PD-related infections of standard and different disconnect systems

A review of 332 patients initiating continuous ambulatory peritoneal dialysis (CAPD) treatment from January 1988 throughout September 1993, with a total observation time of 5237 patient-months. Seven peritoneal dialysis (PD) systems were used, three of which were comparable regarding patient characteristics: standard system (Baxter) and two disconnect systems, Twinbag (Baxter) and Gemini (Gambro). The two disconnect systems were identical in principle, except that Twinbag used iodine as disinfectant of connections and Gemini used alcohol as disinfectant. We found a reduction of peritonitis rates in one of the disconnect systems--Twinbag (iodine) 0.42 episodes/patient/year--and a slight increase in another disconnect system--Gemini (alcohol) 1.17 epi/patient/yr--compared to standard system (iodine) 0.92 epi/patient/yr. An improvement of exit-site infections (ESI) and tunnel infections was seen in both disconnect systems (0.17 and 0.20 epi/patient/yr) compared to standard system (0.35 epi/patient/yr). Introduction of disconnect CAPD system reduced peritonitis rates in systems using iodine as disinfectant. Disconnect systems reduced ESI, probably due to less trauma to the catheter. We recommend the use of disconnect CAPD systems using iodine instead of alcohol as disinfectant.