Recurrent Infection and Catheter Loss in Patients on Continuous Ambulatory Peritoneal Dialysis

Abstract

Objective To elucidate the factors leading to catheter loss from recurrent infection in patients on continuous ambulatory peritoneal dialysis (CAPD). Design All catheters removed from patients were prospectively examined for infection. Setting CAPD unit in large tertiary-care general hospital. Patients Sixty-five consecutive patients undergoing catheter removal for whatever cause; 20 catheters rejected because of desiccation or contamination in transit. Interventions None. Main Outcome Measures Micro-organisms linked to catheter removal; their locations on removed catheters. Results Of 45 catheters removed between January 1994 and August 1995, 26 were infected: 13/26 infections were caused by Staphylococcus aureus and 7/26 by Pseudomonas aeruginosa. In only one case was S. epidermidis associated with catheter removal. The most striking finding was that the inner cuff harbored large numbers of the infecting organisms, even when antibiotics had eradicated them from the peritoneal cavity and exit site, where present, and the catheter lumen. Conclusion The importance of S. aureus and Ps. aeruginosa rather than S. epidermidis in catheter loss due to relapsing infection is confirmed. Persistence of the causative organisms in the inner cuff is a likely explanation for relapse after treatment, and might be due to the predominantly intraperitoneal administration of antibiotics. A clinical trial of the effect on catheter retention of empirical use of systemic or oral agents that give high tissue levels and are active against intracellular microorganisms, along with recommended intraperitoneal regimens, is indicated.

Peritoneal Microbiome in End-Stage Renal Disease Patients and the Impact of Peritoneal Dialysis Therapy

“…[1,55], were not significantly altered or increased in ESKD PD patients in comparison to ESKD non-PD patients. The existence of biofilms on PD catheters could explain the increase in Pseudomonaceae in the peritoneal microbiomes of ESKD PD patients [56,57]. However, this explanation is probably incorrect, as no new OTUs of Pseudomonas were generally found in ESKD PD patients; the variation observed in PD patients is an increase in OTUs also present in non-PD patients.…”

Evaluating the Risk of Peritonitis Post Colonoscopy in End Stage Renal Disease Patients on Peritoneal Dialysis: A Prospective Randomized Trial of Intraperitoneal Prophylactic Antibiotic at a Single Center

“…In addition, peritonitis is probably the most common cause of technique failure in PD, and it remains a major cause of patients discontinuing PD and switching to hemodialysis. Therefore, the PD community continues to focus attention on prevention and treatment of PD-related infections [16][17][18][19][20][21][22][23][24]. Peritonitis caused by enteral microorganisms is relatively infrequent in PD patients [25][26][27].…”

“…Our protocol includes colonoscopy for those with unexplained anaemia, weight loss, positive occult blood and chronic constipation or diarrhoea and as part of the prerenal transplantation protocol. The fear of developing peritonitis after colonoscopy is unjustified as few cases have been reported in the literature on post colonoscopy peritonitis in PD patients [17][18][19][20][21]. A retrospective study [22] found that the risk of peritonitis after colonoscopy without antibiotic prophylaxis was 6.3%; colonic biopsy or polypectomy did not appear to further increase the risk and no peritonitis was observed in patients that received prophylactic antibiotics although the difference was not statistically significant.…”

Whether to use or Not Prophylactic Antibiotics in Automated Peritoneal Dialysis Patients Undergoing Colonoscopy, A Prospective Controlled Randomized Study

“…The incidence of colonoscopy-induced bacteremia is variable, reported from 0% to 27% of patients (2,3). It has been suggested that antibiotic prophylaxis be given to immunocompromised patients and those with known valvular heart disease or prostheses prior to colonoscopy (4,5). Few cases have been reported in the literature on peritonitis following colonoscopy in CAPD patients (6)(7)(8)(9)(10).…”