Preventing Peritoneal Dialysis Infections

Many patients with end-stage kidney disease prefer peritoneal dialysis (PD) to hemodialysis to replace kidney function1 but avoid PD due to fears of serious complications, such as peritonitis or catheter exit site and tunnel infections, which often have higher incidences than those recommended by the International Society for Peritoneal Dialysis (ISPD). Factors that increase the risk of PD-related peritonitis include patient nasal Staphylococcus aureus carriage, diabetes, advanced age, obesity, depression, cardiovascular disease, and catheter connection methods or exit site infection (ESI). A 2004 Cochrane systematic review reported 2 different significant effects of antimicrobial agents on patients receiving PD. One randomized clinical trial (RCT) on 2716 patients reported that, compared with placebo, intranasal mupirocin, bactericidal to S aureus, reduced PD catheter ESI and tunnel infections but not peritonitis rates. A meta-analysis of 4 RCTs on 335 patients revealed preoperative intravenous antibiotics reduced the incidence of early peritonitis, but it did not affect catheter ESI or tunnel infections. These results suggest peritonitis and ESI or tunnel infections are independent outcomes potentially responsive to different interventions. Herein, this Evidence Corner examines what can be learned about these 2 different PD-related infectious outcomes from an update3 to the earlier Cochrane review and a study of topical antimicrobial agents.