Recurrent infection and catheter loss in patients on continuous ambulatoryperitoneal dialysis

Objective: To elucidate the factors leading to catheter loss from recurrent infection in patients on continuous ambulatory peritoneal dialysis (CAPD). Design: All catheters removed from patients were prospectively examined for infection. Setting: CAPD unit in large tertiary-care general hospital. Patients: Sixty-five consecutive patients undergoing catheter removal for w hatever cause; 20 catheters rejected because of desiccation or contaminatio n in transit. Interventions: None. Main Outcome Measures: Micro-organisms linked to catheter removal; their lo cations on removed catheters. Results: Of 45 catheters removed between January 1994 and August 1995, 26 w ere infected: 13/26 infections were caused by Staphylococcus aureus and 7/2 6 by Pseudomonas aeruginosa. In only one case was S. epidermidis associated with catheter removal. The most striking finding was that the inner cuff h arbored large numbers of the infecting organisms, even when antibiotics had eradicated them from the peritoneal cavity and exit site, where present, a nd the catheter lumen. Conclusion:The importance of S. aureus and Ps. aeruginosa rather than S. ep idermidis in catheter loss due to relapsing infection is confirmed. Persist ence of the causative organisms in the inner cuff is a likely explanation f or relapse after treatment, and might be due to the predominantly intraperi toneal administration of antibiotics. A clinical trial of the effect on cat heter retention of empirical use of systemic or oral agents that give high tissue levels and are active against intracellular microorganisms, along wi th recommended intraperitoneal regimens, is indicated.