Factors affecting development of peritonitis in continuous ambulatory peritoneal dialysis

Factors Predisposing and Contributing to Peritonitis during Chronic Peritoneal Dialysis in Children: A Ten-Year Experience

Factors contributing and predisposing to peritonitis were studied retrospectively in 83 children treated with continuous ambulatory (CAPD) or continuous cycling peritoneal dialysis (CCPD) from 1978 to 1988. Recurrent peritonitis was the most frequent complication and the major reason for peritoneal dialysis failure. Fifty patients had 171 episodes of peritonitis during the ten years and 33 remained peritonitis -free. The duration of dialysis was significantly shorter in the peritonitis-free group. The incidence of peritonitis was lower with CCPD than with CAPD. Leucopenia was not a predisposing factor nor was blood leucocytosis helpful in diagnosing peritonitis. Serum IgG was low in 33% of patients with episodes of peritonitis, but there was no correlation or predictive value in this finding. The C3 component of complement was relatively lower than the C4 but both components were usually in the normal range. Serum albumin was low in all patients, but lower in those with peritonitis episodes. Age, sex, primary disease, diapers, pyelostomies, dialysis training, and living conditions were not significantly associated risk factors. Sterile dressings gave no benefit over the shower technique. Patient noncompliance, upper respiratory tract infection, skin infections, and dental treatment were potential risk factors. However, peritonitis seemed to be distributed randomly among the patients.

Infections in patients undergoing peritoneal dialysis

Considering experience acquired in the past years, it seems as though physicians have reached a plateau in the frequency of peritonitis. A peritonitis rate of 1 every 2 patient years may be acceptable. Further reduction of this peritonitis rate will require inordinately large efforts on all fronts. One will have to consider what are the acceptable costs and risks of peritonitis in patients on peritoneal dialysis. New developments in catheter technology, improved connections, better understanding of patient selection and training programs, improved diagnostic and therapeutic methods in the management of peritonitis, and understanding of the infectious and immune processes are eagerly awaited developments.

Comparison of peritoneal white blood cell parameters from continuous ambulatory peritoneal dialysis patients with a high or low incidence of peritonitis

The purpose of this study was to determine if there were differences in selected dialysate white blood cells (WBC) parameters between continuous ambulatory peritoneal dialysis (CAPD) patient groups identified as having a high or low incidence of peritonitis. Parameters studied were total peritoneal WBC yield, percentage and absolute number of various WBC types, and expression of WBC receptors known to be involved in normal host defense mechanisms. WBCs were obtained from peritoneal dialysis effluents (overnight dwell), which were collected at monthly intervals for 6 to 8 months from eight CAPD patients--four with a history of high peritonitis incidence (HPI) (more than two episodes in 12 months) and four with a history of low peritonitis incidence (LPI) (no episodes in more than 24 months). Our results demonstrated that there was no significant difference in the overall mean total cell yields or absolute cell counts between the two patient groups. WBC differentials, although differing somewhat among patients, stayed quite stable over time for an individual patient and there was no significant difference between the two patient groups. Analysis of receptors on the peritoneal WBC was performed using flow cytometry and fluorescein-conjugated chemotactic factors (C5a and fMet-Leu-Phe-Lys), as well as monoclonal antibodies specific for Fc receptors and complement receptors, CR1 (CD35) and CR3 (CD11b). Although there was a trend toward increased expression of all these receptors in the HPI patients, there was no significant difference in the fluorescence intensity of peritoneal neutrophils or macrophages that expressed these receptors between the two patient groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Invasive streptococcal infections in the era before the acquired immune deficiency syndrome: a 10 years' compilation of patients with streptococcal bacteraemia in North Yorkshire

Significant streptococcal (non-pneumococcal, non-enterococcal) bacteraemia was detected in 100 patients in two Health Districts of North Yorkshire in the decade 1978-1988. Patients with these infections accounted for 11% of the total 902 patients in the districts in whom bacteraemia was diagnosed during the period. Infection was most often seen with beta-haemolytic streptococci (52 patients) comprising Lancefield group A (Streptococcus pyogenes) (20 patients), group B (13), group C (5), group G (9), haemolytic Streptococcus milleri and non-groupable streptococci (5). The wide variety of serious infections included cellulitis, abscess, septicaemia, pneumonia, septic arthritis, necrotising fasciitis, acute endocarditis and mycotic aneurysm. Of these 52 patients, 21 (40%) died. alpha-Haemolytic streptococcal bacteraemia was diagnosed in 38 patients of whom 24 (63%) suffered from endocarditis and three (8%) died. Three of ten patients with non-haemolytic or anaerobic streptococcal bacteraemia died also. Six of the 100 patients with streptococcal bacteraemia had concomitant acute virus infections. Of the total 56 patients with infective endocarditis diagnosed in the districts during the period, streptococci were responsible in 30 (54%) of them. The predisposing factors, clinical features and outcome of the infections are described and discussed.

A five-year study of the microbiologic results of exit site infections and peritonitis in continuous ambulatory peritoneal dialysis

We studied the culture results from 321 continuous ambulatory peritoneal dialysis (CAPD) related infections (exit site, tunnel infections, and peritonitis) in 137 patients over a 5-year period to determine the contribution of exit site and tunnel infections to peritonitis and catheter loss. Seventeen percent of peritonitis episodes were associated temporally and by microbiologic results with exit site or tunnel infections. Twenty-one percent of exit site and tunnel infections and 20% of peritonitis episodes resulted in catheter loss. Peritonitis due to Staphylococcus aureus was more likely to be associated with an exit site or tunnel infection and was more likely to result in loss of the catheter than peritonitis due to Staphylococcus epidermidis. Peritonitis and exit site infections due to Pseudomonas sp also frequently resulted in catheter removal. We found that exit site infections cause significant morbidity in CAPD patients. Further studies in this area are needed.