Bacterial and clinical sequelae of the Twin bag system in continuous ambulatory peritoneal dialysis. A single centre...

Since the introduction of disconnect systems, a marked reduction in continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis has been reported in the literature. At our centre too, a highly significant decline in the peritonitis rate was observed after the introduction of the Twin bag in 1990. In a multivariate analysis which we published recently, the Twin bag system, in conjunction with the more frequent use of the swan neck catheter, correlated significantly (p < 0.001) with an increase in the peritonitis-free interval. In the present study we retrospectively analyzed the bacteriological cultures of the peritonitis episodes, the antibiotic treatment prescribed, and the number of hospitalization days (HDs) before (non-Twin bag group; NTG) and after the introduction of the Twin bag system in our centre (Twin bag group; TG). In terms of absolute numbers, the decreased incidence of peritonitis in the TG was due by and large to a decline in all pathogenic micro-organisms, but mostly to a reduction of coagulase-negative staphylococci (CNS) compared with the NTG. The incidence of culture-negative episodes, however, showed no difference between the two groups. Proportionally, there was a significant increase in culture-negative peritonitis in the TG, whereas infections caused by CNS significantly decreased in comparison with the NTG (p < 0.01). The pattern of the antibiotics prescribed, i.e. mono- versus multi-drug regimens, did not differ between the two groups. Since, of all micro-organisms involved, CNS infections showed the largest decline in absolute numbers. Staphylococcus aureus increased relatively (43%) after the introduction of the Twin bag system.(ABSTRACT TRUNCATED AT 250 WORDS)