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Infection in continuous ambulatory peritoneal dialysis (CAPD): aetiology, complications and risk factors
Abstract:
Continuous ambulatory peritoneal dialysis (CAPD) was started in the Singapore General Hospital in 1980. Peritonitis and exit site infections have been the major cause of morbidity and catheter loss in CAPD. In 1990, 130 patients were on CAPD and the peritonitis rate was one episode in 20.4 patient months. Gram positive organisms accounted for 54% of the infections of which Staphylococcus epidermidis was the commonest (24%). Catheter removal was required in 14% of the cases and 9% of the patients discontinued CAPD as a result of peritonitis. The exit site infection rate was one episode in 27.5 patient months and the commonest organism was Staphylococcus aureus (54%). Twenty-three (47%) of the cases of exit site infection required catheter removal and 83% of the cases were the result of S. aureus infections. Patients with preexisting exit site infections experienced more episodes of peritonitis. Patients above the age of 50 years experienced more episodes of peritonitis and exit site infection. Sex, diabetes and the duration on CAPD did not influence the frequency of infections. Patients using the UV Germicidal Exchange Device had fewer episodes of peritonitis than those using the conventional spike system.
Insights
Continuous ambulatory peritoneal dialysis (CAPD) patients face infections like peritonitis and exit site infections. Using the UV Germicidal Exchange Device may reduce peritonitis episodes compared to the standard spike system.
Area of Science:
- Nephrology
- Infectious Diseases
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a renal replacement therapy. Peritonitis and exit site infections are significant complications impacting patient morbidity and catheter survival.
- In 1990, 130 patients were undergoing CAPD at Singapore General Hospital, with specific infection rates documented.
Purpose of the Study:
- To analyze the incidence and causative organisms of peritonitis and exit site infections in CAPD patients.
- To identify risk factors associated with these infections and evaluate the impact of the UV Germicidal Exchange Device.
Main Methods:
- Retrospective analysis of CAPD patient data from Singapore General Hospital.
- Documentation of peritonitis and exit site infection rates, microbial profiles, and clinical outcomes including catheter removal and CAPD discontinuation.
- Comparison of infection rates between patients using the UV Germicidal Exchange Device and the conventional spike system.
Main Results:
- The peritonitis rate was 1 episode per 20.4 patient-months, with Gram-positive organisms (54%) being most common, particularly Staphylococcus epidermidis (24%).
- Exit site infection rate was 1 episode per 27.5 patient-months, with Staphylococcus aureus (54%) being the predominant pathogen.
- Older patients (>50 years) and those with prior exit site infections had higher infection rates. The UV Germicidal Exchange Device group showed lower peritonitis rates.
Conclusions:
- Peritonitis and exit site infections remain major challenges in CAPD, often requiring catheter removal or treatment cessation.
- Staphylococcus species are the primary culprits. Patient age and pre-existing exit site infections are risk factors for increased infection frequency.
- The UV Germicidal Exchange Device may offer a protective effect against peritonitis in CAPD patients.