The Use of Gentamicin in Peritoneal Dialysis. II. Microbiologic and Clinical Results

Gentamicin was administered in 33 episodes of peritoneal dialysis complicated by persistence of a turbid dialysate. Antibiotic treatment was considered indicated if the effluent from dialysis contained a predominance of polymorphonuclear leukocytes. Bacteria were isolated from the dialysate in approximately 50 % of patients, the majority of whom had either fever or abdominal symptoms. In most instances, evidence of infection cleared during therapy with gentamicin or other antibiotics subsequently selected according to microbiologic data. Four patients with bacteriologically confirmed peritonitis, three due to Pseudomonas aeruginosa and one to Staphylococcus aureus, responded poorly to gentamicin. Prolonged antibiotic therapy resulted in one case of superinfection with Candida. Gentamicin is a useful single drug for the initial treatment of potential bacterial peritonitis due to either gram-positive or gram-negative pathogens. However, treatment with a semisynthetic penicillin or cephalothin for staphylococcal peritonitis, and the addition of carbenicillin for peritoneal infection due to Pseudomonas appear preferable to the continued use of gentamicin alone. Early consideration of ther