Recurrent infection and catheter loss in patients on continuous ambulatory peritoneal dialysis.
OBJECTIVE
To elucidate the factors leading to catheter loss from recurrent infection in patients on continuous ambulatory peritoneal dialysis (CAPD).


METHODS
All catheters removed from patients were prospectively examined for infection.


METHODS
CAPD unit in large tertiary-care general hospital.


METHODS
Sixty-five consecutive patients undergoing catheter removal for whatever cause; 20 catheters rejected because of desiccation or contamination in transit.


METHODS
None.


METHODS
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.


CONCLUSIONS
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 micro-organisms, along with recommended intraperitoneal regimens, is indicated.
Bayston
R
R
Division of Microbiology, University of Nottingham, United Kingdom.
Andrews
M
M
Rigg
K
K
Shelton
A
A
D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy; D002408:Catheters, Indwelling / Q000382:microbiology*; D006801:Humans; D007274:Injections, Intraperitoneal; D010529:Peritoneal Cavity / Q000382:microbiology; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects / Q000295:instrumentation*; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000175:diagnosis; D011550:Pseudomonas aeruginosa / Q000254:growth & development; D012008:Recurrence; D013203:Staphylococcal Infections / Q000175:diagnosis; D013211:Staphylococcus aureus / Q000254:growth & development; D013212:Staphylococcus epidermidis / Q000254:growth & development; D014018:Tissue Distribution
D000900:Anti-Bacterial Agents