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Higher incidence of catheter-related infections in a tropical climate
F R Alves1, R C Dantas, J R Lugon
1CDR-Clínica de Doenças Renais, Rio de Janeiro, Brazil.
Insights
Catheter-related infections (CRIs) in continuous ambulatory peritoneal dialysis (CAPD) patients are high, especially during hot weather. A retrospective study found significantly more CRIs in hot seasons, suggesting climate impacts infection rates.
Area of Science:
- Nephrology
- Infectious Diseases
- Epidemiology
Background:
- Catheter-related infections (CRIs) are a significant cause of morbidity in continuous ambulatory peritoneal dialysis (CAPD).
- Previous observations suggested unusually high CRI rates in the study population.
Purpose of the Study:
- To confirm high CRI rates in a CAPD population.
- To investigate the potential impact of climate conditions, specifically hot weather, on CRI incidence.
Main Methods:
- A retrospective study analyzed data from 80 CAPD patients over 1080 patient-months.
- CRI rates were compared between hot seasons (mean max temp ≥ 32°C) and control seasons (mean temp < 28°C).
- Data on catheter types and CAPD systems were also analyzed.
Main Results:
- A total of 139 CRI episodes were recorded, with an overall rate of 1/8 patient-months.
- CRIs contributed to 26% of peritonitis episodes and 48% of catheter losses.
- Significantly higher CRI incidence was observed during hot seasons (1/9 patient-months) compared to control seasons (1/19 patient-months), p < 0.05.
Conclusions:
- The study confirms a high incidence of CRIs in the studied CAPD population.
- Catheter type and CAPD system did not significantly influence CRI rates.
- Hot climate conditions are associated with an increased rate of CRIs in CAPD patients.
Abstract:
Catheter-related infections (CRIs) have become a prominent morbidity factor in continuous ambulatory peritoneal dialysis (CAPD). To confirm a clinical impression that CRI rates in our population (n = 80, 1080 patient-months) were unusually high, a retrospective study was performed. In addition, data from adult patients treated for at least 12 months were analyzed (n = 28, 325 patient-months) to determine if climate conditions could account for our findings. Comparisons were made between CRI rates during months with a mean maximal temperature of 32 degrees C or higher (hot season) and CRI rates during months with a mean temperature lower than 28 degrees C (control season). Two-cuff Tenckhoff catheters were used on 68 occasions and the Swan neck Missouri catheter 2 on 20 occasions. Main CAPD systems were the O-set (n = 48) and the disposable Y-set (n = 35). A total of 139 CRI episodes were recorded with a rate of 1/8 patient-months. A CRI was implicated as a causative factor in 18 of 69 episodes of peritonitis (26%) and in 13 of 27 catheter losses (48%). CRI rates were similar when comparing either Swan neck versus Tenckhoff catheters (1/7 and 1/8 patient-months) or the O-set versus disposable Y-set (1/7 and 1/10 patient-months). Most importantly, a significantly higher incidence of CRI was found during the hot seasons in comparison to the control seasons (1/9 vs 1/19 patient-months, p < 0.05, one-way signed rank test). Our data suggest that a hot climate can adversely affect the rate of CRIs.