Natural History of Exit-Site Infection (ESI) in Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD)

Abstract

One hundred and thirty-one patients were started on continuous ambulatory peritoneal dialysis (CAPD) between January 1984 and June 1987. They ranged in age from 14 to 82 years (mean 52.8). Sixty patients (1914 patient months) developed 133 episodes of exit-site infection (ESI), an incidence of one episode per 14.4 patient months. Sixty-six episodes were purulent and 67 were nonpurulent (redness, crust, or serous discharge). In diminishing order of frequency, the bacteria isolated were Staph. aureus, Staph. epidermidis, Pseudomonas, and diphtheroids. The probability for remaining free of ESI was 54% at one year and 22% at three years. Factors like single or double-cuff catheters, diabetes, and sex did not influence the development of ESI. Recurrence was common especially in purulent ESI, and medical or surgical treatment did not eradicate the infection. Patients with purulent ESI had a higher incidence of peritonitis than those with no ESI-one episode per 8.1 patient months vs. one episode per 20.9 patient months. In the ESI group, of the 154 catheters implanted, 24 (15.6%) were removed; five were lost without ESI (3%). The main cause leading to catheter removal in the ESI group were Staph. aureus and Pseudomonas infections. Peritonitis following ESI was not necessarily due to the organisms isolated from the ESI.