Intracatheter streptokinase for recurrent peritonitis in CAPD

Area of Science:

• Nephrology
• Infectious Diseases
• Medical Devices

Background:

• Continuous ambulatory peritoneal dialysis (CAPD) patients often experience recurrent bacterial peritonitis and catheter-related complications.
• Intracatheter streptokinase (SK) has been proposed as a treatment for these issues, aiming for efficacy with minimal adverse effects.

Purpose of the Study:

• To evaluate the efficacy and safety of intracatheter streptokinase (SK) in treating bacterial peritonitis and catheter malfunction in CAPD patients.

Main Methods:

• A retrospective review of 35 SK instillations in 20 CAPD patients was conducted.
• Data collected included treatment outcomes, side effects, and specific microbial causes of peritonitis.

Main Results:

• A high incidence of side effects (86%) was observed, including fever, turbid dialysis effluent, and abdominal pain, suggestive of a peritonitis-like syndrome.
• SK showed a 50% cure rate for relapsing bacterial peritonitis but was ineffective for catheter malfunction.
• Treatment failure was noted in Staphylococcus epidermidis infections, potentially due to the organism's slime production and adherence properties.
• Two cases of fungal peritonitis occurred post-SK treatment.

Conclusions:

• Intracatheter streptokinase is a useful treatment for relapsing bacterial peritonitis in CAPD patients, despite a significant side effect profile.
• SK is not effective for catheter malfunction and shows limited efficacy against Staphylococcus epidermidis infections.
• The
• peritonitis-like syndrome
• observed is likely due to the release of bacteria and debris from the catheter into the peritoneal cavity.