Frequency of various types of peritoneal catheter infections and therapeutic outcome of treatment.
To analyze peritoneal catheter infections (PCIs), primarily the type (acute or chronic), frequency, and therapeutic outcome, we assessed 113 patients treated between January 1992 and December 1994. The average age was 56.3 +/- 15.3 years, and 38% were diabetics. One hundred and thirty peritoneal catheters (PCs) were placed surgically in the lateral abdominal wall. The peritonitis rate fell from 0.61 episodes/year to 0.33 episodes/year, but the exit-site and/or tunnel infection (ESI/TI) rate increased (from 0.48 episodes/year to 0.61 episodes/year). Seventy-nine cases of PCI were observed; 58 (73.4%) were acute ESI/TI and 21 (26.6%) were exacerbations of chronic ESI/TI. Thirty-one (53.4%) acute PCIs were cured, 17 (29.3%) became persistent, and in 10 (17.2%) cases the PC was removed. In chronic ESI/TI, of the 21 exacerbations registered, in 12 cases (57.1%) conservative treatment was effective, while in 9 cases (42.9%) the PC was removed. We conclude that ESI/TIs are the most frequent type of continuous ambulatory peritoneal dialysis (CAPD) infection and the more frequent cause of PC removal compared to peritonitis (p < 0.001). PC removal is more frequent in chronic than in acute ESI/TI (p < 0.005). The progression of infection towards the external and even the internal cuff is a poor prognostic sign. Staphylococcus aureus and Pseudomonas aeruginosa were the most common causes of infection and the most serious infective agents, causing chronic infection or catheter removal. Clinical evaluation of ESI/TI can be helped significantly by ultrasound examination, which is 100% positive in chronic ESI/TI and not more than 52.1% positive in acute ESI/TI (p < 0.005).
Gucek
A
A
University Medical Center, Department of Nephrology, Ljubljana, Slovenia.
Benedik
M
M
Zakelj
B
B
Stanisavljevic
D
D
Lindic
J
J
Hergouth
V
V
Bren
A F
AF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy* / Q000209:etiology* / Q000382:microbiology; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010529:Peritoneal Cavity; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D010538:Peritonitis / Q000209:etiology; D011446:Prospective Studies; D016896:Treatment Outcome