A 65-Year-Old Man on Chronic Peritoneal Dialysis (PD) for Two

A 65-year-old man on chronic peritoneal dialysis (PD) for two years complains of 1 day of diffuse abdominal pain.  He has not noticed any changes in his catheter exit site, changes in bowel movements, fever, or chills.
His temperature is 37.2 C (99.0 F) , blood pressure is 140/90 mm Hg, and pulse is 90/min.  Bowel sounds are normal.  There is mild, diffuse abdominal tenderness without definite rebound tenderness.  The catheter exit site looks normal.
Analysis of peritoneal fluid reveals a white blood cell count of 110 cells/µL.  Gram stain of the peritoneal fluid is negative.
Laboratory results are as follows:

Which of the following would be the most appropriate next step in management?

A) Abdominal CT scan
B) Colonoscopy
C) Dialysis catheter removal
D) Intraperitoneal vancomycin and cefepime
E) Intravenous aminoglycoside and cefazolin

Correct Answer:

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