Research directions in peritoneal dialysis infections

There are many promising areas of research on peritoneal dialysis related infections. Improvements in connection technology, especially the Y set and CCPD, have led to a decrease in the rate of peritonitis due to Staphylococcus epidermidis. The search to find a more biocompatible dialysate that is less immunocompromising is underway; clinical trials examining peritonitis rates with these new formulations remain to be performed. Considerable progress has been made in elucidating peritonitis related to catheter infection, especially that due to Staphylococcus aureus. Nasal carriage has been identified as a risk factor for subsequent infections. Several prophylactic antibiotic approaches including rifampin, trimethoprim/sulfamethoxazole and mupirocin have shown promise in reducing these infections. Innovative catheter designs that decrease the risk of bacterial colonization are another investigative approach. The timing of both catheter removal and replacement for infection is controversial and requires further study. Lastly, much remains to be learned about peritonitis from an enteric source.