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A five-year study of the microbiologic results of exit site infections and peritonitis in continuous ambulatory
B Piraino1, J Bernardini, M Sorkin
1Renal-Electrolyte Division, University of Pittsburgh, PA.
Abstract:
We studied the culture results from 321 continuous ambulatory peritoneal dialysis (CAPD) related infections (exit site, tunnel infections, and peritonitis) in 137 patients over a 5-year period to determine the contribution of exit site and tunnel infections to peritonitis and catheter loss. Seventeen percent of peritonitis episodes were associated temporally and by microbiologic results with exit site or tunnel infections. Twenty-one percent of exit site and tunnel infections and 20% of peritonitis episodes resulted in catheter loss. Peritonitis due to Staphylococcus aureus was more likely to be associated with an exit site or tunnel infection and was more likely to result in loss of the catheter than peritonitis due to Staphylococcus epidermidis. Peritonitis and exit site infections due to Pseudomonas sp also frequently resulted in catheter removal. We found that exit site infections cause significant morbidity in CAPD patients. Further studies in this area are needed.
Insights
Exit site and tunnel infections frequently lead to peritonitis and catheter loss in continuous ambulatory peritoneal dialysis (CAPD) patients. Staphylococcus aureus and Pseudomonas species infections pose a higher risk for catheter removal.
Area of Science:
- Nephrology
- Infectious Diseases
- Medical Microbiology
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a vital renal replacement therapy.
- Infections, including exit site, tunnel, and peritonitis, are significant complications in CAPD patients.
- Understanding infection pathways is crucial for preserving catheter function and patient outcomes.
Purpose of the Study:
- To investigate the contribution of exit site and tunnel infections to peritonitis development.
- To determine the rate of catheter loss associated with these infections.
- To identify specific microorganisms linked to increased peritonitis and catheter loss.
Main Methods:
- Retrospective analysis of culture results from 321 CAPD-related infections.
- Inclusion of data from 137 patients over a 5-year period.
- Correlation of infection types, causative agents, and clinical outcomes (peritonitis, catheter loss).
Main Results:
- 17% of peritonitis episodes were linked to exit site or tunnel infections.
- 21% of exit site/tunnel infections and 20% of peritonitis episodes resulted in catheter loss.
- Staphylococcus aureus and Pseudomonas species peritonitis were associated with higher rates of catheter loss compared to Staphylococcus epidermidis.
Conclusions:
- Exit site infections significantly contribute to peritonitis and morbidity in CAPD patients.
- Prompt management of exit site and tunnel infections is critical to prevent peritonitis and catheter loss.
- Further research is warranted to develop strategies for mitigating these infection-related complications.