Prevention of catheter related infections in patients on CAPD

Catheter-related infections remain a serious problem for patients on perito neal dialysis. Such infections can be reduced by careful patient selection and training, by the use of the best connection technology and screening an d treating nasal carriage. To date, treatment is less than optimal and ther efore, the primary goal should be prevention of catheter-related infections . Prevention is based on improving catheter design and implantation techniq ue, while providing careful exit-site care. Regardless of how it is impleme nted, we must aggressively pursue the prevention of catheter-related infect ions by eradicating S.aureus exit-site carriage in PD patients. Based on it s effectiveness in adult PD patients, its low rate of adverse effects, and its reasonable cost-effectiveness, application of mupirocin ointment at the exit-site is the current method of choice for preventing PD catheter infec tions caused by S. aureus. In addition to reducing S. aureus exit-site infe ctions, mupirocin seems to reduce the rates of staphylococcal peritonitis a nd PD catheter loss. Whether the ointment should be applied in the nares, t o the exit-site or both, and whether it should be used only in staphylococc al nasal carriers or all PD patients requires further study.