Objective To determine if peritoneal dialysis -related infection rates are higher in older patients compared with younger patients. Design A retrospective review of prospectively collected data. Control adult patients were matched with older study patients for race, sex, insulin dependence, connection device, and time on dialysis. Setting A university-based peritoneal dialysis program which includes patients from a Veterans Administration Hospital outpatient dialysis program. Patients Infection rates of 103 patients 60 years of age (older patients) were compared with 103 matched control patients 18–49 years of age (younger patients). Main Outcome Measures Rates of peritonitis, exit site and tunnel infection expressed as episodes/patient/year (episodes/year) and the infecting organisms for each were examined. Outcomes, including catheter removal and the cause for removal, transfer to another dialysis modality and the reason for such, death and transplantation were also assessed. Results Mean time on peritoneal dialysis was the same in each group (20±21 months in the older and 18±17 months in the younger patients). The overall peritonitis rates were the same in the two groups (0.95/year in the older and 0.89/year in the younger patients), but the older patients had a higher rate of S. epidermidis peritonitis (0.28/year vs 0. 13/year, p=0.0001). S. aureus peritonitis rates were similar (0.16/year in older and 0.17/year in younger patients). Older patients had fewer exit-site infections (0.80/year versus 1.2/year, p=0.0001) and, specifically, lower rates of S. aureusexit-site infections (0.23/year vs 0.47/year, p=0.0001). Tunnel infections were also less common in older patients (0.15/year vs 0.23/year, p=0.008), but S. aureustunnel infection rates were similar (0.05/year and 0.09/year). Catheter infection was the most common reason for catheter removal in both patient groups (35% of catheters in the older and 44% of catheters in the younger patients, p=NS). More catheters were removed from older patients because of dementia or the loss of mechanical skills required to perform peritoneal dialysis exchanges (15% vs 5%, p=0.04). Conclusions Older age per se is not associated with higher peritonitis rates, but the use of disconnect sys tems should be encouraged in older patients and their mental and physical skills monitored to avoid S. epidermidis peritonitis. The lower rates of S. aureus catheter infection in older patients requires further study.
Although the definition of S. aureus nasal carriage in peritoneal dialysis patients Is variable, carriage is often defined as 2 or more positive cultures for S. aureus. We Investigated the relationship between S. aureus Infections and nasal carriage (defined as 1 or more positive nose cultures) In 138 patients on peritoneal dialysis. By this definition, approximately 50% of the patients were carriers. The rates of S. aureus exit-site infection (0.28/year vs 0.43/year, p<0.001) and peritonitis (0.08/year vs 0.20/year, p<0.001) were lower in the noncarriers (patients with no positive nose cultures) than in those patients who had 1 or more positive nose cultures. Patients with only 1 positive nose culture had a similar S. aureus exit-site infection rate (0.31/year vs 0.28/year), but a higher peritonitis rate (0.24/year vs 0.08/year, p<0.001) compared to those petients with no positive nose cultures. However, patients with 2 or more positive nose cultures were at Increased risk for both S. aureus exit-site Infections and peritonitis. This relationship held even when only petients with frequent nose cultures were Included In the analysis. Thus patients with even 1 positive nose culture for S. aureus are at risk for S. aureus peritonitis and should not be classified as noncarriers.
Nomenclature in nephrology: preserving 'renal' and 'nephro' in the glossary of kidney health and disease.
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). Exitsite infection rates were 1.2/year versuss 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 0.1 0/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 exit-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.
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