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Persistence of positive dialysate cultures after apparent cure of CAPD peritonitis
A H Tzamaloukas1, M F Hartshorne, L J Gibel
1Renal Section, Veterans Affairs Medical Center, Albuquerque, New Mexico.
Abstract:
Clinical features, diagnosis and outcomes of persistently positive dialysate culture (PPDC) after apparent cure of continuous ambulatory peritoneal dialysis (CAPD) peritonitis were investigated in 16 PPDC episodes observed in 16 elderly (age 62 +/- 8 years) men who had been on CAPD for 14 +/- 9 months. Seven patients (46.7%) were diabetic. Peritonitis was caused by S. aureus in 14 cases and S. epidermidis in 2 cases. Preexisting or simultaneous infectious foci were present in 15 cases, exit-site infection in 5, tunnel infection in 13, and intra-abdominal abscess in 2 cases. Indium scans were positive in 6/9 cases (67%). Two patients died with the peritoneal catheter in situ, one from intercurrent myocardial infarction and one from S. aureus sepsis with pneumonia. In another 14 cases the peritoneal catheters were removed because of either tunnel abscess (8 cases) or peritonitis recurrence (6 cases). PPDC following apparent cure of CAPD peritonitis is almost always associated with exit-site, tunnel, or intra-abdominal abscess and leads invariably to catheter loss. Associated mortality is substantial.
Insights
Persistently positive dialysate cultures after continuous ambulatory peritoneal dialysis peritonitis indicate underlying infections, often requiring catheter removal and leading to significant mortality.
Area of Science:
- Nephrology
- Infectious Diseases
- Medical Technology
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a common treatment for end-stage renal disease.
- Peritonitis is a serious complication of CAPD, requiring prompt diagnosis and treatment.
- Persistent positive dialysate cultures (PPDC) after apparent peritonitis cure pose a clinical challenge.
Purpose of the Study:
- To investigate the clinical features, diagnosis, and outcomes of PPDC in elderly CAPD patients.
- To identify associated infectious foci and complications in PPDC cases.
- To determine the impact of PPDC on CAPD catheter survival and patient mortality.
Main Methods:
- Retrospective analysis of 16 PPDC episodes in elderly male CAPD patients.
- Review of clinical data, microbiological findings, and diagnostic imaging (Indium scans).
- Assessment of treatment outcomes, including catheter removal and mortality.
Main Results:
- PPDC predominantly occurred in elderly men with prolonged CAPD duration, often complicated by diabetes.
- Staphylococcus aureus was the most common causative agent.
- Associated infectious foci (exit-site, tunnel, intra-abdominal abscess) were present in most cases, with positive Indium scans in 67% of evaluated patients.
- Catheter removal was necessary in 14 cases due to tunnel abscess or recurrent peritonitis.
- Two patients died, one from sepsis and pneumonia, and another from myocardial infarction.
Conclusions:
- PPDC following CAPD peritonitis is strongly associated with underlying abscesses and invariably leads to peritoneal catheter loss.
- The condition carries a substantial mortality risk, particularly in elderly and diabetic patients.
- Aggressive management of associated infectious foci is crucial for improving outcomes in CAPD patients with PPDC.