risk of peritonitis vs. risk of antibiotics

[midges]

So I have a decision to make and am interested in hearing feedback from the group. My catheter sprung a leak about a week and a half ago (12/15). I remembered my training and clamped off above the leak. I couldn't get a new transfer set until the next day because it was a Sunday night. I skipped treatment that night (obvs) and went in first thing the next morning for a new transfer set and vancomycin in my bag. At that time my nurse took a sample of my fluid. Since I had skipped treatment the night before and I go dry during the day there was very little fluid and they couldn't really tell much from it. There was some wbc present,but it was only a little out of range (my neph would like to see <100 and my wbc was 200. Higher than normal, but well below what would constitute an actual infection, which is usually > 20,000). Subsequent bags were clear and I had no fever, cramping or any other signs of infection. Friday (12/20) I returned to clinic with a (clear) sample from my bag that my clinic sent off for culture. I also had a blood draw to check antibiotic levels and another dose of vanco. At this time I talked to the neph who said regardless of whether or not the culture came back clear, they wanted to but me on a 3 week course of vancomycin *and* cipro, *even though there were still no signs that I actually had an infection.* Also, my blood results from Friday showed that the amount of vanco in my system at that point was below a therapeutic dose, so it's unlikely that the doses of vanco I've had so far are just suppressing infection. On Friday I talked the doctor out of the cipro, though he was intent that I have 2 more doses of vanco, even if the culture came back clear and I still showed no signs of infection. I figured I'd just wait and see what happened. I went to clinic today and talked to my nurse about the results and told her that given the fact that I am showing no indications of infection and it has been 9 days since my catheter leaked and the culture came back clean I would rather not take any additional and seemingly unnecessary doses of antibiotics. She basically said I would be acting AMA. She gave me the meds that they want me to take and sent me on my way. So now it's up to me. I think I want to just keep any eye on my bags and watch for any signs of infection, but not take any more antibiotics unless something actually turns up. That to me seems preferable to the possibility of getting a yeast infection or thrush when I don't seem to actually have an infection right now. Thoughts?

[cassandra]

Mmmm difficult one, but as it is 9 days, and all those tests have been done, and if the cultures are done,,,,, I would keep a close I, just as you are planning to.

Good luck midges, keep us informed

Love, Cas

[okarol]

That's a dilemma, not sure what I would do. The antibiotic won't do any harm, short term, but we do build up resistant bugs over the long term. The risk of an infection is pain, losing your catheter or even having to do hemo for a time, right?

[amanda100wilson]

Let's face it, peritonitis is a life-threatening condition, which is why they apply such stringent protocols.  It is also possible for peritonitis to risk your peritoneum so that you can no longer do PD.  Not something to play with IMO.  That being said, I cannot recall using such a long-winded dosing of vanco. When I was on PD.

[Weggy]

I've had two tears in my catheter. Both times I was given only one dose of vanco and told to watch my fluid closely. My case might be different since I have lots of antibiotic allergies and they don't want to have resistance built up, but it seems like that is a bit long for a regime of vanco.

[midges]

Update: It has been 11 days since my catheter tore, 6 days since my second dose of vancomycin and 3 days since I declined to take additional doses of antibiotics. Drain bags are still clear and I'm feeling no symptoms of infection.

[cassandra]

Good to hear! But keep'n eye on your temperature too.

Love, Cas