How to record peritoneal catheter infections

Due to discrepant definitions of exit-site infections and/or tunnel infections (ESI/TI), as well as to the variety of infection rates, data on ESI/TI are extremely difficult to compare. Twardwski et al. have defined exit site, while Nolph et al. have proposed new monitoring and reporting of ESI/TI. The aim of our prospective study was to try combining both systems. From January 1992 to December 1995 we treated 127 patients, in whom 147 double-cuff peritoneal catheters (PCs) were inserted. Tunnel infection was defined as external-cuff infection (ECI), inter-cuff segment infection (ICSI), and/or internal-cuff infection (ICI). Sixty-four PCs (43.5%) were infected. Thirty-eight (25.8%) had acute PC infection (PCI) from 2.4% to 4.7% of the total patient-months of care per year, and 26 (17.7%) PCs were chronically infected from 2.1 to 11.1% of the time per year. Almost all cases of removed acutely and chronically infected PCs had ECI in combination with ESI. According to our experience, ECI should be classified as TI. The proposed approach to monitoring and reporting is very useful for ESI, but does not include TI. Comparison between different peritoneal dialysis units is only possible when they share a common PC classification system, and when their personnel are well experienced, highly trained, and very accurate.