RISK-FACTORS FOR PERITONEAL DIALYSIS-RELATED INFECTIONS

Objective: To identify factors associated with peritoneal dialysis-rel ated infections at one center. Design: The study was a retrospective s tudy of a 3-year time period with relatively stable treatment patterns . Setting: A single center experienced academic peritoneal dialysis pr ogram. Patients: Patients (N = 163) receiving peritoneal dialysis (PD) from January 1989 to December 1991 who had received treatment at home for at least one month. Interventions: None. Main Outcome Measures: C atheter-related infection and peritonitis were the main outcome measur es. Variables affecting infection rates that were assessed included ag e, time on PD, prior end-stage renal disease (ESRD) therapy, diabetic status, catheter type, exchange device, nasal carriage of S. aureus, a nd prophylactic rifampin therapy. Data were analyzed with univariate a s well as with a fixed-effects and a mixed-effects gamma-Poisson multi ple regression model. Results: Variables associated with an increased risk of new peritonitis included age under 20 years (p < 0.009; rate r atio 4.54) and nasal carriage of S. aureus (p < 0.04; rate ratio 1.75) . Decreased new peritonitis risk was associated with the ULTRA Set exc hange system (p < 0.008; risk ratio 0.38) and intermittent prophylacti c ritampin therapy (p < 0.001; rate ratio 0.99 for each 1% time on the rapy). Catheter-related infections were increased in patients who had double-cuff catheters (p < 0.003) and nasal carriage of S. aureus (p < 0.04; rate ratio 1.82). Decreased catheter-related infections were no ted in older patients (p < 0.02; rate ratio 0.983/year) and increasing months of study follow-up (p < 0.03; rate ratio 0.97/month). Conclusi on: In our program nasal carriage of S. aureus increased the risk of p eritonitis and catheter-related infection. Prophylactic rifampin signi ficantly decreased peritonitis, as did use of the ULTRA Set. Single-cu ff opaque catheters had the lowest catheter infection rate. Analysis o f the relationships between clinical and demographic variables and per itoneal dialysis-related infection rate can identify significant contr ibuting or protective variables and allow peritoneal dialysis programs to develop preventive strategies to minimize the risk of infection.