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Background: Initial presentation of peritoneal dialysis associated infectious peritonitis can be clinically indistinguishable from Clostridioides difficile infection (CDI) and both may demonstrate a cloudy dialysate. Empiric treatment of the former entails use of 3rd-generation cephalosporins, which could worsen CDI. We present a logical management approach of this clinical scenario providing examples of two cases with CDI associated peritonitis of varying severity where the initial picture was concerning for peritonitis and treatment for CDI resulted in successful cure., Case Presentation: A 73-year-old male with ESRD managed with PD presented with fever, abdominal pain, leukocytosis and significant diarrhea. Cell count of the peritoneal dialysis effluent revealed 1050 WBCs/mm 3 with 71% neutrophils. C. difficile PCR on the stool was positive. Patient was started on intra-peritoneal (IP) cefepime and vancomycin for treatment of the peritonitis and intravenous (IV) metronidazole and oral vancomycin for treatment of the C. difficile colitis but worsened. PD fluid culture showed no growth. He responded well to IV tigecycline, oral vancomycin and vancomycin enemas. Similarly, a 55-year-old male with ESRD with PD developed acute diarrhea and on the third day noted a cloudy effluent from his dialysis catheter. PD fluid analysis showed 1450 WBCs/mm 3 with 49% neutrophils. IP cefepime and vancomycin were initiated. CT of the abdomen showed rectosigmoid colitis. C. difficile PCR on the stool was positive. IP cefepime and vancomycin were promptly discontinued. Treatment with oral vancomycin 125 mg every six hours and IV Tigecycline was initiated. PD fluid culture produced no growth. PD catheter was retained., Conclusions: In patients presenting with diarrhea with risk factors for CDI, traditional empiric treatment of PD peritonitis may need to be reexamined as they could have detrimental effects on CDI course and patient outcomes.

A 37-year-old woman with a history of type II diabetes and Crohn's disease, status postcholecystectomy, presented with a >2-week history of cramping abdominal pain, nausea, non-bloody/non-bilious emesis and, later, diarrhoea. A flexible sigmoidoscopy was performed, revealing that 'a segmental pseudomembrane was found from rectum to sigmoid colon'. Clostridium difficile PCR on the stool was repeated twice and resulted negative both times. A food history prior to onset of symptoms was consistent with Staphylococcal food poisoning and a stool culture was positive for heavy growth of methicillin-resistant Staphylococcus aureus and the absence of enteric flora. The patient was successfully treated with oral vancomycin., (2016 BMJ Publishing Group Ltd.)

Objective: The purpose of this study was to ascertain if a relationship exists between the psychosocial characteristics of the CAPD patient and the occurrence of infectious complications exhibited by the patient., Design: Descriptive., Sample/setting: Sixty-five (65) patients from 3 dialysis units in the south-eastern United States. The subjects at the time of the study were (a) using CAPD and performing their exchanges using a spike decontamination system, or (b) were previously treated by CAPD using a spike decontamination system., Methods: Patients completed the Exercise of Self-Care Agency scale (ESCA) and three subscales of the Adjective Check List (ACL). The relationship of the patient's occurrences of infectious complication and the scores on these instruments was evaluated using multiple regression techniques and Cox Hazard Ratio., Results: Of the characteristics studied, only autonomy was found to be significantly related to the incidence of peritonitis, time to the first episode of peritonitis, and the total incidence of infectious complications. None of the psychosocial characteristics studied were significantly related to the occurrence of exit site infections., Conclusions: The patient's autonomy and factors other than the psychosocial characteristics presented in this study contribute to the occurrence of infectious complications in CAPD patients. Attitudes about ESRD and CAPD expressed by the patients permitted them to be categorized into three groups, which had vastly different degrees of success with CAPD; these categorizations may serve as the basis for further study.