title: Comparison of exit-site infections in disconnect versus nondisconnect systems for peritoneal dialysis.
abstract: OBJECTIVE
  To determine if disconnect systems reduce the incidence of exit-site infections when compared to nondisconnect systems.
  
  
  METHODS
  We prospectively monitored exit-site infections and peritonitis rates in 96 disconnect patients (Y-set, automated peritoneal dialysis (APD)) and 60 nondisconnect patients (spike, ultraviolet connection device (UVXD)).
  
  
  METHODS
  A freestanding chronic peritoneal dialysis unit staffed by physicians from both a medical school and a private setting.
  
  
  METHODS
  All patients who began peritoneal dialysis at our unit were monitored, regardless of cause of end-stage renal disease (ESRD) or age.
  
  
  METHODS
  Patients were dialyzed using the system (Y-set, spike, etc.) most appropriate for their life-style and their ability to administer self-care.
  
  
  RESULTS
  We attempted to follow disconnect and nondisconnect patients for a similar median time on dialysis and compared differences in exit-site infections.
  
  
  RESULTS
  Peritonitis rates (episodes/pt year) were reduced for disconnect (0.60) versus nondisconnect (0.99) systems (p = 0.0006). Despite the marked reduction in peritonitis rates, there was no difference in exit-site infection rates (0.35 vs 0.38), the time to the first exit-site infection, or the time to the first catheter removal for disconnect versus nondisconnect groups. When individual systems were compared, differences in exit-site infection rates (episodes/pt years) were noted (0.62,spike; 0.26,UVXD; 0.32,Y-set; 0.41,APD).
  
  
  CONCLUSIONS
  We found no overall difference in exit-site infection rates for disconnect versus nondisconnect systems, despite a reduction in peritonitis rates for disconnect systems.
authors.affiliation: Department of Medicine/Nephrology, Bowman Gray School of Medicine, Winston-Salem, North Carolina.
authors.forename: J M
authors.initials: JM
authors.lastname: Burkart
authors.forename: J R
authors.initials: JR
authors.lastname: Jordan
authors.forename: T A
authors.initials: TA
authors.lastname: Durnell
authors.forename: L D
authors.initials: LD
authors.lastname: Case
mesh_terms: D000328:Adult; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects* / Q000295:instrumentation; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012874:Skin Diseases, Infectious / Q000453:epidemiology* / Q000209:etiology