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Infecting organisms in continuous ambulatory peritoneal dialysis patients on the Y-set
J L Holley1, J Bernardini, B Piraino
1Renal-Electrolyte Division, University of Pittsburgh, PA.
Abstract:
Disconnect systems for performing continuous ambulatory peritoneal dialysis (CAPD) use a flush-before-fill technique that should theoretically reduce the peritonitis caused by touch contamination. However, little information about the infecting organisms in CAPD-related infections using disconnect systems is available. We performed a retrospective matched-case controlled study to define the organisms responsible for the peritonitis and catheter infections seen in CAPD patients using the Y-set without disinfectant. One hundred nineteen patients who began CAPD on the Y-set were matched with 119 patients who began CAPD on the standard spike system. Patients were matched for age, sex, race, insulin dependence, and time on CAPD. Infection data were prospectively collected for all patients. Peritonitis, exit site, and tunnel infection rates (expressed as number of episodes per patient-year) were all significantly lower in the Y-set patients (0.56 v 0.94, 0.68 v 1.08, and 0.14 v 0.22, respectively). The lower peritonitis rate in the Y-set patients compared with that found in the standard spike system patients was due to a reduction in Staphylococcus epidermidis (0.17 v 0.26, P = 0.02), polymicrobial (0.014 v 0.06, P = 0.01), other gram-positive (0.007 v 0.09, P = 0.001), and sterile (0.10 v 0.19, P = 0.008) peritonitis. Rates of Staphylococcus aureus and gram-negative peritonitis were not different among the two groups. S epidermidis (0.12 v 0.23, P = 0.0014) and gram-negative (0.12 v 0.18, P = 0.04) exit site infection rates were also lower in the Y-set patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Continuous ambulatory peritoneal dialysis (CAPD) patients using Y-set disconnect systems experienced significantly fewer infections. This study highlights reduced peritonitis and exit site infections with the Y-set compared to standard spike systems.
Area of Science:
- Nephrology
- Infectious Diseases
- Medical Devices
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is susceptible to infections like peritonitis.
- Disconnect systems aim to reduce touch contamination during CAPD.
- Limited data exists on specific organisms causing infections with CAPD disconnect systems.
Purpose of the Study:
- To identify organisms causing peritonitis and catheter infections in CAPD patients using Y-set disconnect systems.
- To compare infection rates between CAPD patients using Y-set systems and standard spike systems.
Main Methods:
- Retrospective matched-case controlled study.
- 119 CAPD patients using Y-set systems were matched with 119 CAPD patients using standard spike systems.
- Infection data, including peritonitis, exit site, and tunnel infections, were prospectively collected.
Main Results:
- Y-set patients showed significantly lower rates of peritonitis (0.56 vs. 0.94 episodes/patient-year), exit site infections (0.68 vs. 1.08), and tunnel infections (0.14 vs. 0.22).
- Reduced peritonitis in Y-set users was attributed to lower rates of Staphylococcus epidermidis, polymicrobial, other gram-positive, and sterile peritonitis.
- Lower exit site infection rates were observed for Staphylococcus epidermidis and gram-negative organisms in Y-set patients.
Conclusions:
- Y-set disconnect systems are associated with significantly lower rates of peritonitis and exit site infections in CAPD patients.
- The Y-set system effectively reduces infections caused by common CAPD pathogens like Staphylococcus epidermidis.
- This suggests Y-set disconnect systems may offer an improved safety profile for CAPD patients.