Grading of exit sites cannot predict peritonitis in patients on CAPD

Grading of exit sites was performed at 265 routine outpatient visits of 28 patients starting CAPD between January 1988 and February 1990, with a total observation time of 398.5 months to December 1990. Six patients had no peritonitis episode. The remaining 22 patients suffered from 43 peritonitis episodes. Fifty-eight per cent of these were caused by Staphylococcus epidermidis. Eighty-six per cent of the examinations of exit sites of patients with peritonitis episodes showed 0 to 1 point on an arbitrary grading scale of up to 9 points. Staphylococcus aureus was found after bacterial culture from exit site smears in 3 cases. All were adequately treated. None of these cases showed any peritonitis episodes with this bacteria. No relationship could be found between the grading of the exit site at routine outpatient clinic visits and the appearance of a peritonitis episode. Grading of exit sites is of clinical importance but cannot predict the appearance of peritonitis.