A Single-Centre Experience: Peritoneal Dialysis-Related Infections in Patients on Long-Term Dialysis
Viravarn Luvira MD*, Bancha Satirapoj MD**, Ouppatham Supasyndh MD**, Amnart Chaiprasert MD**, Prajej Ruangkanchanasetr MD**, Naowanit Nata MD**, Inseey Kanjanakul MD**, Thanom Supaporn MD**, Panbuppa Choovichian MD**, Sutachard Bijaphala MD**, Usana Luvira MD**, Danabhand Phiboonbanakit MD***
Affiliation : * Department of Clinical Tropical Medicine, Faculty of Tropical, Mahidol Univesity, Bangkok, Thailand ** Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand *** Division of Infectious Disease, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
Objective : Peritoneal dialysis is a convenient way of maintaining patients with end stage renal disease (ESRD) and in the
present days, the Thai government supports all payments for ESRD patients. Continuous ambulatory peritoneal dialysis-
(CAPD) related infections are the major cause of morbidity and mortality. The present study was conducted to identify the
incidence and epidemiological data of CAPD-related infection.
Material and Method: Medical records of 333 CAPD patients attending the Dialysis Unit of Phramongkutklao Hospital from
January 1983 to June 2007 were reviewed. The historical cohort study was focused on the incidence of CAPD-related
infections, causing pathogens, risk factors, and patient outcome.
Results : In total, 73.3% of episodes developed peritoneal infection. The incidences of peritonitis, exit site infection, and tunnel
infection were 0.864, 0.213, and 0.034 episodes per patient per year, respectively. The most common infecting organisms were
gram positive cocci (49.1%). The main pathogens were Coagulase-negative staphylococcus (15.9%), Staphylococcus aureus
(15.2%) and Pseudomonas spp. (14.2%). CAPD-related infections increased in patients who had age > 60. A total of 81%
of the infections responded to initial antibiotic therapy administered in the dialysis fluid. Overall, there were 10 episodes
(1.9%) of the refractory group and 83 episodes (15.4%) of peritoneal catheter loss, with an overall mortality rate of 1.1%.
Non-vancomycin based regimens were applied in 63.9% of peritoneal infected patients.
Conclusion : The authors’ center’s CAPD-related infection rate achieved the International Society for Peritoneal Dialysis
(ISPD) recommendation. A significantly enhanced incidence of CAPD-related infection occurred in advanced age. Coagulase-
negative staphylococcus is still a very common organism that generally responds well to antibiotic therapy.
Keywords : CAPD, Peritonitis, ISPD recommendation, Advanced age
