Divergent etiologies of CAPD peritonitis in integrated double bag and traditional systems?

Thirty-four patients on integrated double bag systems (IDBS) without disinfectants were compared with 33 patients on traditional single bag systems for incidence, probability of remaining free of peritonitis, type, and association of peritonitis (PE). In another 13 patients, the influence of a change in bag system was analyzed. On IDBS, the probability of remaining free of PE was 59% at 12 months and the incidence of PE was 0.44/year (1/27.3 months) while on traditional systems the probability of remaining PE free was 29% (p = 0.03) and the incidence was 1.06/year (1/11.3 months). The switch from single bag systems to IDBS decreased the incidence from 1.7/year to 0.7/year. The distribution of microbes that caused peritonitis on IDBS was different from patients on traditional systems, where the causative microbes were mainly coagulase negative Staphylococci. The use of IDBS decreased considerably the occurrence of infections caused by these skin bacteria. Some associated disorder (e.g., exit site infection, dental infection, broken transfer set) was found significantly more often in patients on IDBS. In conclusion, IDBS affect both the occurrence and type of PE by diminishing effectively intraluminal contamination by skin bacteria. Thus, other sources of infection have a proportionally greater significance.