Treatment of Pseudomonas infections in peritoneal dialysis patients.

Pseudomonas species infections in the peritoneal dialysis population consist primarily of peritonitis or exit site infections. These organisms have traditionally proven difficult to eradicate, and the standard antibiotic regimen has carried the potential for nephrotoxicity. At our institution, all peritoneal dialysis patients with Pseudomonas exit site infections or peritonitis were treated with an antibiotic combination of intraperitoneal ceftazidime and oral ciprofloxacin. Treatment duration was dependent upon the site of infection. Recurrent exit site infections were treated with a repeated course of the antibiotics, and with surgical debridement and subsequent shaving of the external cuff of double-cuffed catheters. We saw a total of 11 Pseudomonas aeruginosa exit site infections in 7 patients (4 recurrent). Patients with recurrent infections were subsequently cured with the regimen as outlined above. Of 7 patients with Pseudomonas species peritonitis (aeruginosa, fluorescens, stutszeri, and maltophilia), 5 were cured with the initial antibiotic regimen. The 2 failures were both infected with Pseudomonas maltophilia, which is consistent with observed organism sensitivity data. The combination of ceftazidime and ciprofloxacin with the option for surgical debridement of the external cuff (in exit site infections) appears effective in the treatment of Pseudomonas species infections in the peritoneal dialysis population. Sensitivity data should be used to adjust the antibiotic regimen when appropriate.

Comparison of two non-disconnect CAPD delivery systems.

Intraluminal transmission of bacteria remains a significant factor in the morbidity and procedural success of CAPD. A worsening rate of peritonitis in a longstanding CAPD program (first patients 1978) led to a search for a system which might allow a lesser rate of peritonitis. Simplicity in the procedure was a requirement. For this reason disconnect systems were not considered. The Travenol spike system was prospectively compared with Delmed leur lock in terms of rate of peritonitis and difficulty in training. The former had been used by the center since inception of the CAPD program. 28 patients new to CAPD were alternately assigned to each system without other bias, including diagnosis, age, sex, or race. The study, while ongoing, was analyzed at 12 months. 66 patient months were involved with each system. The peritonitis rates were: 2.2 episodes: patient year with the Travenol; 0.9 episode:patient year for the Delmed systems. The Delmed system appears to provide a lower rate of peritonitis. In addition, less manual dexterity, steadiness, and hand eye coordination are necessary.