Before starting empiric antibiotics for suspected PD peritonitis, what is the recommended step?

• A. Begin antibiotics immediately and then sample the effluent
• B. Obtain effluent sample for culture before starting antibiotics
• C. Ignore cultures and proceed with empirical antifungals
• D. Wait for several days before taking action

Answer: (B)

When PD peritonitis is suspected, the most important first step before starting antibiotic therapy is to obtain an effluent sample for culture using sterile technique. Collecting the sample prior to antibiotics maximizes the chance of growing the causative organism and allows accurate identification and antibiotic susceptibility testing, which guides targeted therapy and improves outcomes. If you delay antibiotics to wait for culture, you risk worsening infection and patient condition, and starting antifungals without a clear fungal indication is not appropriate. In practice, you should obtain the culture sample promptly and then begin empiric antibiotics as soon as the sample is collected, especially if the patient is ill.