams, reversing prior concerns about first-generation cephalosporins
- 2-week therapy now supported for most gram-negative peritonitis, shortening the previous 3-week standard; Pseudomonas, Acinetobacter, and Stenotrophomonas remain 3-week exceptions
- Gentamicin eliminated for Pseudomonas aeruginosa: CLSI no longer supports breakpoints; tobramycin is preferred if an aminoglycoside is required
- New NTM peritonitis guidance: catheter removal required; Mtb peritonitis can be managed with anti-tuberculous therapy alone without removal
Practice Applications
- Apply antifungal prophylaxis (nystatin or fluconazole) whenever systemic or intraperitoneal antibiotics are prescribed, regardless of indication
- Remove the PD catheter immediately when fungal elements appear in effluent; do not wait for speciation or culture confirmation
- Benchmark your program annually: peritonitis rate below 0.4 episodes/year, culture-negative rate below 15%, post-insertion peritonitis below 5% within 30 days
- Conduct an apparent cause analysis after every peritonitis episode to identify patient and center-level risk factors
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