The effectiveness of mupirocin preventing Staphylococcus aureus in catheter-related infections in peritoneal dialysis.

The objective of this study was to evaluate the effectiveness of mupirocin on Staphylococcus aureus with regard to peritoneal dialysis (PD)-catheter exit-site infections (ESI), tunnel infections (TI), and peritonitis episodes (PE). The study was performed on 42 continuous ambulatory peritoneal dialysis (CAPD) patients (group I) treated from April 1998 to July 1999. These patients were instructed to apply mupirocin daily at the catheter exit site as part of their exit-site care. The control was the same group's historical infection data. Results were also recorded for a second group of 16 patients (group II) with newly implanted PD catheters were also instructed to apply mupirocin at the exit site daily. During the control period (before daily mupirocin application), group I recorded 16 episodes of ESI (0.30 episodes per patient-year), 6 episodes of TI (0.11 episodes per patient-year), 15 episodes of PE (0.28 episodes per patient-year), and one case of catheter removal (0.019 episodes per patient-year) owing to S. aureus exit-site infection coexisting with peritonitis. The rate of S. aureus exit-site infection during this period was 0.11 episodes per patient-year; of S. aureus tunnel infection, 0.057 episodes per patient-year; and of S. aureus peritonitis, 0.076 episodes per patient-year. During the mupirocin period, infections and peritonitis owing to S. aureus dramatically decreased (p < 0.01 and p < 0.001 respectively). The rate of S. aureus exit-site infection was 0.02 episodes per patient-year, with no S. aureus tunnel infections, and no catheter removals owing to S. aureus peritonitis. Similarly, in group II, no episodes were recorded of any ESI, TI, or PE owing to S. aureus, although 4 episodes of ESI (0.37 episodes per patient-year, 2 with other gram-positive bacteria, and 2 with gram-negative bacteria) and 8 PEs (0.75 episodes per patient-year) were seen. We conclude that mupirocin application provides excellent prophylaxis for catheter-related infections owing to S. aureus, and that reduction of these infections may improve the long-term survival of patients on CAPD.

Nonsurgical implantation of Tenckhoff peritoneal catheters in patients on continuous ambulatory peritoneal dialysis.

From 1994 to 1998, 54 Tenckhoff peritoneal catheters were implanted in 49 patients undergoing continuous ambulatory peritoneal dialysis. The implantation technique included bedside insertion of peritoneal catheters via trocar under local anesthesia. Early and late complications of this technique were comparable with surgical techniques. Cumulative survival of all catheters was 91% after one year, 78% after two years, 71% after three years, and 68% after four years. Our results suggest that the percutaneous technique for insertion of peritoneal catheters remains an easy, safe, and useful technique in the management of end-stage renal disease patients.

Evaluation of bone mineral density in CAPD patients with dual energy X-ray absorptiometry.

In this study bone mineralization was evaluated using dual energy x-ray absorptiometry (DEXA), which measured regional bone mineral density [BMD (g/cm2)] at two skeletal sites, the lumbar spine and the femur, in 33 patients (15 male, 18 female) undergoing continuous ambulatory peritoneal dialysis (CAPD) with no history of chronic disease or medications affecting bone. The biochemical profile included measurements of plasma levels of calcium, phosphorus, alkaline phosphatase, and intact parathyroid hormone (iPTH). We did not find any statistically significant difference or correlation between BMD and the examined parameters, except for the lower BMD values in the female population. Because of the reported findings of significantly lower PTH levels in CAPD patients with low turnover bone disease (adynamic bone disease) and the higher prevalence in CAPD than in hemodialysis patients, we tried to evaluate any correlation between BMD and iPTH levels in CAPD patients that were separated into two groups: group A (iPTH < 200 pg/mL), 13 patients, and group B (iPTH > 200 pg/mL), 20 patients. Data analysis revealed a negative correlation between PTH levels and BMD values (r = -0.66, p = 0.014) as PTH and serum calcium (r = -0.77, p = 0.002) only in group A. No other statistically significant changes were observed. These findings suggest that there is a favorable influence of CAPD modality on bone mineralization, while no special DEXA findings are representative of the possible appearance of adynamic bone disease.

Treatment of CAPD peritonitis with clavulanate potentiated ticarcillin.

A total of 16 episodes of peritonitis in 14 patients (9 males, 5 females), were treated with Clavulanate potentiated ticarcillin (TC), a -lactamase stable parenteral penicillin. All the pts were hospitalized and received initial loading dose of 3.2 gr intraperitoneally (i.p.) in a 6-hour 1 L exchange, which was followed by four 1 L exchanges with 320 mg/LTC. The therapy was continued for ten days. The bacteria isolated were: Staph. epid. (4), Staph. aureus (2), Strept. viridans (1), Enterococcus (1), Klebsiella Pneum. (1), Serratia (1), Enterobacter (1), Pseudomonas species: stutszeri (2), cepacia (1), fluorescens (1), negative cultures (1). Recurrence of peritonitis was seen in three patients with Pseudomonas (stutszeri (2), fluorescens (1)) peritonitis, 10-16 days after cessation of therapy. No clinical or biological side effects were seen in any patient during and/or after the therapy. These results suggest that, i.p. monotherapy of TC is effective in the treatment of CAPD peritonitis, while in cases of Pseudomonas peritonitis more specific regimens should be used.