Does the response to hepatitis B vaccination predict CAPD-associated infections?
Rates of peritoneal dialysis-associated catheter infections and peritonitis were compared in continuous ambulatory peritoneal dialysis patients grouped on the basis of their response to hepatitis B vaccination with Engerix to assess the usefulness of vaccination in predicting patients at risk for peritonitis and catheter infections. Engerix was given intramuscularly in a dose of 40 micrograms at 0, 1, 2, and 6 months. Sixty-three percent (20/32) of patients developed hepatitis B surface antibodies (converters). Converters and nonconverters were not different in proportions of women, whites, diabetics, or Staphylococcus aureus nasal carriers; mean age and mean months on peritoneal dialysis were also not different. Overall, peritonitis (0.46/year vs 0.33/year) and catheter infection (0.53/year vs 0.54/year) rates were not different among converters and nonconverters, respectively. Nonconverters had higher S. aureus peritonitis rates (0.12/year vs 0.04/year, p < 0.05) but lower S. epidermidis peritonitis rates (0.03/year vs 0.18/year, p < 0.02). However, when the patient with recurrent S. epidermidis peritonitis was excluded from analysis, S. epidermidis peritonitis rates among converters and nonconverters were not different (0.13/year vs 0.03/year, respectively, p < 0.09). These data suggest that the development of surface antibodies with hepatitis B vaccination does not predict a reduced risk of S. epidermidis peritonitis. The possibility that nonconverters are more likely to be S. aureus nasal carriers and therefore at greater risk of S. aureus peritonitis deserves further study.
Holley
J L
JL
Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pennsylvania, USA.
D000328:Adult; D000368:Aged; D002408:Catheters, Indwelling; D005260:Female; D006510:Hepatitis B Antibodies / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000276:immunology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000276:immunology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000295:instrumentation; D010538:Peritonitis / Q000276:immunology*; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000276:immunology; D013211:Staphylococcus aureus / Q000276:immunology; D013212:Staphylococcus epidermidis / Q000276:immunology
D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines