[Peritonitis associated with peritoneal dialysis.]

Continuous ambulatory peritoneal dialysis (CAPD) is now a recognised treatment for end stage renal disease. An estimated number of 27.000 patients was being treated by CAPD world-wide in the year 1985. The most important complication is infection, peritonitis. The CAPD program started in Iceland in April 1985 at the dialysis department of the National University Hospital. The aim of this study was to estimate the incidence of infection associated with peritoneal dialysis during the first five years. All positive cultures of peritoneal dialysates from the Department of Bacteriology, and the hospital records of patients on CAPD, during the time period 12.04.1985 to 12.04.1990, were studied retrospectively. CAPD was considered started as soon as the peritoneal catheter had been inserted. Peritonitis was considered to be present when the white blood cell count was > 100/ul or there were clinical signs of infection together with a positive culture from the dialysate. During the study period 27 patients were treated by CAPD for 609.6 treatment months. Peritonitis was diagnosed 83 times in 18 of these patients, giving an incidence of 1.63/treatment year. The most common cause was Staphylococcus aureus, which was isolated 35 times (42%). Other causative organisms were: 17 coagulase negative staphylococci (21%), three Gram negative rods (4%), one yeasts and three mixed cultures. In 12 (14%) of the peritonitis episodes, no organisms were isolated. Admission to hospital was considered necessary in 74% of the episodes. One patient died of peritonitis. Studies have demonstrated various infection rates (0.23-6.3 infections/year), but has usually been between 0.8 and 1.2 infections/year. It is of interest to note that the most common causative organism in this study was S. aureus, as opposed to coagulase negative staphylococci, that have normally been the most prevalent. S. aureus usually causes tunnel infections, that are difficult to clear, without removing the catheter. This study demonstrates an above average prevalence of infection, which should prompt a reevaluation of the current management protocols.