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A comparison of peritoneal dialysis-related infections in short- and long-term peritoneal dialysis patients
B Piraino1, J Bernardini, J L Holley
1Department of Medicine, University of Pittsburgh School of Medicine, Pennsylvania.
Objective:
We hypothesized that the infection rates and organisms would differ in long-term peritoneal dialysis (PD) patients versus those who died or transferred to hemodialysis during the first 4 years on PD.
Design:
Data on PD-related infections and outcome were collected from 1979 to 1991 (prospectively since 1982).
Setting:
The patients were followed at University and Veterans Administration dialysis centers.
Patients:
All patients on continuous ambulatory peritoneal dialysis (CAPD) or continuous cycling peritoneal dialysis (CCPD) for 4 years or more (n = 43) were compared to those patients who died or transferred to hemodialysis prior to 4 years on PD (n = 213).
Main Outcome Measures:
Infection rates due to various microorganisms and reasons for transfer to hemodialysis were examined.
Results:
Peritonitis rates were 1.2/year versus 0.8/year (p < 0.001) in patients on peritoneal dialysis less than 4 years compared to those on 4 years or more, respectively, a difference due to S. epidermidis (0.32/year vs 0.20/year, p = 0.0001) and gram-negative rods other than P. aeruginosa (0.15/year versus 0.06/year, p < 0.001). Exit-site infection rates were 1.2/year versus 0.7/y (p < 0.0001) in the patients on less than 4 years compared to those on 4 years or more, respectively, a difference in part due to S. aureus (0.45/year vs 0.3/year, p < 0.001) and other gram-positive organisms (0.28/year vs 0.10/year, p < 0.001). The rates of infections that were similar in the two groups were tunnel infections (0.2/year), P. aeruginosa infections, and S. aureus peritonitis (0.18/year vs 0.14/year, p = 0.09). S. aureus was the most common cause of exist-site and tunnel infections in both groups. Forty-two percent of the patients on PD 4 years or more subsequently transferred to hemodialysis, most often due to infections, especially S. aureus.
Conclusions:
Although infection rates are lower in patients on peritoneal dialysis 4 years or more, S. aureus and P. aeruginosa continue to account for a high proportion of the infections. Improvement in technique survival will require prevention of these infections.