Characteristics and outcome of peritoneal dialysate leaks and associated infections

Much is known about leaks on continuous ambulatory peritoneal dialysis (CAPD), but little is known about peritoneal dialysis-related infection associated with leaks. All catheter infections and peritonitis associated with leaks in established CAPD/CCPD (continuous cyclic peritoneal dialysis) patients occurring between 1979 and 1 July, 1992 were reviewed. Seventy-nine leaks occurred in 66 patients involving 76 catheters. Prophylactic antibiotics were given for all leaks. Thirty-three (42%) of the leaks were associated with an infection, and 46 (58%) were not. Patient sex, age, race, insulin dependence, and renal transplant within 60 days of leak were not different among patients with infection-associated leaks and those with leaks without infection. The median time on peritoneal dialysis prior to the leak was shorter in patients without an associated infection than in those with an associated infection (1.9 vs 5.6 months, p = 0.03). More catheters were removed in the infection-associated group (17/33, 52% vs 11/43, 26%, p = 0.03). Infection preceded leaks by a median of 20 days in 22/33 and was followed by leaks in a median of 14 days in 11/33 leaks. More of the catheters with a preceding infection were removed (14/22, 64% vs 3/11, 27%, p = 0.05). Infections occurring after a leak were often polymicrobial (5/7 catheter infections and 2/4 peritonitis episodes), while those occurring before a leak were single-organism infections (21/22). Catheter infections and peritonitis followed by a leak often lead to catheter loss and probably indicate infection of the catheter's deep cuff. Infections following leaks often resolve and are likely secondary, rather than primary infections.(ABSTRACT TRUNCATED AT 250 WORDS)